Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A department of veterans affairs cooperative study

Clegg, Daniel O.; Reda, Domenic J.; Weisman, Michael H.; Cush, John J.; Vasey, Frank B.; Schumacher, H. Ralph; Budiman‐Mak, Elly; Balestra, Dominic J.; Blackburn, Warren D.; Cannon, Grant W.; Inman, Robert D.; Alepa, F. Paul; Mejías, Edwin; Cohen, M. R.; Makkena, Rama; Mahowald, Maren L.; Higashida, Jean; Silverman, Stuart L.; Parhami, N; Buxbaum, Joel N.; Haakenson, Clair; Ward, Richard H.; Manaster, B.J.; Anderson, Robert J.; Ward, John; Henderson, William G.

doi:10.1002/art.1780391211

Cited by 135 publications

(60 citation statements)

References 7 publications

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“…No significant adverse events were reported (139,207). A large multicenter study conducted by the Department of Veterans' Affairs in patients with a chronic mean ReA duration of 10 years and unresponsive to conventional therapy demonstrated that sulfasalazine (2 g/day) is well tolerated and effective in treating ReA (34). A reanalysis of the same study published by the same study group showed different responses to sulfasalazine in patients with axial or peripheral involvement (33).…”

Section: Pharmacologic Approachmentioning

confidence: 99%

“…Depending on the triggering infection and on the follow-up time, chronic arthritis is observed in 2 to 18% of patients, sacroiliitis is observed in 14 to 49%, and AS is observed in 12 to 26% (91,117,200). In one of the earliest studies of ReA, chronic disability was found in 40 of 100 persons who were available for reexamination 25 years after onset of disease (34).…”

Section: Coursementioning

confidence: 99%

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HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004

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Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, nonculturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease

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Section: Pharmacologic Approachmentioning

confidence: 99%

Section: Coursementioning

confidence: 99%

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004

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“…However, a substantial proportion of patients (ϳ20%) experience a chronic course that continues longer than 12 months (8,9). Currently, patients are treated symptomatically with nonsteroidal antiinflammatory drugs (NSAIDs) or, in severe cases, with steroids, and those with chronic courses are treated with second-line drugs, such as sulfasalazine, which have been shown to be effective (10). To shorten self-limited courses and to treat chronic cases more effectively, a better and possibly curative treatment is needed.…”

mentioning

confidence: 99%

No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: A three-month, multicenter, double-blind, randomized, placebo-controlled study

Sieper

Fendler

Laitko³

et al. 1999

Arthritis & Rheumatism

144

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Objective. To investigate the effect of long-term antibiotic treatment in patients with reactive arthritis (ReA) and undifferentiated oligoarthritis. Methods. One hundred twenty-six patients were treated with ciprofloxacin (500 mg twice a day) or placebo for 3 months, in a double-blind, randomized study. Of these patients, 104 (48 treated with cipro-floxacin and 56 treated with placebo) were valid for clinical evaluation: 55 were diagnosed as having ReA with a preceding symptomatic urogenic or enteric infection and 49 as having undifferentiated oligoarthritis. These 2 groups were randomized separately. The triggering bacterium was sought by serology and/or culture. The percentage of patients in remission after 3 months of treatment was chosen as the primary efficacy parameter. Results. A triggering bacterium could be identified in 52 patients (50%): Chlamydia trachomatis in 13, Yersinia in 14, and Salmonella in 25. No patient was positive for Campylobacter jejuni or for Shigella. No difference in outcome was found between treatment with ciprofloxacin or placebo in the whole group or in subgroups of patients with ReA or undifferentiated oligoarthritis. No difference was seen in patients with a disease duration <3 months. Ciprofloxacin was not effective in Yersinia-or Salmonella-induced arthritis but seemed to be better than placebo in Chlamydia-induced arthritis. This difference was not significant, however, which might be due to the small sample size. Conclusion. Long-term treatment of ReA with ciprofloxacin is not effective; however, it might be useful in the subgroup of patients who have Chlamydia-induced arthritis. This has to be proven in a bigger study focusing on patients with Chlamydia-induced arthritis.

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“…Hier hat sich SSZ (2 bis max. 3 g/Tag; [7]) bewährt. Trotz unzureichender Studienlage kommen auch andere DMARDs, insbesondere MTX, zum Einsatz.…”

Section: Immunsuppressive Therapieunclassified

Therapie der sekundären Arthropathien

Gödde

Müller‐Ladner

2006

Internist

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Arthralgia is one of the most common complaints in Western society. The classification of joint diseases with respect to genesis is crucial for the determination of adequate treatment. For inflammatory arthropathies, treatment options have expanded significantly over the last decade. This review summarizes the current treatment of psoriatic arthritis and Reiter's disease, both belonging to the spectrum of seronegative spondyloarthropathies. Regardless of our increasing knowledge of chondrogenesis, the treatment of osteoarthritis is still more or less symptomatic. Premature age of onset and the atypical joint distribution of osteoarthritis should bring metabolic diseases, for example hemochromatosis, into consideration.

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Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A department of veterans affairs cooperative study

Abstract: Objective. To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mglday is effective in the treatment of reactive arthritis (ReA) that has been unresponsive to nonsteroidal antiinflammatory drug (NSAID) therapy.

Cited by 135 publications

References 7 publications

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: A three-month, multicenter, double-blind, randomized, placebo-controlled study

Therapie der sekundären Arthropathien

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