SELECTION OF SUITABLE PATIENTS FOR SECONDLINE THERAPY IN RHEUMATOID ARTHRITIS

Investigators studying second-line drugs often try to enrol‘ideal’ patients with a high ESR, short diseaseduration and who have received no previous second-line therapy.In this paper we investigate the influence of gender, diseaseduration, previous second-line therapy, and initial ESR in 150rheumatoid patients with clinically-active disease treated withsulphasalazine. Clinical improvement was seen in all subgroupsand no difference in toxicity could be demonstrated. Haematologicalresponse was absent in patients with an initial low ESR althoughthese patients improved clinically. Thus, patients with clinically-active disease suggesting a needfor second-line drugs should benefit from sulphasalazine therapyirrespective of any of the above variables. The implicationsfor clinical trial design regarding patients with low ESR, however,may be more complex. KEY WORDS: Rheumatoid arthritis, Sulphasalazine, Disease activity, Previous treatment, ESR