Sulfasalazine absorption without colon?

I had a colectomy decades ago, now looking into treating arthritis-like joint pain and swelling issues. My rheumatologist has suggested sulfasalazine, which is an appealing place to start as it seems less scary than some of the other options.

However, poking around online a little, it seems like sulfasalazine might primarily be absorbed in the colon? I know bowel function can adapt and change after surgery to some extent, so I'm wondering if anyone out there with no colon has successfully taken sulfasalazine and found it helpful? Or found it ineffective? 

Just interested in what others experiences have been... thanks for any thoughts you have to share!

Original Post

Sulfasalazine can be effective for us. The sulfa component bond to the 5-ASA component is broken by the action of bacteria. Typically, this is in the colon, but for us it will be in the terminal ileum. 

I’ve been on it close to 20 years post op. First it was for cuffitis, then later on for arthritis, at an increased dose. It was not enough and I was put on biologics pretty soon after my diagnosis.


Thanks for the reply! Its encouraging to know sulfasalazine can be effective even in the absence of a colon, and so interesting how the bowel adapts. 

How have the biologics been for you? They sound scary, but I know they can make an amazing difference for some people. I have a friend with RA who avoided them for as long as she could, but she's been very happy on remicade. So I suppose I should keep an open mind.

Hope you are feeling well!



I’ve been on one biologic or another since 2005 for my arthritis, and since 2016 for pouchitis in addition to arthritis. At that time I switched to Remicade combined with azathioprine. It’s been fine.

In regard to worries about side effects; I worry much more about what state I would be in without the biologics.


Hi I was on remicade for 5 years no problems but then started to have swollen joints and severe pain. I have now been taken off  remicade and started Sulfasalazine and Hyrochloriquine since sept - it’s got rid of my pain in body but I’m struggling to empty my pouch.

i hope this helps. 


Linzalisha xx

Thanks for both of your replies! I'm glad the Remicade and azathioprine are working well for you Jan. :-) Linzalisha, I'm glad you were able to find a new combo to help with pain - I hope you can find a good solution for the pouch as well! It can be so frustrating testing out different medications, trying to figure out what will work.

I was on Sulfasalazine for years when I had very active UC.  The only result for me was my toilet seat became tinted orange.  I wouldn't put up with that now.  I have an expensive TOTO bidet and I am not about to "mess with" the very white toilet seat!  Vain, I know!

Oh boy, it's nice to have things to look forward to! XD 

I'll take the colorful pee though if that's the primary side-effect I get, (and if it actually works well to treat joint issues of course!) When I started with one tablet a day I got sick by the end of the week, but that all seems to have passed, so I'll be increasing the dose a bit.

I hear you on the bidet. I was skeptical, but they're really nice!

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