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