Sulfasalazine for treating rheumatoid arthritis

Suarez‐Almazor, María E.; Belseck, Elaine; Shea, Beverley; Wells, George A.; Tugwell, Peter

doi:10.1002/14651858.cd000958

Cited by 46 publications

(39 citation statements)

References 19 publications

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“…The most frequent side eVects responsible for sulfasalazine discontinuation reported in a meta-analysis were gastrointestinal symptoms in 10% and mucocutaneous reactions in 7% [40]. There are conXicting evidence linking acetylator status to toxicity and eYcacy [41][42][43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients

et al. 2010

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The present study was conducted in Indian rheumatoid arthritis (RA) patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) to determine the incidence and type of adverse drug reactions (ADRs) leading to their withdrawal in the initial 6 months of therapy. This was considered important as pharmacogenetic variations in the pattern of RA in different populations and genetic differences in efficacy and safety to drugs demand separate studies to be conducted in different populations. Hospital records were used to identify 1,000 consecutive patients with RA fulfilling the American College of Rheumatology criteria and having at least 6-month follow-up. Age, gender, duration of arthritis, drug usage and ADR-related drug withdrawal were recorded from the charts. Most of the patients were put on single DMARD. Combined use of DMARD was less frequent and non-use of DMARD was common; however, disease control was good. The commonest DMARD used in our hospital was hydroxychloroquine 444 (44%) and the commonest combination used was methotrexate with hydroxychloroquine by 55 (6%). Sulphasalazine use showed preference to young and males. Supportive drugs used were NSAIDs by 883 (88%), corticosteroids by 646 (65%), paracetamol by 594 (59%) and amitriptyline by 88 (9%). Incidence of ADR-related DMARD withdrawal was maximum with leflunomide 2/15 (13.33%) followed by methotrexate 9/116 (7.76%), sulphasalazine 6/185 (3.24%), chloroquine 3/131 (2.29%) and hydroxychloroquine 8/444 (1.8%). Severity and symptomatology of disease, genetic pattern of patients, financial status, previous experience of the clinicians and patients, availability of drugs, patient expectations and compliance were the main factors that lead to a difference in pattern of therapy in our patients compared to other population.

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Section: Discussionmentioning

confidence: 99%

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients

et al. 2010

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“…Multiple drug efficacy trials for SSZ have been performed with those for RA often including a primary outcome measure of pain control [20,24]. In a Cochrane report three of six studies reported on pain outcome versus placebo, all three had reduced pain scores with a standardized weighted mean difference of for pain −0.42 (95%CI −0.72;−0.12), test for overall effect: Z = 2.80 (P = 0.0051).…”

Section: Sulfasalazine’s Analgesic Action In Rheumatoid Arthritismentioning

confidence: 99%

Analgesia by inhibiting tetrahydrobiopterin synthesis

Costigan

Latrémolière

Woolf

2012

Current Opinion in Pharmacology

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Physiological control of the co-factor tetrahydrobiopterin (BH4) is tight in normal circumstances but levels increase pathologically in the injured somatosensory system. BH4 is an essential co-factor in the production of serotonin, dopamine, epinephrine, norepinephrine and nitric oxide. Excess BH4 levels cause pain, likely through excess production of one or more of these neurotransmitters or signaling molecules. The rate limiting step for BH4 production is GTP Cyclohydrolase 1 (GCH1). A human GCH1 gene haplotype exists that leads to less GCH1 transcription, translation, and therefore enzyme activity, following cellular stress. Carriers of this haplotype produce less BH4 and therefore feel less pain, especially following nerve injury where BH4 production is pathologically augmented. Sulfasalazine (SSZ) an FDA approved anti-inflammatory agent of unknown mechanism of action, has recently been shown to be a sepiapterin reductase (SPR) inhibitor. SPR is part of the BH4 synthesis cascade and is also upregulated by nerve injury. Inhibiting SPR will reduce BH4 levels and therefore should act as an analgesic. We propose SSZ as a novel anti-neuropathic pain medicine.

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“…São contra-indicadas em pacientes que apresentem alterações retinianas e de campo visual (2) (D). b) Sulfasalazina é considerada mais efetiva que o placebo na redução da atividade da doença, no controle da dor e na avaliação clínica global (23) (A). Recentemente, confirmou-se sua eficácia clínica e interferência sobre a progressão radiográfica (24) (A).…”

Section: Drogas Modificadoras Do Curso Da Doença (Dmcd)unclassified

Atualização do consenso brasileiro no diagnóstico e tratamento da artrite reumatóide

Bértolo¹,

Brenol²,

Goldenstein-Schainberg³

et al. 2007

Rev. Bras. Reumatol.

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Sulfasalazine for treating rheumatoid arthritis

Abstract: Bacon PA. A double-blind controlled study comparing sulphasalazine with placebo in rheumatoid factor (RF)-negative rheumatoid arthritis..

Cited by 46 publications

References 19 publications

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients

Analgesia by inhibiting tetrahydrobiopterin synthesis

Atualização do consenso brasileiro no diagnóstico e tratamento da artrite reumatóide

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