Long-term usage and side-effect profile of sulphasalazine in rheumatoid arthritis

In a cohort of patients with early rheumatoid arthritis, sulphasalazine (SASP) was mainly given as a first-choice second-line agent. SASP resulted in a significantly better survival rate compared with hydroxychloroquine, which is also given as a first-choice agent. When the survival rate of SASP was compared with that of aurothioglucose, both given as second-choice agents, again, a statistically significant better survival rate was found for SASP. In 9% of the patients, SASP could be withdrawn as a complete remission was obtained. Adverse reactions occurred mainly during the first 3 months of treatment, and in 20% of patients these were severe enough to stop treatment. Gastrointestinal adverse reactions were most frequently observed, and all adverse reactions were completely reversible after treatment withdrawal. Treatment was started with a standard dose of 2000 mg/day. However, in approximately 30% of the patients, this dose was increased up to 3000 mg/day and, in another 30%, the dose was decreased to 1,500 or 1,000 mg/day.