Limited effect of sulphasalazine treatment in reactive arthritis. A randomised double blind placebo controlled trial

Abstract

Objective-To assess the eYcacy and safety of sulphasalazine in reactive arthritis. Methods-Double blind placebo controlled trial of six months duration comparing sulphasalazine 2-3 g per day (n = 37) with matching placebo (n = 42) in adults with active reactive arthritis (age 19-57 years, median 34). Treatment response was evaluated once a month by changes in erythrocyte sedimentation rate (ESR), pain, peripheral arthritis, tender iliosacral joints, entesopathy, extra-articular manifestations, and working ability. Results-15 patients in the sulphasalazine group and eight in the placebo group withdrew from the study prematurely. Adverse events, primarily gastrointestinal, were the main reason for withdrawal in the actively treated group. Intention-totreat analyses showed significant improvements over time in both groups in ESR, pain, and number of swollen joints (P < 0.01). Number of days on sick leave decreased significantly in the sulphasalazine group only (P < 0.01). No significant diVerences between the two groups were present after six months. Among the patients completing the trial according to protocol, persistent complete remission had occurred within two months in five (23%) of the actively treated, but in no placebo treated patients (P = 0.013). Conclusions-Sulphasalazine seemed to improve only the very short term outcome of reactive arthritis. The possible beneficial eVect of the drug should also be weighed against the risk of adverse events. Although these were mainly mild, almost 25% of the patients in the actively treated group gave up treatment for this reason.

A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis

“…Results demonstrated that despite early treatment and an overall initial improvement, the majority of patients were still symptomatic at 12 months. This finding indicates a significant level of disease persistence in a young population of patients and is consistent with other published studies (2,3,7). The purpose of the current study was to assess the efficacy of early intervention with intraarticular corticosteroids followed by therapy with SSZ in patients with persistent disease compared with initial NSAID therapy alone followed by later intervention with intraarticular corticosteroid and SSZ in cases of disease persistence.…”

“…It is the most common pattern of disease seen in the seronegative arthritides such as reactive arthritis (ReA), psoriatic arthritis, and inflammatory bowel disease-associated arthritis, as well as in so-called undifferentiated arthritis. It often affects young patients and causes a high level of morbidity (1,2). The outcome in patients with oligoarthritis is variable, with some studies describing as many as 75% of patients with ReA having persistent disease at 6 months (2), whereas other cohort studies have suggested rates of persistence as low as 15% (3).…”

Reactive arthritis

“…There is only a limited amount of information of the efficacy of such an approach. Egsmose et al (71) reported that patients with acute ReA, when started on sulfasalazine during the first 3 months, reached clinical remission more rapidly than with those in the placebo arm. Sulfasalazine is also effective when used in chronic ReA (72).…”

Successful use of Etanercept for the treatment of Reiter’s syndrome: a case report and review of the literature

“…The only traditional disease-modifying ant rheumatic drugs (DMARD) formally studied in ReA is sulfasalazine [6].…”