Sulphasalazine in the treatment of reactive arthritis

Trnavskỳ, K; Pelísková, Z; Vácha, J

doi:10.3109/03009748809105304

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…9 10 In the first place, one third of the patients completing per protocol in the placebo arm (or a little over 25% evaluated by intention-to-treat analysis) went into remission within six months reflecting the spontaneous course of the disease. In the second place, success rate—expressed as percentage of patients experiencing complete remission— was only half of that reported by Mielants and Veys3 and Trnavský et al 10…”

Section: Discussionmentioning

confidence: 99%

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

Egsmose

Hansen

Andersen

et al. 1997

Annals of the Rheumatic Diseases

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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.

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Section: Discussionmentioning

confidence: 99%

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

Egsmose

Hansen

Andersen

et al. 1997

Annals of the Rheumatic Diseases

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“…A long-lasting remission of their ReA was observed in both studies, even after the sulfasalazine therapy was discontinued. No significant adverse events were reported (139,207). A large multicenter study conducted by the Department of Veterans' Affairs in patients with a chronic mean ReA duration of 10 years and unresponsive to conventional therapy demonstrated that sulfasalazine (2 g/day) is well tolerated and effective in treating ReA (34).…”

Section: Pharmacologic Approachmentioning

confidence: 99%

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004

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Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, nonculturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease

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“…Whether such an effect could be due to the antimicrobial effect of the sulphonamide component is uncertain. Anyway, already in the 1980s some studies yielded encouraging results [49,50]. A large randomised double-blind study on the effect of sulphasalazine given for 36 weeks included also 134 patients with ReA.…”

Section: Long-term Antibiotic Treatment Of Es-tablished Reamentioning

confidence: 98%

Antibiotics in the Treatment of Reactive Arthritis

Toivanen¹,

Yli‐Kerttula

Möttönen

2006

CRR

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Reactive arthritis is triggered by an infection. Much of evidence has been accumulated to prove that the causative microbes or their components may persist in the organism for extended periods, maintaining an active immune response. Therefore, the question about the value of antibiotics has been entertained by several research groups. A number of studies have demonstrated that antibiotics may be useful only if applied very early, before the pathogenetic process has started. In established reactive arthritis short-term treatment is apparently not effective. Also a three-month course of ciprofloxacin has been demonstrated to be without clinical effect as observed during a one-year follow-up. The same findings were made in a large multicenter EULAR study regarding azithromycin. However, when patients were re-examined four to seven years after an initial 3-month course of the antibiotics in the Finnish ciprofloxacin study, it turned out that patients in the placebo group had significantly more often developed chronic joint symptoms and objective findings of rheumatic disease than those treated with the antibiotic. In addition, a recent study suggests that intensive treatment with a combination of doxycycline and rifampin may have a beneficial effect even in chronic reactive arthritis. The question must be raised whether antibiotics, after all, should be considered especially in HLA-B27 positive patients.

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Sulphasalazine in the treatment of reactive arthritis

Cited by 12 publications

References 8 publications

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

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

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

Antibiotics in the Treatment of Reactive Arthritis

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