Sulfasalazine in the treatment of ankylosing spondylitis

Abstract

Eighty-five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine ( 5 3 gm/day, mean 2.5) or placebo for 26 weeks. There was a statistically significant improvement, compared with baseline, in most of the clinical variables in patients receiving the active drug. Laboratory parameters (erythrocyte sedimentation rate, Creactive protein, IgG, IgM, and IgA) also improved during the active treatment, suggesting a beneficial effect of sulfasalazine on AS. At the end of the treatment, significant differences between the sulfasalazine and placebo groups were observed in morning stiffness, chest expansion, erythrocyte sedimentation rate, and in all immunoglobulin classes. Two patients in each treatment group discontinued the trial because of side effects. Enteric-coated sulfasalazine seemed to be effective and well tolerated in patients with active AS.Ankylosing spondylitis (AS) is one of the HLA-B27-associated diseases (1). In some of these diseases, infection is considered to be an etiologic factor.To date, however, the role of infection in the etiology of AS has not been confirmed. The association beFrom the Rheumatism Foundation

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

“…Reductions in none, one, two or all three of the IgA, IgG, or IgM classes have been reported3 [49][50][51][52][53][54][55][56][57][58][59][60][61][62] Six of our patients had increased serum IgA anti-gliadin antibody levels. The serum levels of IgA anti-gliadin antibodies decreased significantly during SASP therapy.…”

IgA1 and IgA2 subclass antibodies against Klebsiella pneumoniae in the sera of patients with peripheral and axial types of ankylosing spondylitis.

“…The effect of sulphasalazine on antibodies was analysed using the paired Student's t test. The x2 test was used to evaluate associations between the diminishing ESR, CRP, severity of spinal pain or morning stiffness, and the diminishing of Klebsiella antibodies of the IgA subclasses during 25 sulphasalazine treatment.…”

Circulating cytokine levels in patients with rheumatoid arthritis: results of a double blind trial with sulphasalazine.

“…Sulphasalazine has been shown to be beneficial in the treatment of RA25-27 (Australian Multicentre Trial Group, unpublished results) and of ankylosing spondylitis. 28 29 In a comparative study sulphasaladine significantly slowed the rate of bone erosion in patients with RA compared with hydroxychloroquine.0 Like all disease modifying drugs, sulphasalazine has a spectrum of adverse reactions including rashes and gastrointestinal events. It is, however, well tolerated by patients compared with similar drugs.31 32 This study shows that sulphasalazine may inhibit cytokine production in vivo, though we do not know if this is a primary effect of the drug in vivo or a change secondary to the suppresion of inflammation.…”