Sulfasalazine in the treatment of axial spondyloarthritis: A narrative review
Main Article Content
Keywords
spondyloarthriti, ankylosing spondylitis, sulfasalazine
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory di- sease associated with a substantial functional and socioeconomic burden. Before the availability of biologic therapies and Janus kinase inhibitors, sulfasalazine (SSZ) played a relevant role in its treatment. The aim of this narrative review was to synthesize the available evidence on the use of SSZ in axSpA, including mecha- nisms of action, axial and peripheral clinical efficacy, extra-skeletal manifestations, and safety. Clinical trials, observational studies, systematic reviews, clinical guidelines, and mechanistic literature were reviewed. The evidence shows that SSZ exerts systemic immunomodulatory effects and influences the gut-joint axis; how- ever, its impact on axial inflammation and structural progression is limited. The most consistent benefits are observed in peripheral arthritis and inflammatory parameters, whereas imaging studies do not demonstrate clinically meaningful efficacy in established axial disease. Signals of modest benefit have been reported in early axSpA subgroups. SSZ reduces the recurrence of anterior uveitis and has a generally acceptable safety profile, including use during pregnancy and lactation. Overall, SSZ does not replace targeted therapies for axial disease control but retains a specific role in peripheral manifestations and ocular involvement.
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