Although the results of the ASCEND trial suggest a greater short‐term clinical benefit with etanercept, even in this group of patients who may be more sulfasalazine‐responsive, this trial does not address more clinically relevant questions that might elucidate whether sulfasalazine fills a niche in the strategies of AS treatment. More withdrawals because of side effects occurred with sulfasalazine. First, among patients with AS who have active peripheral joint manifestations but mild axial symptoms (that would not warrant treatment with TNF inhibitors), is sulfasalazine or a TNF inhibitor a better treatment? We judged most of the studies as low risk of bias or unclear risk of bias in five domains (random sequence generation, allocation concealment, blinding of outcome assessment, selective reporting, and other sources of bias). In the Prospective Study of Outcomes in Ankylosing Spondylitis (PSOAS), a large observational study of patients enrolled at 5 rheumatology centers in the US, 30% of 888 patients reported ever having been treated with sulfasalazine (Ward M: unpublished observations). Surveys in the US in the 1990s indicated that sulfasalazine was being administered to fewer than 20% of patients, even among those with moderately active or very active AS (5, 7). A response to treatment was observed in 6 of the 8 patients, with improvement in symptoms and reductions in tender joint counts and acute‐phase reactant levels. To date, no intervention is available that alters the underlying mechanism of inflammation in AS. As you've probably guessed by now, I have ankylosing spondylitis. Objective: To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active ankylosing spondylitis (AS) that is not controlled with nonsteroidal antiinflammatory drug therapy. Our health evidence - how can it help you. Seventy‐six percent of subjects treated with etanercept had an ASAS20 response at 16 weeks, compared to 53% of those treated with sulfasalazine. Sulfasalazine is a slow-acting anti-rheumatic drug (SAARD) that may be used to treat certain people with ankylosing spondylitis (AS). It may also affect the shoulders, hips, or other joints. Two review authors independently reviewed unblinded trial reports according to the selection criteria. Chen J, Liu C. J Rheumatol, 33(4):722-731, 01 Apr 2006 Cited by: 35 articles | PMID: 16583475. Review JC: Registered the title; developed the protocol; searched for relevant studies; selected the studies and assessed their risk of bias; extracted and synthesized the data; and wrot Author information: (1)Inflammation Disease Area, Specialty Care Business Unit, Pfizer Inc., 500 Arcola Road, Collegeville, PA 19422, USA. Ankylosing Spondylitis: A Treatment Overview. This large, well‐executed trial suggests that etanercept is more efficacious than sulfasalazine in the treatment of AS symptoms overall. Ankylosing Spondylitis is a very painful and debilitating arthritis of the spine. Dosage: Sulfasalazine normally comes in 500mg tablets. E-mail address: wardm1@mail.nih.gov. Ankylosing spondylitis (AS) is a lifelong condition that has no cure. The same authors independently assessed the risk of bias of included trials and entered the data extracted from the included trials. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. There was a statistically significant improvement, compared with baseline, in most of the clinical variables in patients receiving the active drug. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. The primary goals of treatment of ankylosing spondylitis (AS) are to reduce axial musculoskeletal pain and stiffness, control enthesitis, improve fatigue, and preserve flexibility and mobility. We use cookies to improve your experience on our site. The proportion of patients actively treated with sulfasalazine decreased from 14% in 2004 to 3% in 2010. Noting that some professional organizations recommend that a trial of sulfasalazine be considered for patients with active peripheral arthritis before a TNF inhibitor is prescribed, patients with peripheral arthritis were targeted for enrollment, but this was not an inclusion criterion. Sulfasalazine was first used to treat AS in a 16‐week open‐label trial involving 8 patients with peripheral arthritis (1). Ankylosing Spondylitis (AS) is uncommon and rarely begins after the age of 45. These findings are in contrast to those in studies showing the established efficacy and rapid adoption of TNF inhibitors to treat active AS. Perhaps because of its limited clinical effect on axial symptoms, its selective targeting to the smaller subset of patients with peripheral arthritis, or its sometimes‐troublesome side effects and requirements for laboratory monitoring, sulfasalazine has not been widely used in the treatment of AS. To evaluate the benefits and harms of sulfasalazine for the treatment of ankylosing spondylitis (AS). Inflammatory arthritis in peripheral joints, typically affecting 5 joints or fewer and occurring in up to 40% of patients, also requires treatment. Dr. Ward drafted the article, revised it critically for important intellectual content, and approved the final version to be published. It occurs most frequently in white males 20 to 40 years old, although it can occur in children, too. Our findings are summarised below. We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. Sulfasalazine for ankylosing spondylitis. The main objective of initiating such therapy is to reduce pain, stiffness and discomfort. The pooled MD for back pain measured on a 0 to 100 mm visual analogue scale was -2.96 (95% confidence interval (CI) -6.33 to 0.41; absolute risk difference 3%, 95% CI 1% to 6%; 6 trials). When the doctor told me “You have ankylosing spondylitis,” and handed me a little pamphlet and recommended I start biologic treatment right away, my head was spinning. Pooled results of these trials indicated that compared with placebo, sulfasalazine improved morning stiffness and decreased levels of acute‐phase reactants, but there were no significant effects on other measures, including back pain, tender and swollen joint counts, global health status assessments, and physical functioning (2). : CD004800. Management of ankylosing spondylitis (AS) is challenged by the progressive nature of the disease. This is a reivew of how effective Sulfasalazine (sulfasalazine) is for Ankylosing spondylitis and for what kind of people. 2011 Jun;63(6):1543-51. doi: 10.1002/art.30223. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. None of the included trials assessed BASDAI, BASFI, BASMI or radiographic progression. Eighty-five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine (≤3 gm/day, mean 2.5) or placebo for 26 weeks. Is sulfasalazine effective in ankylosing spondylitis? The primary outcome was the proportion of subjects in each group in whom an Assessment of SpondyloArthritis international Society 20% improvement (ASAS20) response was achieved, a measure that assesses spinal pain, morning stiffness, functioning, and patient's global assessment of disease, after 16 weeks of treatment. Corresponding Author. Subjects were required to have a Bath Ankylosing Spondylitis Disease Activity Index of 30 or higher (on a 0–100 scale, and slightly more permissive than the conventional criterion of 40 or higher) despite treatment with nonsteroidal antiinflammatory drugs, similarly rated levels of morning stiffness, global assessment of disease activity, back pain, or functional limitations, and were judged to be a suitable candidate for treatment with either medication. Eighty‐five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine (≤3 gm/day, mean 2.5) or placebo for 26 weeks. The review showed that in people with ankylosing spondylitis: - compared with fake pills, sulfasalazine probably has little or no difference in pain, disease activity, physical function, spinal mobility, patient and physician global assessment; - damage to the spine as seen on x-ray or magnetic resonance image was not measured and therefore it is not known whether sulfasalazine slows damage; - people had side effects such as stomach upsets, skin reactions/rashes and mouth sores; - more people stopped taking sulfasalazine because of the side effects than when taking fake pills; and. There is not enough evidence to support any benefit of sulfasalazine in reducing pain, disease activity, radiographic progression, or improving physical function and spinal mobility in the treatment of AS. , your doctor might ask you to bend in different directions to test the range of motion in spine... As the outcome, while the latter question examines peripheral arthritis, usually in long! 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