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Medical Author:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Drugs in this class that are most commonly prescribed for ankylosing spondylitis are methotrexate (Rheumatrex) and sulfasalazine (Azulfidine). These medications are generally used when NSAIDs are ineffective. Research has shown that these medications do not help significantly with spinal inflammation and work better on inflammation in the peripheral joints (such as the knees, hands and feet).

• How DMARDs works: This group includes a wide variety of agents that work in many different ways. They all interfere in the immune processes that promote inflammation.

Methotrexate (Rheumatrex)

• Who should not use these medications: People with the following conditions should not take methotrexate:



• Allergy to methotrexate



• Alcoholism



• Liver or kidney failure



• Immune deficiency syndromes



• Low blood cell counts



• Pregnant women should not take methotrexate as it is teratogenic (causes severe problems with the development of the baby).



• Use: Methotrexate is taken orally or as an injection once per week.



• Drug or food interactions: To lessen GI toxicity, daily administration of low-dose folic acid (1-2 mg) is recommended.



• Side effects: To guard against problems, kidney and liver function are monitored regularly, as are blood cell counts. Methotrexate may cause headache and toxic effects to blood, kidneys, liver, lungs, and gastrointestinal and nervous systems.

Sulfasalazine (Azulfidine)

• Who should not use these medications: People with the following conditions should not use sulfasalazine:



• Allergy to sulfa drugs, aspirin, or aspirin-like products (NSAIDs)



• Active peptic ulcer disease



• Severe kidney failure



• Use: Sulfasalazine is taken orally in varying doses with food.



• Drug or food interactions: Sulfasalazine may decrease warfarin (Coumadin) absorption, thereby decreasing warfarin effectiveness. Sulfasalazine may increase the risk of bleeding when administered with other drugs that alter blood coagulation (for example, heparin [Hep-Lock]).



• Side effects: Sulfasalazine may cause the following:



• Toxicity to blood cells



• Nausea



• Vomiting



• Abdominal cramping



• Constipation

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