ABSTRACT
Sulphasalazine was first formulated by Svartz in the early 1940s, specifically for use as a remission inducing drug in rheumatoid arthritis. After the publication of an unfavourable trial, however, the drug was restricted to patients with ulcerative colitis. In the late 1970s sulphasalazine was re-examined in rheumatoid arthritis and favourable results reported in "open" trials. A double blind controlled trial was therefore conducted comparing enteric coated sulphasalazine and D-penicillamine in patients with active rheumatoid arthritis. A total of 63 patients were recruited in two centres; 31 were treated with sulphasalazine and 32 received penicillamine. After 16 weeks' treatment both drugs had produced significant improvements in clinical score, pain score measured on a visual analogue scale, grip strength, Ritchie articular index, erythrocyte sedimentation rate, and serum C reactive protein concentration. Nausea was the major side effect in the sulphasalazine treated group. No potentially dangerous effects of sulphasalazine were encountered in contrast with those seen in the penicillamine group. The results suggest that sulphasalazine is an effective and safe drug capable of producing remissions in active rheumatoid arthritis. They also lend confidence to the use of preliminary "open" trials as a means of screening for remission inducing drugs in rheumatoid arthritis.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Penicillamine/therapeutic use , Sulfasalazine/therapeutic use , Adult , Aged , Arthritis, Rheumatoid/blood , Blood Sedimentation , C-Reactive Protein/analysis , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Middle Aged , Nausea/chemically induced , Penicillamine/adverse effects , Random Allocation , Sulfasalazine/adverse effectsABSTRACT
Fourteen patients with severe rheumatoid arthritis (RA) were given 27 courses of methylprednisolone intravenously, each of 3 infusions of 1 g on alternate days. After 7 days there was marked improvement in clinical state and most laboratory tests; levels of ESR and 4 serum acute-phase proteins, C3, C, IgG, and IgA, fell significantly. Serum IgM and rheumatoid factor titre were unchanged. 125I C1q binding fell in all instances where it was initially raised. Clinical remission lasted a mean of 10 weeks. Serum C-reactive protein (CRP) fell to less than 30 mg/l after all courses except one within 7 days and rose above this figure after a mean of 7 weeks. The ESR fell below 30 mm/h within seven days in 17 courses and remained below this value for a mean of 7 weeks. Three patients had clinical remissions, with serum CRP less than 30 mg/l and ESR less than 30 mm/h, lasting more than 42 weeks.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Methylprednisolone/administration & dosage , Adult , Aged , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/immunology , Blood Sedimentation , C-Reactive Protein/metabolism , Complement C3/metabolism , Complement C4/metabolism , Female , Humans , Immunoglobulin A/metabolism , Immunoglobulin G/metabolism , Injections, Intravenous , Male , Middle Aged , Time FactorsSubject(s)
C-Reactive Protein/analysis , Esophageal Neoplasms/blood , Peptic Ulcer/blood , Serum Globulins/analysis , Stomach Neoplasms/blood , Adult , Aged , Diagnosis, Differential , Endoscopy , Female , Haptoglobins/analysis , Humans , Immunodiffusion , Male , Middle Aged , Orosomucoid/analysis , alpha 1-Antitrypsin/analysisABSTRACT
Seventy-four patients with rheumatoid arthritis were treated with sulphasalazine. There was a significant improvement in clinical score, with substantial falls in serum C-reactive protein concentrations and erythrocyte sedimentation rate four weeks after starting the drug. Improvement was maintained in the 38 patients who remained on the drug for one year. The mean Rose-Waaler titre did not change. There was little difference between the results in seropositive and seronegative patients. The commonest adverse effect was dyspepsia, but five patients developed a megaloblastic anaemia and one patient neutropenia; all made a complete recovery. The results suggest that the drug has a disease-modifying action not attributable to its "salicylate" content. The mode of action might be by an antibacterial effect on gut flora.