HLA-B27 related arthritis and bowel inflammation. Part 1. Sulfasalazine (salazopyrin) in HLA-B27 related reactive arthritis.

In an open study, sulfasalazine was given to 15 HLA-B27 positive patients with asymmetrical pauciarticular arthritis and enthesopathies resistant to nonsteroidal antiinflammatory drugs (NSAID). In 11 patients, long lasting remission of inflammatory and biological variables was obtained after 3 to 12 months of treatment. In the other 4 patients significant improvement of the clinical and biological variables was observed. In the 7 patients on whom ileocolonoscopy was performed, inflammatory signs were seen in the terminal ileum or ileocecal valve, suggestive of inflammatory bowel disease (IBD). It is generally accepted that sulfasalazine improves the intestinal symptoms of IBD; our study suggests that it is also beneficial in HLA-B27 related arthropathies resistant to NSAID. No significant adverse reactions were encountered. These findings are encouraging but have to be confirmed in a double blind controlled study.