SEQUENTIAL STUDY OF BACTERIAL ANTIBODY LEVELS ANTIBODY LEVELS AND FAECAL FLORA IN RHEUMATOID ARTHRITIS PATIENTS TAKING SULPHASALAZINE

Faecal and serum samples were collected from 31 patients withactive RA during treatment with the DMARD sulphasalazine (SASP).These were examined for changes in faecal flora and antibodiesto bacterial antigens respectively. Faecal counts of Clostridiumperfringens but not Escherichia coli or total aerobic or anaerobiccounts fell significantly after 2 weeks of treatment, this decreasebeing maintained throughout the treatment period. There was,however, no relationship between changes in the faecal carriageof this micro-organism and response to drug treatment, as assessedusing clinical and biochemical indicators of disease activity.Changes in antibody levels to antigen preparations of this organismwere also unrelated to response to drug treatment. These resultssuggest that the anti-rheumatic properties of SASP are independentof its antibacterial effect on bacteria in the bowel and alsothat neither faecal carriage of, nor antibody responses to thisbacterium are involved in disease pathogenesis. Antibody levels to an antigen preparation of Cl. perfringenswere found to be significantly lower in those patients who respondwell to SASP than those patients who show poor response; thismay prove useful as a clinical marker for predicting those patientslikely to respond to SASP therapy. KEY WORDS: Sulphasalazine, Clostridium perfringens, Response