Adverse reaction profile of sulfasalazine and its persistence in chronic therapy of rheumatoid arthritis and spondyloarthritis: A multicentric observational study.

OBJECTIVES: Sulfasalazine has been widely used in treatment of rheumatoid arthritis and spondyloarthritis. This study aims to assess persistence with sulfasalazine and also frequency and severity of adverse drug reactions (ADRs) encountered with this very well-established disease-modifying anti-rheumatoid drug. MATERIALS AND METHODS: This retrospective study was done in 1,114 patients from medicine and rheumatology outpatient departments of six centers across India. The inclusion criteria was patients taking sulfasalazine. Patients receiving sulfasalazine for rheumatoid arthritis or spondyloarthritis were selected and details on drugs used, duration of taking sulfasalazine, ADRs to sulfasalazine and whether sulfasalazine had to be stopped due to ADRs were analyzed. RESULTS: Of the total of patients included in the study, 10.1% had ADRs with sulfasalazine, and stopped the drug. Gastritis, deranged liver enzymes, hepatitis, skin rashes were the most commonly encountered ADRs. Of the total number of patients recruited for the study, 11% were lost to follow-up, as most of the centers were army hospitals and the officers and staff were posted to other places. Sulfasalazine was taken for less than 1 month by 3.8% patients while 12.5% had taken the drug for less than 6 months. Of the study patients, 28.6% had taken the drug for 24 - 60 months and 4.6% (51 patients) had taken it for more than 5 years. It was found that ADRs were most commonly encountered within the first year of using the drug, and persistence was seen in patients on long-term therapy. CONCLUSION: Sulfasalazine is a safe option in chronic therapy of rheumatoid arthritis and spondyloarthritis. Although frequency of ADRs with patients taking sulfasalazine is minimal, it did necessitate the stoppage of drug. If not well tolerated, sulfasalazine would not have been continued for more than 12 months as evidenced from this study.

Magnetic Resonance Imaging evidence of Inflammation at Interphalangeal joint of Thumb - A distinct entity in psoriatic arthritis.

BACKGROUND: This study aimed to compare inflammation at the interphalangeal (IP) joint of thumb in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), undifferentiated inflammatory arthritis (UIA), and in psoriasis patients without clinical arthritis (PsO) using low-field magnetic resonance imaging (MRI). METHODS: Age-matched and disease duration-matched patients with inflammatory arthritis (RA, PsA, and UIA) and psoriasis patients without clinical arthritis (PsO), who had undergone MRI of hands were included in this study. The presence or absence of MRI inflammatory lesions including synovitis, tenosynovitis, and bone marrow edema was assessed by three independent readers. Agreement between the readers was assessed using the intraclass correlation coefficient. Risk ratio of MRI global inflammation around thumb IP joints among patients with PsA was compared with the other groups. RESULTS: Clinical parameters and MRI inflammation were studied in 161 patients (42 PsA, 28 RA, 29 UIA, and 62 PsO). Global MRI inflammation at the IP joint of the thumb was observed in 33.3% of PsA patients compared with 14.3% in RA, and 10.3% in UIA. Subclinical MRI inflammation was observed in 8.1% of patients with PsO. The risk ratios of MRI global inflammation at the IP joint of the thumb in PsA patients were 2.3 (95% confidence interval [CI] 0.86-6.36) and 3.2 (95% CI 1.02-10.21) compared with RA and UIA patients, respectively. CONCLUSION: Global MRI inflammation around the IP joint of the thumb is significantly more common in patients with PsA as compared to individuals with UIA.

Prevalence of left ventricular dysfunction in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a polyarticular disorder with many extra-articular features. Cardiovascular disorders, including heart failure (HF), are the leading causes of mortality in RA patients. We studied the prevalence of left ventricular dysfunction (LVD) in patients with RA. MATERIALS AND METHODS: In this cross-sectional study, we evaluated 100 consecutive patients with RA (aged >18 years and duration >1 year) for the presence of LVD. We excluded patients with known cardiac and systemic disorders that may contribute to LVD. LVD is defined by the presence of either left ventricular systolic dysfunction (LVSD) or left ventricular diastolic dysfunction (LVDD), evaluated by the echocardiography. Descriptive statistics and relevant tests were used to analyze the results. RESULTS: The study participants (n = 100; 80F and 20M) had a mean age of 45 ± 11.8 years, duration of disease 7.4 ± 5.4 years, and disease activity score of 3.5 ± 1.1. A total of 46 patients had symptoms of HF, but only 14% of them had signs of HF. LVD was seen in 59 (LVSD-4, LVDD-50, and both together in 5) patients, and none of the participants had severe grades of LVSD and LVDD. LVD showed no relation to the age of the patients (P = 0.186) and it was more with increasing duration of RA (P < 0.001) and higher disease activity (P = 0.042). CONCLUSION: LVD is more common in RA patients, which increases the associated morbidity and mortality. Higher threshold is required by the family practitioners to perform a screening echocardiography in long-standing RA patients.