Which statement is a pearl of Sulfasalazine?

• A. Impair folate absorption (May increase MTX ADE if used together)
• B. Inhibits pyrimidine synthesis
• C. Causes hyperpigmentation
• D. Reduces MTX ADE when used with MTX

Answer: (A)

Sulfasalazine is known for causing folate deficiency by impairing intestinal folate absorption. That makes it particularly relevant in patients who are also taking methotrexate, since MTX already disrupts folate pathways. When these drugs are used together, the risk of folate-related adverse effects—like megaloblastic changes or mucosal issues—rises, which is the key clinical pearl here.

The other statements don’t fit this characteristic. Sulfasalazine’s primary antifolate effect isn’t about inhibiting pyrimidine synthesis directly—that’s more characteristic of methotrexate’s action. It isn’t typically associated with hyperpigmentation, and it does not reduce methotrexate adverse effects; instead, it can increase MTX toxicity due to folate deficiency.