Skip to main content

Advertisement

SpringerLink
Log in

The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the effects of a 1-year course of sulfasalazine monotherapy on enthesal abnormalities of inflammatory rheumatic diseases (IRDs) using ultrasonography. Thirty-six patients with IRD including 20 patients with rheumatoid arthritis (RA) and 16 patients with ankylosing spondylitis (AS) (22 women, 14 men, mean ages 43.3 ± 8.8 years), and 18 healthy controls (10 women, 8 men, mean ages 42.5 ± 9.9 years) matched by age and body mass index were enrolled in this study. For the evaluation of enthesal structures, all patients and controls underwent ultrasonographic (USG) examinations of five enthesal sites of both lower limbs using high-resolution and Doppler USG. An ultrasonographic score of lower limb enthesitis was calculated using Glasgow ultrasound enthesitis scoring system (GUESS). Clinical and laboratory activities of IRD patients were also evaluated. Patient group was made to undergo 2 g/day sulfasalazine monotherapy for 1 year. All evaluations were made at the beginning of the treatment and repeated after 1 year follow-up. Results showed that the frequency of enthesal abnormalities of the IRD group was significantly higher than controls. On USG examination, 301/1,296 (23.2%) enthesal structures were abnormal in IRD patients, and 19/648 (2.93%) structures were abnormal in controls. Mean GUESS score of the IRD group (6.40 ± 2.41) was also significantly higher than controls (1.79 ± 1.60) (p < 0.001). Although there was a significant improvement in clinical and laboratory activity parameters of the IRD patients, significant decrease was not observed in enthesal abnormalities (295/1,296 enthesal structures—22.7%) and mean GUESS score (6.20 ± 2.38) after 1 year sulfasalazine trial. Additionally, there was no significant improvement in enthesal abnormalities and mean GUESS scores of AS and RA subgroups separately. Sulfasalazine treatment was not found effective on enthesal abnormalities of IRD patients. Further studies with larger groups including other IRDs are required to validate our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Firestein GS (2001) Etiology and pathogenesis of rheumatoid arthritis. In: Ruddy S, Harris ED, Sledge CB (eds) Kelley’s textbook of rheumatology, 6th edn. Saunders, Philadelphia, PA, pp 921–967

    Google Scholar 

  2. Elliott JR, O’Dell J (2002) Rheumatoid arthritis. In: West SG (ed) Rheumatology secrets, 2nd edn. Hanley&Belfus, Philadelphia, PA, pp 117–127

    Google Scholar 

  3. van der Linden S, van der Heijden D (2001) Ankylosing spondylitis. In: Ruddy S, Harris ED, Sledge CB (eds) Kelley’s textbook of rheumatology, 6th edn. Saunders, Philadelphia, PA, pp 1039–1053

    Google Scholar 

  4. Genc H, Cakit BD, Tuncbilek I, Erdem HR (2005) Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol 24:272–277

    Article  PubMed  Google Scholar 

  5. Olivieri I, Barozzi L, Padula A (1998) Enthesiopathy: clinical manifestations, imaging and treatment. Baillieres Clin Rheumatol 12(4):665–681

    Article  PubMed  CAS  Google Scholar 

  6. Borman P, Koparal S, Babaoglu S, Bodur H (2006) Ultrasound detection of enthesal insertions in the foot of patients with spondyloarthropathy. Clin Rheumatol 25(3):373–377

    Article  PubMed  Google Scholar 

  7. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) Ultrasonography of enthesal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61:905–910

    Article  PubMed  CAS  Google Scholar 

  8. Balint PV, Sturrock RD (2001) Intraobserver repeatability and interobserver reproducibility in musculoskeletal ultrasound imaging measurements. Clin Exp Rheumatol 19:89–92

    PubMed  CAS  Google Scholar 

  9. Spiegel TM, King W, Weiner SR, Paulus HE (1987) Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography in rheumatoid arthritis. Arthritis Rheum 30(11):1283–1288

    Article  PubMed  CAS  Google Scholar 

  10. Day RO (2001) Sulfasalazine. In: Ruddy S, Harris ED, Sledge CB (eds) Kelley’s textbook of rheumatology, 6th edn. Saunders, Philadelphia, PA, pp 853–858

    Google Scholar 

  11. Jobanputra P, Wilson J, Douglas K, Burls A (2004) A survey of British rheumatologists’ DMARD preferences for rheumatoid arthritis. Rheumatology (Oxford) 43(2):206–210

    Article  CAS  Google Scholar 

  12. Beutler AM, Schumacher HR (1997) Reactive arthritis: is it a useful concept? Br J Clin Pharmacol 51(3):169–172

    CAS  Google Scholar 

  13. van der Horst-Bruinsma IE, Clegg DO, Dijkmans BA (2002) Treatment of ankylosing spondylitis with disease modifying antirheumatic drugs. Clin Exp Rheumatol 20(Suppl 28):67–70

    Google Scholar 

  14. Nash P, Clegg DO (2005) Psoriatic arthritis therapy: NSAIDs and traditional DMARDs. Ann Rheum Dis 64(Suppl 2):74–77

    Google Scholar 

  15. Lehtinen A, Leirisalo-Repo M, Taavitsainen M (1995) Persistence of enthesopathic changes in patients with spondyloarthropathy during a 6-month follow-up. Clin Exp Rheumatol 13(6):733–736

    PubMed  CAS  Google Scholar 

  16. Kumar N, Kay LJ, Walker DJ (2004) The treatment of enthesitis in psoriatic arthritis. J Rheumatol 31(11):2311–2312

    PubMed  Google Scholar 

  17. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  18. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368

    Article  PubMed  Google Scholar 

  19. Ritchie DM, Boyle JA, McInnes Jr et al (1968) Clinical studies with an articular index fort he assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med, New Series, XXXVII, 147, 37:393–406

  20. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 21: 2286–2291

    PubMed  CAS  Google Scholar 

  21. Joshi R, Kumar S, Unnikrishnan M, Mukherjee T (2005) Freee radical scavening reactions of sulfasalazine, 5-aminosalicylic acid and sulfapyridine: mechanistic aspects and antioxidant activity. Free Radic Res 39(11):1163–1172

    Article  PubMed  CAS  Google Scholar 

  22. Volin MV, Campell PL, Connors MA, Woodruff DC, Koch AE (2002) The effect of sulfasalazine on rheumatoid arthritic synovial tissue chemokine production. Exp Mol Pathol 73(2):84–92

    Article  PubMed  CAS  Google Scholar 

  23. Smedegard G, Bjork J (1995) Sulphasalazine: mechanism of action in rheumatoid arthritis. Br J Rheumatol 34(Suppl 2):7–15

    PubMed  Google Scholar 

  24. Plosker GL, Croom KF (2005) Sulfasalazine: a review of its use in the management of rheumatoid arthritis. Drugs 65(13):1825–1849

    Article  PubMed  CAS  Google Scholar 

  25. Strand V, Scott DL, Emery P, Kalden JR, Smolen JS, Cannon GW, Tugwell P (2005) Physical function and health related quality of life: analysis of 2 year data from randomized, controlled studies of leflunomide, sulfasalazine, or methotrexate in patients with active rheumatoid arthritis. J Rheumatol 32(4):590–601

    PubMed  CAS  Google Scholar 

  26. Wick MC, Lindblad S, Weiss RJ, Klareskog L, van Vollenhoven RF (2005) Estimated prediagnosis radiological progression: an important tool for studying the effects of early disease modifying antirheumatic drug treatment in rheumatoid arthritis. Ann Rheum Dis 64(1):134–137

    Article  PubMed  CAS  Google Scholar 

  27. Stenger AA, Van Leeuwen MA, Houtman PM, Bruyn GA, Speerstra F, Barendsen BC, Velthuysen E, van Rijswijk MH (1998) Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 37(11):1157–1163

    Article  PubMed  CAS  Google Scholar 

  28. Dougados M, Emery P, Lemmel EM, Zerbini CA, Brin S, van Riel P (2005) When a DMARD fails, should patients switch to sulfasalazine or add sulfasalazine to continuing leflunomide? Ann Rheum Dis 64(1):44–51

    Article  PubMed  CAS  Google Scholar 

  29. Korpela M, Laasonen L, Hannonen P, Kautiainen H, Leirisalo-Repo M, Hakala M, Paimela L, Blafield H, Puolakka K, Mottonen T (2004) Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: five year experience from the FIN-RACo study. Arthritis Rheum 50(7):2072–2081

    Article  PubMed  CAS  Google Scholar 

  30. Taylor HG, Beswick EJ, Dawes PT (1991) Sulphasalazine in ankylosing spondylitis. A radiological, clinical and laboratory assessment. Clin Rheumatol 10(1):43–48

    Article  PubMed  CAS  Google Scholar 

  31. Fraser SM, Sturrock RD (1990) Evaluation of sulphasalazine in ankylosing spondylitis—an interventional study. Br J Rheumatol 29(1):37–39

    Article  PubMed  CAS  Google Scholar 

  32. Kirwan J, Edwards A, Huitfeldt B, Thompson P, Currey H (1993) The course of established ankylosing spondylitis and the effects of sulphasalazine over 3 years. Br J Rheumatol 32(8):729–733

    Article  PubMed  CAS  Google Scholar 

  33. Chen J, Liu C (2005) Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev 18(2):CD004800

    Google Scholar 

  34. Gonaghan PG, O’Connor P, McGonagle D, Astin P, Wakefield RJ, Gibbon WW et al (2003) Elucidation of the relationship between synovitis and bone damage. A randomised magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 48(1):64–71

    Article  Google Scholar 

  35. Wick MC, Lindblad S, Klareskog L, van Vollenhoven RF (2004) Relationship between inflammation and joint destruction in early rheumatoid arthritis: a mathematical description. Ann Rheum Dis 63:848–852

    Article  PubMed  CAS  Google Scholar 

  36. Fassbender HG (1998) What destroys the joint in rheumatoid arthritis? Arch Orthop Trauma Surg 117:2–7

    Article  PubMed  CAS  Google Scholar 

  37. Mulherin D, Fitzgerald O, Bresnihan B (1996) Clinical improvement and radiological deterioration in rheumatoid arthritis: evidence that the pathogenesis of synovial inflammation and articular erosion may differ. Br J Rheumatol 35:1263–1268

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Department of Physical Medicine and Rehabilitation, Ministry of Health, Ankara Research and Education Hospital, Ankara, Turkey

    Hakan Genc, Burcu Duyur Cakit, Barıs Nacir, Meryem Saracoglu & Hatice Rana Erdem

  2. Department of Radiology, Ministry of Health, Ankara Research and Education Hospital, Ankara, Turkey

    Mahmut Kacar

  3. 2. Fizik Tedavi ve Rehabilitasyon Klinigi, S.B. Ankara Egitim ve Arastırma Hastanesi, 06340, Cebeci, Ankara, Turkey

    Hakan Genc

Authors
  1. Hakan Genc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Burcu Duyur Cakit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barıs Nacir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meryem Saracoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mahmut Kacar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hatice Rana Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hakan Genc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genc, H., Duyur Cakit, B., Nacir, B. et al. The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases. Clin Rheumatol 26, 1104–1110 (2007). https://doi.org/10.1007/s10067-006-0460-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-006-0460-6

Keywords

Search

Navigation