SULFASALAZINE & FOOD POISONING - Is Anyone Else Affected?

[Jimminey]

In the first 20 months of taking Sulfasalazine I had food poisoning 8 times from food where no other partakers had any problems - 4 times with vomiting and diarrhoea (I had 2 such cases in the previous 60 years).

My GP put it down to the immunosuppressant effects of Sulfasalazine making me more susceptible, but my rheumatology department are not aware of other patients with this problem.

Has anyone else had increased incidences of food poisoning while taking Sulfasalazine?

I am also wondering whether it has any connection to the report in The Lancet Rheumatology about Sulfasalazine being identified as a major risk factor for severe Covid, probably due to its immunosuppressant properties:

creakyjoints.org/living-wit...

Reports or comments would be much appreciated.

[MuppetBaby]

I’ve had food poisoning twice once just before taking RA meds and one after. I was told omeprazole makes me more susceptible rather than RA meds because it lowers acid production which would normally potentially kill off the bugs. Both cases were within 2 years of each other having never had it before. In one case about 8 people had the same thing to eat as me but were not ill.

Just found this link though

blog.arthritis.org/living-w...

[Jimminey in reply to MuppetBaby]

Thank you for the link - despite many searches I've never come across something linking RA and food poisoning. And I take omeprazole aswell, but didn't have food poisoning until starting the sulfa.

[Jackie1947]

I've been on Sulphzasaline for 17 years never experienced food poisoning. Also I've had covid on Sulphzasaline plus Benipali and it was mild

[Jimminey in reply to Jackie1947]

Thank you for the info.

[TheBoys]

hi

Sorry to hear of your problems. My Dad was on sulfa for twenty years - no issues plus I took it for a little while and no issues like this

Paul

[Jimminey in reply to TheBoys]

Thank you.

[Hidden]

I find your question and your link to the article in the lancet fascinating. Thank you. I have had RA for more than 40 years and have been taking sulphasalazine for around 20 of these. About 10 years ago I had a severe bowel infection. It was identified as SBIO and I was given antibiotics. It flares up frequently resulting in more antibiotics. A connection with sulphazalasine was never suggested. However a friend of mine had exceedingly low white blood cells count on this medication and was in hospital for months. My neutropils have dropped on benpali and from research articles I have read , having been on sulphazalasine for decades ,might be a factor here too. I also notice, in my case, that despite good dental hygiene and seeing a dental hygienist every 3 months, I have gum disease. If my gums are inflammed my bowel is infected and my RA is worse. I think gum disease and bowel infection could be a trigger for RA. There certainly is a link. I have no answers. I am just sharing my experience. I had covid once. I was denied antivirals and it took me much longer than average to recover.

[Jackie1947 in reply to Hidden]

There is a trigger for bowel disease/problems and gums with RA.I'm having a colonoscopy next week as my Dr is of the opinion it could be microscopic colitis. A biopsy will tell.

[Hidden in reply to Jackie1947]

Good luck Jackie. I have had signoidoscopies, colonoscopies, endoscopies, ultrasound. They have removed polyps but found nothing else. In my case they could not find evidence of microscopic colitis so assumed SIBO. The last colonoscopy showed my bowel is now long , loopy and twisted, possibly caused by years of excess gas etc. I hope they find what is causing your symptoms, pain and discomfort.

[Jackie1947 in reply to Hidden]

Thank you. I have also been diagnosed with DD and Pancreatitis 🤷

[Hidden in reply to Jackie1947]

Good luck

[Jimminey in reply to Hidden]

I also have gum disease, although being in my late sixties I am told this is not uncommon. I did however have a short lived swelling in my gums 3 months ago and since then my RA has been worse - although I had a uti at about the same time, which was possibly a side effect of rituximab that I'm no longer taking. My white blood cell count is low, but not very.

Thank you very much for your experience and I hope you've fully recovered from the covid - being denied antivirals seems mean in the extreme (I know sulfa is not on 'the list' but it can or does cause immunosuppression as perhaps you experience bears out).

[bpeal1]

I’ve been taking sulphasalazine for 16 years and never had food poisoning.

[Runrig01]

I don’t take Sulphasalazine, but was given a leaflet re what foods to avoid when I started biologics. I’ve attached a screenshot. Basically it’s to follow a pregnancy type diet.

Dietary advice

[Gilliancheche in reply to Runrig01]

Having a weakened immune system , I also have a very low white cell count, I was given similar advice to avoid the exact same food groups. I think we are just more susceptible to infection. Hope you are fully recovered.

[Hidden in reply to Runrig01]

Thank you Runrig. I have only been on biologicals for 6 months and sulphazalazine for decades.I saw this diet when starting biologicals and I am careful to avoid foods that can cause food poisoning. I very rarely eat out. I now have a long loopy twisty bowel which might be the cause.I find eating small but frequent amounts help as well as taking probiotics, Kefir, kimchi.I eat a balanced diet and a wide range of fruit and vedge but easily get d , c, bloating and excess gas. I avoid triggers including sugar. I have tried low food map, anti inflammatory, etc. Eating small and frequent and nothing in excess helps.

[Runrig01 in reply to Hidden]

I was advised by my rheumatologist to avoid probiotics and kefir etc due to being on immunosuppressants

Are live cultures safe

[Hidden in reply to Hidden]

I hope you ar feeling better too.

[Jimminey in reply to Runrig01]

Thank you for the leaflet - though none of the food that gave me food poisoning is on it. I suppose there's always the added factor of how the food was prepared...

[oldtimer2]

It's all a bit nebulous currently as the authors say: “a more detailed understanding of the mechanism of action of sulfasalazine, related to its ability to inhibit type 1 [interferon] is required."

You certainly seem to have been unfortunate. I have been taking immune suppressants of various types for 35 years and I have never had food poisoning. Generally the aim is to reduce our overactive immune system to more normal levels, but there is bound to be a variable response as individuals.

I wonder if you should be looking at possible other causes - inflammatory bowel disease for example which is also an auto-immune condition?

[Jimminey in reply to oldtimer2]

Thank you for the suggestion of IBD, but since I've been preparing all my own food since the start of Covid I've not had any food poisoning, and I also have no other symptoms of IBD. But I shall continue to look for other causes.

The identification, though, of sulfasalazine as a major risk factor for severe Covid has not been taken onboard by the medical authorities/Government (although the exact mechanism may be a bit nebulous) as taking sulfasalazine does not qualify for Covid antivirals.

[acousmetre]

Perhaps it was intolerance rather than poisoning or some other autoimmune response as mentioned above. I took sulfasalazine for around a year. No diarrhoea, but a big drop in appetite and a lot of nausea. I lost 8kg. Put it back on as soon as I stopped.

[Jimminey in reply to acousmetre]

Thank you for your reply. Yes, I've come across sulfasalazine causing a loss of appetite and nausea in others. In my case, I've had food poisoning before and recognised it when I had it again after starting sulfasalazine. But I will keep an open mind...

[acousmetre]

Oh, of course, and sorry, didn't mean to doubt that you've had food poisoning. I was speaking from my experience where it took me years to understand that I have intolerance to certain food types, especially those in the so-called "fodmap" category - which includes some of favourite fruit, apples being top of the list! Lots of garlic is another thing that sets me off. Cheers