Sulfasalazine in the treatment of spondylarthropathy

Dougados, Maxime; Linden, Sjef van der; Leirisalo‐Repo, Marjatta; Huitfeldt, Bernhard; Juhlin, Roger; Veys, Eric; Zeidler, Henning; Kvien, Tore K; Olivieri, Ignazio; Dijkmans, Ben A. C.; Bertouch, J. V.; Brooks, Peter; Edmonds, John; Major, Gabor; Amor, B; Calin, Andrei

doi:10.1002/art.1780380507

Cited by 336 publications

(25 citation statements)

References 21 publications

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“…At least ten double-blind studies have evaluated the efficacy of sulfasalazine, but none included patients with IBD arthropathies. A meta-analysis of five randomized controlled studies in 1990 concluded that there are some beneficial effects of sulfasalazine therapy [22] in AS, but this was followed by two large multicenter trials showing that efficacy of this treatment was limited to the peripheral joint involvement of the disease [23,24,25]. While less well evaluated, the use of mesalamine is supported by the results of two small studies [21, 26, 27].…”

Section: Treatmentmentioning

confidence: 79%

Extraintestinal Manifestations of Crohn’s Disease

et al. 2005

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In each case of extraintestinal manifestations of Crohn’s disease, active disease, if present, should be treated to induce remission, which may positively influence the course of most concomitant extraintestinal manifestations. For some extraintestinal manifestations, however, a specific treatment should be introduced. This latter part of disease management will be discussed in this chapter, in particular for pyoderma gangrenosum, uveitis, spondylarthropathy – axial arthropathy – and primarysclerosing cholangitis, which have also been described in quiescent Crohn’s disease. Few new drugs for the treatment of extraintestinal manifestations of Crohn’s disease have been developed in the past and only the role of infliximab has increased in Crohn’s disease-related extraintestinal manifestations. Drugs specifically aimed at this treatment, stemming from a few randomized controlled studies or case series, are sulfasalazine, 5-ASA, corticosteroids, azathioprine or 6-mercaptopurine, methotrexate, infliximab, dapsone and cyclosporine or tacrolimus.

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Section: Treatmentmentioning

confidence: 79%

Extraintestinal Manifestations of Crohn’s Disease

et al. 2005

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“…At least 10 double-blind studies have evaluated the efficacy of sulfasalazine, but none included patients with IBD arthropathies. A meta-analysis of 5 randomized controlled studies in 1990 concluded that there are some beneficial effects of sulfasalazine therapy [22] in AS, but this was followed by 2 large multicenter trials showing that efficacy of this treatment was limited to the peripheral joint involvement of the disease [23,24,25]. The same limitation (to peripheral joint symptoms) was reported in a recent Cochrane meta-analysis of 11 controlled trials.…”

Section: Treatmentmentioning

confidence: 87%

Extraintestinal Manifestations of Crohn’s Disease

et al. 2007

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In each case of extraintestinal manifestations of Crohn’s disease, active disease, if present, should be treated to induce remission, which may positively influence the course of most concomitant extraintestinal manifestations. For some extraintestinal manifestations, however, a specific treatment should be introduced. This latter part of disease management will be discussed in this chapter, in particular for pyoderma gangrenosum, uveitis, spondylarthropathy – axial arthropathy – and primary sclerosing cholangitis, which have also been described in quiescent Crohn’s disease. Few new drugs for the treatment of extraintestinal manifestations of Crohn’s disease have been developed in the past and only the role of infliximab has increased in Crohn’s disease-related extraintestinal manifestations. Drugs specifically aimed at this treatment, stemming from a few randomized controlled studies or case series, are sulfasalazine, 5-ASA, corticosteroids, azathioprine or 6-mercaptopurine, methotrexate, infliximab, adalimumab, etanercept and cyclosporine or tacrolimus. Unfortunately, because of the paucity of data in this field, the best evidence presented and discussed in this article for the treatment of these extraintestinal manifestations is extrapolated from patients that for the most part did not suffer from Crohn’s disease.

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“…It should be considered that there is a wide diversity of presenting symptoms in AS, and clinical expression varies a lot [21]. It is probable that immunological and other biological parameters show a similar variety in that rheumatic disorder, further influenced by anti-inflammatory drug therapy.…”

Section: Discussionmentioning

confidence: 98%

Stimulation of whole blood cultures in patients with ankylosing spondylitis by a mitogen derived fromMycoplasma arthritidis (MAS) and other mitogens

et al. 1997

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In this study we compared cytokine production and cell proliferation of immunocompetent cells derived from patients with ankylosing spondylitis (AS) to those from healthy blood donors using a whole blood assay. To this end, blood cell cultures were stimulated with the superantigens MAS (Mycoplasma arthritidis supernatant) and staphylococcal enterotoxin B (SEB) and the plant lectins phytohaemagglutinin (PHA) and concanavalin A (Con A). The number of white blood cells (WBC) and lymphocyte subsets were also determined. Cell proliferation and levels of interferon-gamma (IFN-gamma), interleukin-1 beta (IL-1 beta) and interleukin-6 (IL-6) were measured after stimulation with the different mitogens. An ELISA test was used to analyse supernatant cytokine levels. Individuals with AS showed significantly lower IFN-gamma concentrations and markedly lower cell proliferation rates with all tested mitogens than healthy controls, while there was no significant difference in IL-6 synthesis. IL-1 beta levels were slightly impaired in the patient group, but only blood cell cultures stimulates with MAS showed a statistical significance. Furthermore, there was a significant elevation of leucocytes and lymphocytes in patients with AS resulting in higher numbers of CD4-positive cells, which implies a higher CD4:CD8 cell ratio. CD19- and CD8-positive cells were not significantly distinct compared to healthy controls. This deviation in cytokine levels and cell proliferation points to a suppression of T lymphocytes. A disturbed T-lymphocyte function may play a part in the pathogenesis of AS.

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Sulfasalazine in the treatment of spondylarthropathy

Cited by 336 publications

References 21 publications

Extraintestinal Manifestations of Crohn’s Disease

Extraintestinal Manifestations of Crohn’s Disease

Extraintestinal Manifestations of Crohn’s Disease

Stimulation of whole blood cultures in patients with ankylosing spondylitis by a mitogen derived fromMycoplasma arthritidis (MAS) and other mitogens

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