Infectious mononucleosis-like syndrome induced by salazosulfapyridine in a patient with rheumatoid arthritis

Abstract

We describe a 43-year-old woman with rheumatoid arthritis (RA), who developed severe infectious mononucleosis (IM)-like syndrome during treatment with salazosulfapyridine (SASP). She presented with fever, skin rash, lymphadenopathy, and hepatosplenomegaly. Laboratory tests revealed a marked increase of atypical lymphocytes in the peripheral blood and biphasic hepatic dysfunction. IM-like syndrome can be caused by various drugs, including SASP, and the concept of drug-induced hypersensitivity syndrome has been proposed recently. IM-like syndrome due to SASP has been reported in patients taking higher dosages for the treatment of inflammatory bowel disease, but has not been reported earlier in patients with RA. The results of the drug-induced lymphocyte stimulation test tests suggested that 5-aminosalicylic acid was a possible causative metabolite. This severe type of drug-induced hypersensitivity reaction mimicking IM due to SASP should be granted wider awareness in the field of rheumatology, because the drug is widely used for the treatment of RA.     

A comparative study of the effects of bucillamine and salazosulfapyridine in the treatment of rheumatoid arthritis

Abstract

Bucillamine (Buc), developed in Japan, is a disease-modifying antirheumatic drug (DMARD) which has been used to treat numerous patients with rheumatoid arthritis (RA) in Japan and Korea with favorable results. However, it has not been used globally. In the present study, we compared the timing of onset of efficacy and the usefulness of this drug with that of the globally accepted agent salazosulfapyridine (SASP). There were 26 patients in the Buc group and 23 in the SASP group. We compared changes in the number of swollen joints, number of painful joints, duration of morning stiffness, grip strength, levels of inflammatory marker [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)], rheumatoid factor (RF), physician’s rating by visual analogue scale (VAS), patient’s rating of pain, patient’s overall rating (VAS), and improvement according to European League against Rheumatism (EULAR) criteria (DAS28-CRP, DAS28-ESR) in these two groups of patients. Both Buc and SASP were shown to be efficacious within 3 months after the start of treatment. Both drugs were found to be suitable as first-line treatment of early RA. Signs of efficacy tended to occur earlier with Buc than with SASP, and Buc also tended to have higher efficacy than SASP.     

Chronic granulomatous disease of childhood: Gastric manifestation and response to salazosulfapyridine therapy

The case history of a 10-year-old boy with chronic granulomatous disease (CGD) and gastric obstruction is presented. First abdominal symptoms occurred at 4 years of age when antral narrowing was detected. Due to unresponsiveness to antibiotic and steroid treatment, salazosulfapyridine therapy was initiated. Objective remission was observed within 3 months and salazosulfapyridine was withdrawn after a further 6 months of therapy. At 6 years of age clinical and radiological recurrence of gastric obstruction was observed. Salazosulfapyridine was reinstated and continued as maintenance therapy. The child has been well for more than 4 years. Salazosulfapyridine therapy can be recommended as safe conservative treatment of gastric obstruction in CGD.     

英夫利昔单抗与柳氮磺胺吡啶在克罗恩病中的疗效对比

目的：探讨比较英夫利昔单抗与柳氮磺胺吡啶在克罗恩病（CD）中的疗效及安全性。方法：将50例克罗恩病患者随机分为A组（英夫利昔单抗组）25例和B组（柳氮磺胺吡啶组）25例,后将两组患者的治疗总有效率、不良反应发生率及治疗前后的血沉、CRP（C反应蛋白）、唾液酸及α2球蛋白进行检测及比较。结果：A组总有效率（92.00%）高于B组（68.00%）,不良反应发生率低于B组（24.00%vs 36.00%）,而血沉、CRP、唾液酸及α2球蛋白均低于B组,P〈0.05或P〈0.01,有显著性或有非常显著性差异。结论：英夫利昔单抗在CD患者具有较佳的疗效。     

复合法诱发小鼠结肠炎模型的建立和免疫学验证

目的:建立2,4-二硝基氯苯(DNCB)和醋酸(AA)复合法诱导的小鼠结肠炎模型,并验证其在炎性肠病(IBD)发病及治疗机制中的研究价值。方法:昆明种小鼠48只,按体重随机分为正常对照、模型、硫氮磺胺吡啶(SASP)及中药灌肠治疗4组,肠道积分法观察组织病理学变化;DAPI染色检测淋巴细胞凋亡指数的改变;流式细胞仪分析外周血中CD4~ CD29~ T细胞及外周血和肠系膜淋巴结中CD3~ 、CD4~ T细胞的变化。结果:成功建立免疫型小鼠结肠炎模型。模型组小鼠肠道病理学损伤较正常对照组明显加重;特别是模型组CD4~ CD29~ T细胞比例明显高于正常对照组(P<0.01);免疫组织淋巴细胞凋亡指数显著升高(P<0.01);而CD3~ 、CD4~ T细胞较正常对照组明显降低(P<0.05)。经SASP和中药灌肠治疗后,肠道组织病理损伤明显减轻,免疫组织淋巴细胞凋亡指数显著降低,且CD3~ 、CD4~ T细胞亚群较模型组明显增高。结论:DNCB AA法诱导的小鼠结肠炎模型,是一种较理想的IBD动物模型,可成功用于炎性肠病发病及治疗机制的研究。     

An HLA-B27-positive patient diagnosed with ulcerative colitis 15 years after the onset of arthropathy

Abstract

A 28-year-old woman had persistent pain of both hip joints since the age of 13 years. X-ray analysis showed destructive changes in both hip joints and ossification of sacroiliitic joints. The patient had mild diarrhea and slight abdominal pain for 8 years. Blood-stained stool was not noticed. Barium enema showed changes consistent with the diagnosis of ulcerative colitis (UC). Inflammatory bowel syndrome should be considered in patients with persistent coxitis, even in the absence of severe abdominal symptoms.     

Infectious mononucleosis-like syndrome induced by salazosulfapyridine in a patient with rheumatoid arthritis

We describe a 43-year-old woman with rheumatoid arthritis (RA), who developed severe infectious mononucleosis (IM)-like syndrome during treatment with salazosulfapyridine (SASP). She presented with fever, skin rash, lymphadenopathy, and hepatosplenomegaly. Laboratory tests revealed a marked increase of atypical lymphocytes in the peripheral blood and biphasic hepatic dysfunction. IM-like syndrome can be caused by various drugs, including SASP, and the concept of drug-induced hypersensitivity syndrome has been proposed recently. IM-like syndrome due to SASP has been reported in patients taking higher dosages for the treatment of inflammatory bowel disease, but has not been reported earlier in patients with RA. The results of the drug-induced lymphocyte stimulation test tests suggested that 5-aminosalicylic acid was a possible causative metabolite. This severe type of drug-induced hypersensitivity reaction mimicking IM due to SASP should be granted wider awareness in the field of rheumatology, because the drug is widely used for the treatment of RA.     

Efficacy and safety of iguratimod compared with placebo and salazosulfapyridine in active rheumatoid arthritis: a controlled, multicenter, double-blind, parallel-group study

We conducted a 28-week, randomized, double-blind, parallel-group study of iguratimod in 376 Japanese patients with active rheumatoid arthritis to compare the efficacy and safety of the drug with those of placebo and salazosulfapyridine. In the American College of Rheumatology (ACR) 20 response rate, iguratimod was superior to placebo (53.8% versus 17.2%; Fisher's exact test, P < 0.001) and was not inferior to salazosulfapyridine (63.1% versus 57.7%, 95% confidence interval for the rate difference, −7.9% to 18.7%). Iguratimod began exhibiting its therapeutic effect within 8 weeks after the initiation of treatment and was effective even in patients who had a poor response to previous treatment with disease-modifying antirheumatic drugs. No statistically significant difference was noted in the incidence of adverse reactions between iguratimod and salazosulfapyridine. The study results suggest that iguratimod could become a new option for the treatment of rheumatoid arthritis.     

Experience with the Use of Salazosulfapyridine for Intractable Diarrhea after Hematopoietic Stem Cell Transplantation

We encountered 2 children with intractable diarrhea after allogeneic hematopoietic stem cell transplantation (SCT). In both cases, salazosulfapyridine (SASP) was administered to treat the diarrhea. One patient was a 14-year-old male with acute myelogenous leukemia who received SCT from a related HLA-identical donor. The leukemia recurred early, and a second SCT from the same donor was performed approximately half a year later. Because intestinal graft-versus-host disease (GVHD) was observed, steroids and octreotide were administered, but the symptoms were not improved. Thereafter, SASP was administered, and the symptoms remitted 9 days later. The other patient was a 12-year-old male with chronic myelogenous leukemia who received SCT from an unrelated HLA-identical donor. Diarrhea and abdominal pain developed early after engraftment and did not respond to either steroids or tacrolimus. Oral administration of SASP was initiated on day 236, and the diarrhea remitted 4 days later without recurrence thereafter. SASP may be effective in children for the digestive system symptoms of chronic GVHD.     

连理汤加减治疗溃疡性结肠炎31例

目的:观察连理汤加减治疗溃疡性结肠炎的临床疗效。方法:将62例溃疡性结肠炎患者随机分为对照组和治疗组,每组31例。对照组给予柳氮磺胺吡啶治疗,治疗组给予连理汤加减治疗。结果:治疗组有效率为80.65%,对照组有效率为74.19%,治疗组优于对照组(P0.05)。结论:连理汤加减治疗溃疡性结肠炎疗效显著。