Sulfasalazine plus Chloroquine-Induced Mood Disorder in a Patient with Rheumatoid Arthritis

Abstract

Rheumatoid arthritis is a chronic systemic inflammatory diseasethat affects approximately 0.5-1% of the world population.The current approach to this disease is to start an intensivetreatment without delay once the disease has developed.Various studies in the literature have shown that combinationof disease modifying antirheumatic drugs such as sulfasalazineand chloroquine offers a more advantageous treatment.Although these drugs may cause central nervous system adverseeffects such as serious psychiatric problems includingmania and psychosis, these symptoms have been reported tooccur only infrequently. The present case study reports a femalepatient who was hospitalized due to bipolar affective disorder-mixed episode. She had been receiving 250 mg/daychloroquine for 9 months for rheumatoid arthritis without exhibitingany adverse psychiatric effects. However, upon receivinga combination of 250 mg/day chloroquine and 2 gr/day sulfasalazine,she developed serious psychiatric symptoms.

Keywords

• Chloroquine
• sulfasalazine
• affective disorders
• mood disorder
• rheumatoid arthritis