American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a potential side effect of sulfasalazine that mandates folate supplementation?

1. Vitamin B12 deficiency

2. Folate deficiency

3. Iron deficiency

4. Calcium deficiency

The correct answer is: Folate deficiency

Folate deficiency is a well-known potential side effect of sulfasalazine, which is a medication commonly used in the treatment of inflammatory bowel disease and rheumatoid arthritis. Sulfasalazine can interfere with folate absorption in the intestines, leading to decreased folate levels. This is particularly important because folate is crucial for numerous bodily processes, including DNA synthesis and repair, and its deficiency can lead to megaloblastic anemia and other health complications. Due to this risk, it is often recommended that patients taking sulfasalazine receive folate supplementation to prevent deficiency. This proactive approach helps maintain adequate folate levels in the body, ensuring that patients do not experience the adverse effects associated with low folate. Other options, while related to general nutritional deficiencies, do not arise as a direct consequence of sulfasalazine usage. For instance, while vitamin B12 deficiency can occur in various contexts, it is not specifically linked to sulfasalazine treatment. Similarly, iron and calcium deficiencies do not have a distinct relationship with sulfasalazine that necessitates supplementation resulting from its usage. Thus, folate deficiency is the focus regarding sulfasalazine’s side effects and warrants supplementation.