Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1992 Aug;51(8):955–958. doi: 10.1136/ard.51.8.955

Evaluation of sulphasalazine in the treatment of spondyloarthropathies.

M Dougados 1, A Maetzel 1, M Mijiyawa 1, B Amor 1
PMCID: PMC1004802  PMID: 1358038

Abstract

Sulphasalazine has been shown to have an effect in patients with spondyloarthropathies, but the clinical indication for its use is controversial and its long term effect has not yet been evaluated. Treatment with sulphasalazine was analysed retrospectively in a group of 372 patients with a wide range of spondyloarthropathies to determine subsets of patients showing differential effects of the drug. One hundred and one patients received sulphasalazine at a mean daily dose of 2 g (ankylosing spondylitis, 54 patients; psoriatic arthritis, 21 patients; reactive arthritis, four patients; arthritis related to inflammatory bowel disease, six patients; undifferentiated spondyloarthropathy, 16 patients). A comparison between treated and untreated patients suggests that only patients with active and severe disease were treated whatever the precise diagnosis or the amount of axial disease in the spondyloarthropathy. After six months of treatment improvement was noted in 59 patients unrelated to their subgroup or amount of axial disease. After a mean follow up of 20 months, 37 patients were still receiving treatment, 33 had discontinued the drug because of inefficacy, 14 because of side effects, six because of remission of the disease, and 11 for other reasons. Comparison between the beginning and end of treatment showed a statistically significant decrease in morning stiffness, erythrocyte sedimentation rate, and daily dose of non-steroidal anti-inflammatory drugs (NSAIDs). It is concluded that: (a) a low percentage of patients with spondyloarthropathy have active disease requiring treatment with sulphasalazine despite the use of NSAIDs (27% in this study); (b) in this subgroup of patients sulphasalazine seems to be of clinically relevant benefit in 59%; and (c) this benefit does not seem to be correlated with either the precise diagnosis of spondyloarthropathy or the amount of axial disease.

Full text

PDF
958

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amor B., Dougados M., Mijiyawa M. Critères de classification des spondylarthropathies. Rev Rhum Mal Osteoartic. 1990 Feb;57(2):85–89. [PubMed] [Google Scholar]
  2. Amor B., Kahan A., Dougados M., Delrieu F. Sulfasalazine and ankylosing spondylitis. Ann Intern Med. 1984 Dec;101(6):878–878. doi: 10.7326/0003-4819-101-6-878_1. [DOI] [PubMed] [Google Scholar]
  3. Arnett F. C. Seronegative spondylarthropathies. Bull Rheum Dis. 1987;37(1):1–12. [PubMed] [Google Scholar]
  4. Davis M. J., Dawes P. T., Beswick E., Lewin I. V., Stanworth D. R. Sulphasalazine therapy in ankylosing spondylitis: its effect on disease activity, immunoglobulin A and the complex immunoglobulin A-alpha-1-antitrypsin. Br J Rheumatol. 1989 Oct;28(5):410–413. doi: 10.1093/rheumatology/28.5.410. [DOI] [PubMed] [Google Scholar]
  5. Dougados M., Alemanni M., Tulliez M., Abadia R., Kahan A., Delrieu F., Awada H., Christoforov B., Amor B. Iléocolonoscopie systématique au cours des spondyloarthropathies séronégatives. Rev Rhum Mal Osteoartic. 1987 Mar;54(3):279–283. [PubMed] [Google Scholar]
  6. Dougados M., Boumier P., Amor B. Sulphasalazine in ankylosing spondylitis: a double blind controlled study in 60 patients. Br Med J (Clin Res Ed) 1986 Oct 11;293(6552):911–914. doi: 10.1136/bmj.293.6552.911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dougados M. Diagnosis and monitoring of spondylarthropathy. Compr Ther. 1990 Apr;16(4):52–56. [PubMed] [Google Scholar]
  8. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  9. Farr M., Kitas G. D., Waterhouse L., Jubb R., Felix-Davies D., Bacon P. A. Treatment of psoriatic arthritis with sulphasalazine: a one year open study. Clin Rheumatol. 1988 Sep;7(3):372–377. doi: 10.1007/BF02239195. [DOI] [PubMed] [Google Scholar]
  10. Feltelius N., Hällgren R. Sulphasalazine in ankylosing spondylitis. Ann Rheum Dis. 1986 May;45(5):396–399. doi: 10.1136/ard.45.5.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ferraz M. B., Tugwell P., Goldsmith C. H., Atra E. Meta-analysis of sulfasalazine in ankylosing spondylitis. J Rheumatol. 1990 Nov;17(11):1482–1486. [PubMed] [Google Scholar]
  12. Gupta A. K., Ellis C. N., Siegel M. T., Duell E. A., Griffiths C. E., Hamilton T. A., Nickoloff B. J., Voorhees J. J. Sulfasalazine improves psoriasis. A double-blind analysis. Arch Dermatol. 1990 Apr;126(4):487–493. [PubMed] [Google Scholar]
  13. Leisen J. C., Duncan H., Riddle J. M., Pitchford W. C. The erosive front: a topographic study of the junction between the pannus and the subchondral plate in the macerated rheumatoid metacarpal head. J Rheumatol. 1988 Jan;15(1):17–22. [PubMed] [Google Scholar]
  14. Lonauer G. Therapiestudie der chronischen Polyarthritis mit Sulphasalazin unter dem besonderen Aspekt des Nebenwirkungsprofils. Z Rheumatol. 1990 Jan-Feb;49(1):44–49. [PubMed] [Google Scholar]
  15. McConkey B., Amos R. S., Durham S., Forster P. J., Hubball S., Walsh L. Sulphasalazine in rheumatoid arthritis. Br Med J. 1980 Feb 16;280(6212):442–444. doi: 10.1136/bmj.280.6212.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mielants H., Veys E. M. Inflammation of the ileum in patients with B27-positive reactive arthritis. Lancet. 1984 Feb 4;1(8371):288–288. doi: 10.1016/s0140-6736(84)90163-6. [DOI] [PubMed] [Google Scholar]
  17. Mielants H., Veys E. M., Joos R. Sulphasalazine (Salazopyrin) in the treatment of enterogenic reactive synovitis and ankylosing spondylitis with peripheral arthritis. Clin Rheumatol. 1986 Jan;5(1):80–83. doi: 10.1007/BF02030973. [DOI] [PubMed] [Google Scholar]
  18. Moll J. M., Haslock I., Macrae I. F., Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore) 1974 Sep;53(5):343–364. doi: 10.1097/00005792-197409000-00002. [DOI] [PubMed] [Google Scholar]
  19. Nissilä M., Lehtinen K., Leirisalo-Repo M., Luukkainen R., Mutru O., Yli-Kerttula U. Sulfasalazine in the treatment of ankylosing spondylitis. A twenty-six-week, placebo-controlled clinical trial. Arthritis Rheum. 1988 Sep;31(9):1111–1116. doi: 10.1002/art.1780310905. [DOI] [PubMed] [Google Scholar]
  20. Peppercorn M. A. Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development. Ann Intern Med. 1984 Sep;101(3):377–386. doi: 10.7326/0003-4819-101-3-377. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES