OBJECTIVE: To investigate the frequency of gut inflammation in the ankylosing spondylitis and the role of gut lesion in the pathogenesis of the ankylosing spondylitis. METHODS: Ileocolonoscopy and biopsy were performed in 24 patients with. ankylosing spondylitis. RESULTS: 1) Endoscopic lesions were observed in 7 patients(29.2%) of 24 patients and more often in the terminal ileum(6/7) than in the colon(I/7). Among 7 patients with endoscopic lesions, 5 patients were presented as juvenile chronic arthritis. 2) Histologic signs of gut inflammation were detected in 14 patients(58. 3%). Actue lesions were seen in 2 patients (8. 3%) and chronic lesions were seen in 12 patients (50%). 3) In 12 patients without the involvement of peripheral joints, acute lesion was not seen(0%), and chronic lesions were seen in 6 patients(50%). In 12 patients with the involvement of peripheral joints, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 6 patients(50%). Gut inflammations were more frequent in patients with the involvement of peripheral joints than in those without the involvement of peripheral joints. 4) In 12 patients without the administration of sulfasalazine, acute lesion was not seen(0%), and chronic lesions were seen in 7 patients(58.7%) In 12 patients with the administration of sulfasalazine, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 5 patients(41.6%). The frequency of gut lesions in patients without the administration of sulfasalazine was not different from that in patients with the administration. of sulfasalazine (p<0.05). CONCLUSION: Gut inflammation was frequently found in patients with ankylosing spondylitis. Chronic gut inflammation could play a role in the pathogenesis of the ankylosing spondylitis.
Arthritis, Juvenile ; Biopsy ; Humans ; Inflammation ; Joints ; Spondylitis, Ankylosing* ; Sulfasalazine

Collagenous colitis is an uncommon condition charaeterized clinically by diarrhea and weight loss and histologically by thickening of the subepithelial collagen band with chromic inflammation. Laboratory tests of blood, urine and stool, and colonscopic findings are usually normal. The etiology of collagenous colitis is unknown. We report a case of collagenous colitis improved after treatment with sulfasalazine with review of literatures.
Colitis, Collagenous* ; Collagen* ; Diarrhea ; Inflammation ; Sulfasalazine ; Weight Loss

Sulfasalazine produces a varied spectrum of adverse reactions on the hematopoietic system. Sulfasalazine-induced megaloblastic anemia is very rare and a few cases have been reported in patients with inflammatory bowel disease. Most of them show a low serum folate level. The pathogenesis is known as folate deficiency by intestinal folate malabsorption, inhibition of folate enzyme, or hemolysis. We experienced a 43-year old female with Behcet's disease, who presented with megaloblastic anemia having normal serum folate level after treatement of sulfasalazine (2 g/day for 3 months). Megaloblastic anemia recovered after withdrawal of the drug only.
Adult ; Anemia, Megaloblastic* ; Female ; Folic Acid* ; Hematopoietic System ; Hemolysis ; Humans ; Inflammatory Bowel Diseases ; Megaloblasts* ; Sulfasalazine

Leflunomide is a novel, isoxazol based disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Its mechanism differs from other DMARDs in that it inhibits de novo pyrimidine synthesis by inhibiting the enzyme dihydroorotate dehydrogenase (DHODH). It is a pro-drug and undergoes rapid conversion to its active form in vivo, A77-1726. A77-1726 inhibits the mitochondrial enzyme DHODH, which plays a key role in the de novo synthesis of pyrimidine ribonucleotide uridine monophosphate (rUMP). Leflunomide prevents clonal expansion of activated lymphocytes by interfering with the cell cycle progression due to inadequate production of rUMP and utilizing mechanisms involving p53. The relative lack of toxicity of A77-1726 on non-lymphoid cells may be due to the ability of these cells to fulfill their ribonucleotide requirements by use of salvage pyrimidine pathway, which makes them less dependent on de novo synthesis. Several phase II clinical trials of patients with RA revealed that leflunomide was effective and well tolerated. Large-scale phase III clinical trials have shown that leflunomide (20mg/day) provided a statistically significant clinical benefit and prevention of radiographic progression in comparison to placebo. The clinical benefits of leflunomide were similar to or greater than methotrexate and sulfasalazine. Now, many multi-national studies are in progress and planning, including combination therapy with other DMARD. In future, those studies will provide us more information about the effectiveness and potential adverse effect of leflunomide.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Cell Cycle ; Humans ; Lymphocytes ; Methotrexate ; Oxidoreductases ; Sulfasalazine ; Uridine Monophosphate

Leflunomide is a novel, isoxazol based disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Its mechanism differs from other DMARDs in that it inhibits de novo pyrimidine synthesis by inhibiting the enzyme dihydroorotate dehydrogenase (DHODH). It is a pro-drug and undergoes rapid conversion to its active form in vivo, A77-1726. A77-1726 inhibits the mitochondrial enzyme DHODH, which plays a key role in the de novo synthesis of pyrimidine ribonucleotide uridine monophosphate (rUMP). Leflunomide prevents clonal expansion of activated lymphocytes by interfering with the cell cycle progression due to inadequate production of rUMP and utilizing mechanisms involving p53. The relative lack of toxicity of A77-1726 on non-lymphoid cells may be due to the ability of these cells to fulfill their ribonucleotide requirements by use of salvage pyrimidine pathway, which makes them less dependent on de novo synthesis. Several phase II clinical trials of patients with RA revealed that leflunomide was effective and well tolerated. Large-scale phase III clinical trials have shown that leflunomide (20mg/day) provided a statistically significant clinical benefit and prevention of radiographic progression in comparison to placebo. The clinical benefits of leflunomide were similar to or greater than methotrexate and sulfasalazine. Now, many multi-national studies are in progress and planning, including combination therapy with other DMARD. In future, those studies will provide us more information about the effectiveness and potential adverse effect of leflunomide.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Cell Cycle ; Humans ; Lymphocytes ; Methotrexate ; Oxidoreductases ; Sulfasalazine ; Uridine Monophosphate

A 50-year-old woman presented with a 4-day history of apathy, perseveration, and confusion. These symptoms appeared 16 days after she had started taking sulfasalazine for rheumatoid arthritis. Brain MRI showed bilateral symmetrical discoid lesions involving the corona radiata. She fully recovered 7 days after stopping the medications. Follow-up brain MRI revealed remarkable improvement of the lesions. The pathomechanisms related to sulfasalazine-induced leukoencephalopathy may be demyelinating processes due to impaired T-cell-mediated immunity.
Apathy ; Arthritis, Rheumatoid ; Brain ; Female ; Follow-Up Studies ; Humans ; Leukoencephalopathies ; Middle Aged ; Sulfasalazine

PURPOSE: To seek the role of nuclear factor kappa B (NF-kB) on the corneal epithelial cell death after ultraviolet (UV) irradiation. METHODS: Human corneal epithelial cells transfected by Simian Virus 40 were used in this study. UVB(312 nm) located at 10cm distance from bottom (0.6 mW/cm2 ) was irradiated for 10, 20, 30, and 40 seconds. To measure the cytotoxicity, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) method was used. Translocation of NF-KB was examined by immunocytochemistry with anti NF-K B p65 antibody and Electrophoretic Mobility Shift Assay (EMSA). To confirm the role of NF-KB , sulfasalazine, a specific inhibitor of NF-KB (0.5 mmole), was pretreated for 30 minutes before irradiatrion, and cytotoxicity and translocation of NF-KB was evaluated. RESULTS: UV irradiation resulted in a significant decrease in viability of cultured human corneal epithelial cells, especially after 20 second duration. When HCECs were irradiated with UVB, the translocation of N F -KB was observed in immunocytochemistry. These translocation was peaked 2 hours after UV irradiation in EMSA. In HCECs pretreated with sulfasalazine, either the cellular death or the translocation of NF-KB was blocked. CONCLUSION: UV irradiation can translocate NF-KB on the cultured human corneal epithelial cells. The cellular death after UV irradiation was blocked by sulfasalazine, a potent inhibitor of translocation of NF-KB. These findings suggest that NF-KB plays an important role in cellular death after UV irradiation.
Electrophoretic Mobility Shift Assay ; Epithelial Cells* ; Humans ; Immunohistochemistry ; NF-kappa B ; Simian virus 40 ; Sulfasalazine

Nonspecific ulcer of the small bowel is rare in children. Nonspecific ulcer of the colon or small bowel is clinically and pathologically recognized as a disease related to intestinal Behcet's disease. Differentiation of nonspecific ulcers from Behcet's ulcer by pathologic findings is often impossible and the clinical course is similar. A 13-year-old boy was admitted due to massive lower gastrointestinal bleeding with an intractable tongue ulcer. Colonoscopic findings revealed a well demarcated deep ulcer on the terminal ileum. The patient was treated with steroids and sulfasalazine and the response was favorable. We report a case of nonspecific ulcer of terminal ileum with massive rectal bleeding in a 13-year-old boy.
Adolescent ; Child ; Colon ; Hemorrhage* ; Humans ; Ileum* ; Male ; Steroids ; Sulfasalazine ; Tongue ; Ulcer*

Human immunodeficiency virus (HIV) infection is a global pandemic affecting more than 2.9 million people. Aside from opportunistic infections and malignancies, it involves multiple organs, resulting in many complications, and frequently shows various rheumatic manifestations. With improving survival of patients due to the development of highly active anti-retroviral therapy, the number of HIV-infected patients with rheumatic complications is certain to increase. However, reports on HIV induced rheumatic manifestations in Korean patients are limited. On the other hand, spondyloarthropathy is the most common form of inflammatory arthropathy in HIV associated rheumatic manifestations and is frequently accompanied by peripheral arthritis and enthesitis, while axial skeletal involvement is a rare presentation. Herein we report on a 46-year-old man with HIV infection presenting with an axial spondyloarthropathy who was treated successfully with nonsteroidal anti-inflammatory drug, sulfasalazine, and low dose steroid.
Arthritis ; Hand ; HIV Infections ; HIV* ; Humans ; Humans* ; Middle Aged ; Opportunistic Infections ; Pandemics ; Rheumatic Diseases ; Spondylarthropathies* ; Sulfasalazine

The goals of treatment in Spondyloarthropathy are to reduce pain and stiffness, and to maintain good quality of life. Regular exercise with stretching of axial skeleton is most important. No drugs have been prevented ankylosis, but non steroidal anti inflammatory drugs (NSAIDs) are the first line drugs and these are very effective in most of patients who have inflammatory back pain. In recent years, reports that long-term use of NSAIDs may reduce the ankylosis are coming out and expect NSAIDs as anti ankylosis drugs. If NSAIDs is not effective, anti TNF agents can be used in severe inflammatory back pain. In peripheral arthritis, sulfasalazine or steoids can be used, and If these are failed, anti TNF agents can be used.
Ankylosis ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Back Pain ; Humans ; Quality of Life ; Skeleton ; Spondylarthropathies ; Steroids ; Sulfasalazine