Sulfasalazine is known as a disease modifying anti-rheumatic drug (DMARD). In the gut it is broken down (by the normal gut bacteria) into 2 parts, 1 part a sulphonamide antibiotic which kills harmful bacteria and the other part acts to reduce the process driving inflammation as well as helping to control the overactive immune system.


Other names


Type of JIA

Enthesitis Related JIA, Oligoarticular JIA and Polyarticular JIA. Not used in Systemic onset JIA or young children.

How is it taken?

Tablet; liquid

How often?

Twice daily

How long for?

Long term

How soon does it start working?

A benefit can often be felt in four to eight weeks, but may need three months or longer for full benefit


Sulfasalazine was introduced in the 1950s, initially to treat inflammatory bowel disease, and later (from the 1970s) for rheumatoid arthritis (RA) and ankylosing spondylitis. It has been used in JIA for over 25 years.


These days it is used as an alternative to methotrexate in most forms of arthritis (except young children or in those with Systemic onset JIA).

The daily dose of sulfasalazine is gradually increased each week, usually for three weeks, until the maximum prescribed daily dose has been achieved.


Sulfasalazine should be avoided by people with G6PD deficiency, blood disorders affecting white cells, liver disease, poorly controlled asthma, or who are allergic to aspirin or antibiotics with ‘sulpha’ compounds.

Blood tests

These are performed to monitor for early signs of side effects affecting the blood and liver. A change in the test result may not be due to sulfasalazine; often it is due to an infection that may be obvious or not.

Blood tests are performed every two to four weeks for the first few months and then stretched out to every two to three months if there have been no problems.


Chickenpox vaccine is given (as two injections one month apart) to children who are not immune before starting sulfasalazine. If for any reason your child is not immune to chickenpox and has face-to-face contact of more than 15 minutes with someone who has it, please contact your healthcare team for advice as soon as possible.

Other medicines

Sulfasalazine may interfere with the absorption of folic acid, so a supplement may be prescribed, as for methotrexate. Be sure to inform your healthcare team if your child is taking any complementary therapies.


Alcohol can be consumed when taking sulfasalazine, but observe normal precautions, as with methotrexate.


Teenagers taking sulfasalazine who are thinking of starting a family in the future should talk to their healthcare team.

Updated: 01/07/2021