Sulfasalazine therapy for juvenile rheumatoid arthritis

To determine the safety and therapeutic potential of sulfasalazine (SSZ) in the treatment of a large cohort of patients with juvenile rheumatoid arthritis (JRA).

All patients who required the addition of a second line agent were offered SSZ and assessed at regular intervals. Thirty patients took SSZ as their sole drug therapy. One hundred thirty-nine patients with an average age of 11.5 yrs (range 1.5-21.8 yrs) took the medication. The duration of symptoms at the start of treatment was 30 mo (1-130 mo). All subtypes of JRA were included in the study group. Patients were treated for a mean of 13 mo (1-42 mo) with 31 mg/kg/day of SSZ. Significant improvement was defined as 50% decrease in the number of joints with active arthritis; or 50% decrease in the number of joints with effusion; or 50% decrease in total degrees of joint contractures; or normalization of an elevated erythrocyte sedimentation rate within 12 months of starting treatment. Data on adverse reactions, remissions, and treatment failure were also collected.

One hundred two patients (73%) had significant improvement after starting SSZ. Fifty-six patients (40%) were able to stop all other medication at an average of 9.5 mo. Thirty-nine patients (28%) remitted and discontinued all medication. Twenty-three patients (17%) discontinued the drug for adverse reactions. All reactions resolved completely when the drug was discontinued.

SSZ is safe and appears to be an effective primary or second line therapy for JRA, and should be studied further in a multi-institutional, placebo controlled study.