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

Rheumatoid arthritis is a chronic systemic inflammatory dis-ease that affects approximately 0.5-1% of the world popula-tion. The current approach to this disease is to start an inten-sive treatment without delay once the disease has developed. Various studies in the literature have shown that combination of disease modifying antirheumatic drugs such as sulfasa-lazine and chloroquine offers a more advantageous treatment. Although these drugs may cause central nervous system ad-verse effects such as serious psychiatric problems including mania and psychosis, these symptoms have been reported to occur only infrequently. The present case study reports a fe-male patient who was hospitalized due to bipolar affective dis-order-mixed episode. She had been receiving 250 mg/day chloroquine for 9 months for rheumatoid arthritis without ex-hibiting any adverse psychiatric effects. However, upon receiv-ing a combination of 250 mg/day chloroquine and 2 gr/day sul-fasalazine, she developed serious psychiatric symptoms. Iran J Med Sci 2009; 34(1): 72-75.