Ali KANDEĞER, Hazan M.D**. TOMARBOZKURT, Güneş Devrim KICALI, ÖZKAN GÜLER

Sülfasalazine Bağlı Psikotik Özellikli Majör Depresif Bozukluk

Ankilozan spondilit (AS); nedeni bilinmeyen, esasen omurgayı olmak üzere diğer eklemleri de etkileyebilen kronik inflamatuar bir hastalıktır. AS, spondiloartropatilerin prototipi olup dünya nüfusunun % 0,9'unu etkilemektedir. Sülfasalazin, AS tedavisinde kullanılan hastalık modifiye edici antiromatizmal ilaçlardan biridir. Sülfasalazinin; mani, depresyon ve psikoz gibi ciddi psikiyatrik problemler de dahil olmak üzere merkezi sinir sistemi üzerinde olumsuz etkilere yol açtığına dair olgular nadir olarak bildirilmiştir. Bu yazıda, psikotik özellikli majör depresif bozukluk nedeniyle başvuran bir erkek hasta sunulmaktadır. Hastada ciddi psikiyatrik belirtiler gelişirken, AS için günde 1000 mg sülfasalazin alıyordu. Romatoloji bölümüne konsulte edilen hastanın, sülfasalazinin psikiyatrik semptomların nedeni olabileceğinden şüphelenildiği için, sulfasalazin tedavisi kesildi. Şikayetler, psikiyatrik tedavinin başlangıcından 1 ay sonra tamamen geriledi.

Sulfasalazine-Induced Major Depressive Disorder With Psychotic Features

Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause and affects mainly the spine, but can also affect other joints. AS is the prototype of spondyloarthropathies that affects 0,9% of the world population. Sulfasalazine is a disease-modifying antirheumatic drug used in the treatment of AS. Sulfasalazine may cause central nervous system adverse effects such as serious psychiatric problems including mania, depression, and psychosis, and these symptoms have been reported to occur only infrequently. This present case reports a male patient who presented due to major depressive disorder with psychotic features. He had been receiving 1000 mg/day sulfasalazine for AS while he developed serious psychiatric symptoms. The patient was stopped being given sulfasalazine after consulting rheumatology, as it was suspected sulfasalazine might have been the cause of his psychiatric symptoms. Complaints were fully resolved 4 months after the beginning of the 1 year psychiatric treatment.

PDF

___

1. Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O ve ark. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. J Rheumatol 2008;35 (2):305-309.
2. Chen J, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev 2005;18 (2):CD004800.
3. Joshi P, Dhaneshwar SS. An update on disease modifying antirheumatic drugs. Inflamm Allergy Drug Targets 2014;13(4):249-261.
4. Russinko PJ, Agarwal S, Choi MJ, Kelty PJ. Obstructive nephropathy secondary to sulfasalazine calculi. Urology 2003;62(4):748.
5. Simon LS. The treatment of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2004;18:507-538.
6. Capell H, Madhok R. Disease-modifying antirheumatic drugs 2: sulfasalazine. Rheumatology, 4th ed. Philadelphia: Mosby Elsevier;2008. p. 437-47.
7. American Psychiatric Association, Desk reference to the Diagnostic Criteria for DSM-5, Arlington, APA, 2013.
8. Rebrov VG, Lukomskii MI. A case of depression in the treatment of nonspecific ulcerative colitis with sulfasalazine. Klin Med (Mosk) 1989;67 (8):106.
9. Jajic Z, Jajic I. Acute psychoses in patients with psoriatic arthritis during treatment with sulfasalazine. Reumatizam 1998;46(1):43-4.
10. Gulec G, Yenilmez C, Ayranci U. Sulfasalazine plus chloroquine-induced mood disorder in a patient with rheumatoid arthritis. Iran J Med Sci 2009;34(1):72-75.