Lichen Planus Helped: Lichen planus (LP) is a disturbing pruritic cutaneous disease that may have an spontaneous resolution or exhibit a more chronic course during some weeks or months. 20 patients were treated with sulfasalzine at initial doses of 1.5 g/day, increasing by 0.5 g/week to 3 g/day for 4-16 weeks. Some patients also received descendent doses for 2-12 months. Complete responses were observed in 13 patients and partial responses in seven patients. All patients reported an early resolution of the pruritus. No changes were detected in mucosal LP. Most of the patients tolerated the treatment well and only eight patients presented some minor side-effects. Successful treatment of lichen planus with sulfasalazine in 20 patients. Bauza A, Espana A, et al. University Clinic of Navarra, Pamplona, Spain. Int J Dermatol. 2005 Feb;44(2):158-62.

Crohn's: 5-ASA No Help in Remission: In a review of the 6 DB PC studies found where participants were followed up for 12 months, the odds of relapse while on 5-ASA products was no different from placebo (OR=1.00). For the seventh study where follow up was for 24 months, the odds ratio was 0.98. In further sensitivity analyses, we analysed only participants who completed the study and ignored the dropouts. The odds ratio (fixed effects model) for the 6 studies where follow up was for 12 months was 0.74, but using the random effects model, the OR was 0.68. The OR for the seventh study where follow up was for 24 months (Gendre 1993a), was 0.86. The authors found no evidence to suggest that 5-ASA preparations are superior to placebo for the maintenance of medically-induced remission in patients with Crohn's disease. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn's Disease. Akobeng AK, Gardener E. Manchester, UK. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003715.

Rheumatoid Arthritis Helped Most by Prednisolone-sulfasalazine-methotrexate Combination: In the 56-week COBRA study of patients with early rheumatoid arthritis (RA), prednisolone, methotrexate, and sulfasalazine tapered after 28 weeks) added additional disease control (improvements in disease activity, physical function, and rate of damage progression) at lower or equal cost compared to SSZ alone. Indirect and total costs of early rheumatoid arthritis: a randomized comparison of combined step-down prednisolone, methotrexate, and sulfasalazine with sulfasalazine alone. Korthals-de Bos I, Van Tulder M, et al VU University Medical Center, Amsterdam, The Netherlands. J Rheumatol. 2004 Sep;31(9):1709-16; Also, aggressive initial treatment of 195 early RA patients with the combination of 3 methotrexate, hydro, and sulfasalazine for the first 2 years limited the peripheral joint damage for at least 5 years vs. sulfasalazine alone. Arthritis Rheum. 2004 Jul;50(7):2072-81.

Folic Acid Supplement Needed: Evidence for cellular folate depletion was obtained by the demonstration of an SSZ dose-dependent decrease in leucovorin accumulation. This decreased the effectiveness of methotrexate, building the case for folate supplementation. Arthritis Rheum. 2004 Jul;50(7):2130-9.

Neuroprotective Effects Through NMDA Blockade: Besides anti-inflammatory actions such as blockade of nuclear factor-kappaB and cyclooxygenases, we found that 30 to 1000 micro M sulfasalazine dose dependently blocked N-methyl-D-aspartate receptor-mediated excitotoxicity without intervening kainate or alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid neurotoxicity. The neuroprotective effects of sulfasalazine were attributable to prevention of Ca(2+) influx and accumulation through N-methyl-D-aspartate receptors as a low-affinity antagonist. The systemic administration of sulfasalazine reduced neuronal death following transient cerebral and retinal ischemia in adult rat. Ryu, et al. Ajou University. Korea. J Pharmacol Exp Ther. 2003 Apr;305(1):48-56.

Renal Disease Rarely Caused by 5-ASA: Among the 19,025 5-ASA users with IBD, 130 patients developed renal disease (0.17 cases per 100 patients per year). The incidence among patients with IBD but without 5-ASA use was 0.25 and among patients without IBD was 0.08. In the case-control analysis, the crude odds ratio (OR) for renal disease in current 5-ASA users was 1.60, but the adjusted OR was 0.86. For recent users, the crude OR was 4.18 and adjusted OR 2.48 ; for past users (last prescription more than 12 months before), 1.71 and 0.99 , respectively. Although the numbers were small, mesalazine and sulfasalazine users had comparable risks. In only a few records was renal disease attributed to interstitial nephritis or 5-ASA use. 5-aminosalicylic acids and the risk of renal disease: a large British epidemiologic study. Van Staa TP, Travis S, et al. University of Utrecht, Germany. Gastroenterology. 2004 Jun;126(7):1733-9.

Stevens-Johnson's Case: Photo-induced Stevens-Johnson syndrome due to sulfasalazine therapy. Borras-Blasco J, et al. Spain. Ann Pharmacother. 2003 Sep;37(9):1241-3.

Sulfide Production Inhibited: The toxic, bacterial metabolite sulfide is implicated in ulcerative colitis. Ulcerative colitis patients taking 5-aminosalicylic acid-containing drugs have lower fecal sulfide levels than those not taking these drugs. This study showed a decrease in production by bacterial cultures due to 5-ASA compounds. Inflamm Bowel Dis. 2003 Jan;9(1):10-7.