Sulfasalazine therapy for juvenile rheumatoid arthritis

Sulfasalazine (SSZ) has recently been shown to be effective for the management of juvenile rheumatoid arthritis (JRA). This study investigated the efficacy and adverse effects of SSZ therapy in children with JRA.

Data from the medical records of 24 children with JRA who were treated with oral SSZ during the period from 1993 through 2000 were analyzed retrospectively. Disease onset was polyarticular in six children, oligoarticular in 11, and systemic in seven. All patients had received nonsteroidal anti-inflammatory drugs (NSAIDs) and 17 had received SSZ and azathioprine (AZA) concomitantly. The initial dose of SSZ averaged 21.6 mg.kg-1.d-1. The mean duration of treatment was 13.3 months (range, 3-66 mo). The mean duration of follow-up was 16.6 months (range, 3-66 mo) from the start of SSZ therapy.

Twenty children (83%) showed clinical improvement and 18 children (75%) achieved clinical remission. Patients with systemic-onset JRA had lower response rates than did those with an oligoarticular onset (p < 0.05). SSZ was discontinued in seven patients following 7 months of clinical remission and 10 months of treatment. Relapse occurred in four patients (16.7%) following a mean of 17 months of clinical remission. All achieved remission again after restarting the regimen and increasing the SSZ dosage by one-third. Adverse effects related to SSZ were found in only three patients (12.5%): nausea and epigastralgia in two, skin rash in the other.

SSZ in combination with other drugs (NSAIDs or disease-modifying antirheumatic drugs) is safe and appears to be an effective treatment for JRA, especially in patients with the oligoarticular- and polyarticular-onset disease.