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Efficacy of SLZ and MTX (alone or combination) on the treatment of active sacroiliitis in early AS

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Abstract

Sacroiliitis is an important sign of spondylarthritis (SpA) of which the prototype disease is ankylosing spondylitis. The radiographic changes required for diagnosing AS occur as late as 8–11 years after the onset of clinical symptoms. Nonsteroid anti-inflammatory drugs (NSAIDs) have been the main treatment for spondylitis of AS. For patients refractory or intolerant to NSAIDs, disease-modifying antirheumatic drugs (DMARDs) have been used as a second-line approach. Sulphasalazine (SLZ) is known as the best DMARD in treatment of peripheral arthritis; also methotrexate (MTX) is currently one of the most widely used DMARDs. But there was no objective information about inflammation of sacroiliac joints during treatment with these DMARDS that are the first places of the beginning point of SpA. For this purpose, in this study, the effect of SLZ and MTX, which are used alone and combination in 6 months, on treatment of active sacroiliitis, which is shown by dynamic magnetic resonance and acute phase reactants in laboratory has been investigated. 55 patients (F:M = 34:21) with active sacroiliitis [mean age = 37.05 + 13.03 year (n = 55)] were evaluated and determined by dynamic magnetic resonance imaging in this study. The better response in the SLZ treatment group than the other two groups has been obtained. Nevertheless, those changes were not statistically found different. In conclusion, the ratio of treatment of active sacroiliitis, especially early period, with SLZ as a DMARD is better than MTX or MTX + SLZ, but this difference is not statistically significant. A prospective study of the treatment of active sacroiliitis by DMARDs may be more illustrative.

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References

  1. Khan MA (2002) Ankylosing spondylitis: introductory comments on its diagnosis and treatment. Ann Rheum Dis 61(suppl III):iii3–iii7

    PubMed  Google Scholar 

  2. Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W et al (1988) Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 15:1109–1114

    PubMed  CAS  Google Scholar 

  3. Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23:61–66

    PubMed  Google Scholar 

  4. Oostveen J, Prevo R, den Boer J, van de Laar M (1999) Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography: a prospective, longitudinal study. J Rheumatol 26:1953–1958

    PubMed  CAS  Google Scholar 

  5. Ahlstrom H, Feltelius N, Nyman R, Hallgren R (1990) Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 33:1763–1769. doi:10.1002/art.1780331202

    Article  PubMed  CAS  Google Scholar 

  6. Braun J, Bollow M, Eggens U, Konig H, Distler A, Sieper J (1994) Use-of dynamic magnetic resonance imaging with fast imaging in the classification and diagnosis of early ankylosing spondylitis in the detection of early and advanced sacroiliitis in spondyloarthropathy patients. Arthritis Rheum 37:1039–1045. doi:10.1002/art.1780370709

    Article  PubMed  CAS  Google Scholar 

  7. Dougados M, Dijkmans B, Khan M, Maksymowych W, van der Linder SJ, Brandt J (2002) Conventional treatments for ankylosing spondylitis. Ann Rheum Dis 61(Suppl III):iii40–iii50

    PubMed  CAS  Google Scholar 

  8. Chen J, Liu C (2005) Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev (2):CD004800

  9. Dougados M, van der Linden S, Leirisalo-Repo M, Huitfeldt B, Juhlin R, Veys E et al (1995) Sulfasalazine in the treatment of spondyloarthropathy. A randomized, multicenter, double-blind, placebo-controlled study. Arthritis Rheum 38:618–627. doi:10.1002/art.1780380507

    Article  PubMed  CAS  Google Scholar 

  10. Clegg DO, Reda DJ, Abdellatif M (1999) Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondyloarthropathies: A Department of Veterans Affairs cooperative study. Arthritis Rheum 42:2325–2329. doi:10.1002/1529-0131(199911)42:11<2325::AID-ANR10>3.0.CO;2-C

    Article  PubMed  CAS  Google Scholar 

  11. Chen J, Liu C (2006) Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials. J Rheumatol 33(4):722–731

    PubMed  CAS  Google Scholar 

  12. Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K, Brandt J, Haibel H, Hammer M, Krause A, Mielke F, Tony H-P, Ebner W, Gömör B, Hermann J, Zeidler H, Beck E, Baumgaertner M, Sieper J (2006) Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 65:1147–1153. doi:10.1136/ard.2006.052878

    Article  PubMed  CAS  Google Scholar 

  13. Suarez-Almazor ME, Drummond M (2003) Regulatory issues and economic efficiency. J Rheumatol Suppl 68:5–7

    PubMed  Google Scholar 

  14. Chen J, Liu C (2004) Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev CD004524

  15. Zochling J, Braun J (2007) Quality indicators, guidelines and outcome measures in ankylosing spondylitis. Clin Exp Rheumatol 25(Suppl. 47):S147–S152

    Google Scholar 

  16. Chen J, Liu C, Lin J (2006) Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev (4):CD004524

  17. Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543. doi:10.1136/ard.2003.011247

    Article  PubMed  CAS  Google Scholar 

  18. Chen J, Liu C, Lin J (2008) Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev (4) (Status: Unchanged) Copyright© 2008 The Cochrane Collaboration

  19. Roychowdhury B, Bintley-Bagot S, Bulgen DY, Thompson RN, Tunn EJ, Moots RJ (2002) Is methotrexate effective in ankylosing spondylitis? Rheumatology 41:1330–1332. doi:10.1093/rheumatology/41.11.1330

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Ege University, Izmir, Turkey

    Yasemin Kabasakal, Gul Kitapcioglu, Figen Yargucu, Mehmet Argın & Gurbuz Gumusdis

  2. Tepecik Egitim Hastanesi, Izmir, Turkey

    Ali Taylan

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  1. Yasemin Kabasakal
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  2. Gul Kitapcioglu
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  3. Figen Yargucu
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  4. Ali Taylan
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  5. Mehmet Argın
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  6. Gurbuz Gumusdis
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Correspondence to Gul Kitapcioglu.

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Kabasakal, Y., Kitapcioglu, G., Yargucu, F. et al. Efficacy of SLZ and MTX (alone or combination) on the treatment of active sacroiliitis in early AS. Rheumatol Int 29, 1523–1527 (2009). https://doi.org/10.1007/s00296-009-1057-6

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  • DOI: https://doi.org/10.1007/s00296-009-1057-6

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