Sulfasalazine for ankylosing spondylitis

Area of Science:

• Rheumatology
• Clinical Immunology
• Pharmacology

Background:

• Ankylosing spondylitis (AS) is a chronic inflammatory disease within the spondyloarthropathies (SpA) group.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are primary treatments, with disease-modifying antirheumatic drugs (DMARDs) used for refractory cases.
• Sulfasalazine (SSZ) is a studied DMARD for AS, but its effectiveness requires further evaluation.

Purpose of the Study:

• To assess the efficacy and toxicity of sulfasalazine in treating ankylosing spondylitis.
• To synthesize evidence from randomized and quasi-randomized trials on SSZ's impact on AS.

Main Methods:

• Systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL) for relevant trials.
• Inclusion of randomized and quasi-randomized trials evaluating SSZ efficacy in AS patients.
• Independent review of trial reports, quality assessment, and data extraction for pooled analysis.

Main Results:

• Pooled analysis of eleven studies indicated SSZ significantly reduced erythrocyte sedimentation rate (ESR) and morning stiffness.
• Evidence of benefit was observed for peripheral joint symptoms and responses in patients with peripheral arthritis.
• Higher withdrawal rates due to side effects and other reasons were noted for SSZ compared to placebo, though severe side effects were rare.

Conclusions:

• Sulfasalazine (SSZ) shows efficacy in reducing ESR and alleviating morning stiffness in ankylosing spondylitis (AS) patients.
• No significant benefit was found for physical function, pain, spinal mobility, enthesitis, or global assessments.
• Early-stage AS patients with high ESR and peripheral arthritis may experience greater benefits from SSZ treatment.