Effect of Sulphasalazine on Gastrointestinal Microflora and on Mucosal Heat Shock Protein Expression in Patients With Rheumatoid Arthritis

Abstract

This study was performed in order to elucidate a possible association between mucosal heat shock protein expression, the gastrointestinal microflora and disease activity in 17 patients with RA before and after 16 weeks of sulphasalazine (SASP) treatment. The duodenal-jejunal mucosal binding of the monoclonal antibody ML30, recognizing the 65 kDa heat shock protein of mycobacteria, was increased (P = 0.048) in the untreated RA patients compared to controls, but did not correlate to disease, activity or microflora and was not altered by SASP therapy. There was no convincing evidence for bacterial overgrowth in the jejunum and the faecal microflora was normal. SASP treatment altered the faecal microflora, with significant reductions of the total aerobic bacteria, Escherichia coli and Bacteroides, and increased numbers of Bacillus. SASP had only minor effects on the jejunal microflora. A high carriage frequency of Candida albicans was found in saliva and the counts correlated negatively with the unstimulated whole salivary secretion rate. These results suggest that the gut may be involved in the aetiopathogenesis of RA but do not substantiate the hypothesis that the anti-rheumatic effects of SASP are mediated via its anti-microbial properties. However, the possibility that a micro-organism, not detected in this study, may be of crucial importance in RA, cannot be ruled out.

Oral type II collagen treatment in early rheumatoid arthritis. A double‐blind, placebo‐controlled, randomized trial

“…This could prevent oral tolerance in RA, since nearly all patients are treated with NSAIDs, which have a known mucosa-damaging effect (40,41). Another possibility is that a change of the bacterial gut flora, for example by drugs (42,43) or diet (44), could also influence the An additional factor as to why only a minority of patients responded could be our patient selection. We chose to treat only RA patients with early arthritis (duration 1 3 years).…”

Evidence for differential effects of sulphasalazine on systemic and mucosal immunity in rheumatoid arthritis.

“…In order to obtain jejunal aspirate with a minimum of microbial contamination from the stomach and oral cavity, a special closed tube system (RHP-1 2.0, William Cook Europe AB, Bjaeverskov, Denmark) was used, as described earlier. 34 The tube system was attached to the biopsy collecting device during intubation and clearly visualised fluoroscopically. Aspirate was collected from the proximal part of jejunum immediately before biopsy sampling and thereafter kept in plastic tubes at -70°C until analysis.…”

Increased Bacterial Urease Activity in Faeces in Juvenile Chronic Arthritis: Evidence of Altered Intestinal Microflora?

“…This concept is supported by observations that patients with rheumatoid arthritis gain relief of clinical symptoms by fasting or specific dietary regimens [18][19][20]. Sulphasalazine therapy also diminishes the signs of active joint disease, possibly by altering the intestinal microflora [21,22].…”