Background Sulfasalazine is used in RA, but its role in uveitis is not well established.
Objectives To study the efficiency of sulfasalazine (SSZ) in the treatment of recurrent flares of acute anterior uveitis (AAU) over a one year period.
Methods From June of 1997 to October 2000, 376 patients with uveitis have been attended by Ophthalmologists and Rheumatologists in our outpatient Uveitis Unit according to a protocol based on the pattern of uveitis and clinical symptoms of the patient. Data were prospectively recorded. The criteria to start treatment were: 1) The presence of three or more flares of AAU in the previous year or 2) Recurrence of the uveitis in less than three months from the previous episode. Exclusion criteria to start SSZ were uveitis due to infectious or malignant causes or the presence of any contraindications to this drug. SSZ was started at 500 mg per day and gradually increased untill a dose of 2 g per day. If inadecuate response, the dose was increased untill 3 g. The major outcome was defined as the number of flares of uveitis over a one year period compared in the same group of patients with the flares of the previous year without SSZ, followed prospectively in our unit. Wilcoxon test was used for the statistical study.
Results Eleven patients were in SSZ treatment (5 men, 6 women; 6 ankylosing spondylitis 2 idiopatic uveitis, one Reiter´s syndrome, one intestinal inflammatory disease and one juvenil chronic arthritis). Three of them started SSZ for other reasons than uveitis or in other services of the hospital and were then excluded of the analysis. In the remaining 8 patients, the mean number of AAU flares in the pre-SSZ year was 3.5 (ranging from 3 to 4 flares, SD 0.5). After a one year of treatment, the mean of flares was reduced to 0.6 (ranging from 0 to 2 flares, SD 0.9) that was found to be significant (p = 0.011). Only one patient was found to be a non-responder. Other two patients were considered partially responderes with a reduction from 4 to 2 and from 3 to 1 flares respectively in comparison of the pre and post-treatment one year period. The other 6 patients did not have any new flare of uveitis during the one year SSZ treatment. We found only two adverse events, both with increased transaminase profiles that did not result in discontinuation of the therapy.
Conclusion SSZ treatment reduce the number of flares over a one year period in patients with recurrent AAU.
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