Effects of sulphasalazine on faecal flora in patients with rheumatoid arthritis: a comparison with penicillamine

Twenty-six out-patients with active rheumatoid arthritis (RA) were randomly allocated to treatment with sulphasalazine (SASP) or D-penicillamine (DPA). Faecal samples were collected from all patients at 4-weekly intervals and examined for changes in faecal flora during treatment. Both treatment groups showed substantial clinical improvement. In the SASP-treated group this was accompanied by significant falls in counts of Cl. perfringens and E. coli. No such changes were seen in the DPA-treated group. These results suggest that SASP's efficacy in RA may be related to its antibacterial properties.