Disease modifying effect (DME) of salazopyrin (Sulphasalazine) in seronegative-spondylo-arthropathies (SNSA)

The use of Sulphasalazine in rheumatoid arthritis is well known. Recently it has also been used for the treatment of seronegative spondyloarthropathies (SNSA). Its usefulness in the peripheral arthritis of SNSA is well accepted but its beneficial effect on axial skeleton disease is disputed. It has been suggested that benefit in axial skeleton disease may be seen in patients with early disease. This open add on trial was aimed to study its usefulness in axial and peripheral joint disease of early SNSA. Fourteen patients of SNSA, with stable but unsatisfactory relief on atleast I month of adequate non steroidal anti-intlammatory drugs (NSAID) were advised sulphasalazine 1.5 to 2.00 gms daily over and above their optimum dose of NSAID. The dose of non steroidal anti-inflammatory drugs was not increased during the study. Eleven of the patients could be followed for 3–6 months. Statistically significant improvement was seen in morning stiffness (p<0.01), activities of daily living (p<0.05), pain severity (p<0.001), patient's global assessment (p<0.001), physician's global assessment(p<0.01), ESR and CRP improvement was seen in Schober's test (p<0.01), chest expansion (p<0.5), axial skeleton count (p<0.05) and 50ft. walking time (p<0.01). Improvement in morning stiffness, pain severity, periperal joint swelling was seen on evaluation at 1 month; evaluation at 3rd month; and in rest of the parameters at the end of the study. The median duration of disease in these patients was 12 months. Ten patients did not have fused sacroiliac joint and all the patients had none or less than 3 bridging syndesmophytes indicating early and/or reversible disease. These results suggest that patients with early reversible disecise are likely to have improvement in both peripheral and axial joint disease.