Does Sulfasalazine Still Have Therapeutic Value in the Treatment of Axial Spondyloarthritis? A Real-World Cohort Study From China.

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-08-18 DOI:10.1111/jebm.70055

Jiaxin Zhang, Xiaojian Ji, Lidong Hu, Yiwen Wang, Simin Liao, Jiawen Hu, Yinan Zhang, Lulu Zeng, Shiwei Yang, Jian Zhu, Feng Huang

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引用次数: 0

Abstract

Objective: The efficacy of sulfasalazine (SSZ) in axial spondyloarthritis (ax-SpA) patients meeting both 2009 ax-SpA and 2011 peripheral SpA (p-SpA) criteria is unclear. This study aimed to assess SSZ's clinical efficacy in pure ax-SpA and overlapping ax-SpA patients and to identify factors influencing peripheral symptom development.

Methods: SpA patients from 2016 to 2023 at the First Medical Center of People's Liberation Army General Hospital were categorized into pure ax-SpA and ax-SpA with peripheral features. They received nonsteroidal anti-inflammatory drugs (NSAIDs) alone or with SSZ. The study evaluated SSZ's efficacy, peripheral symptom timing and prevalence, and factors affecting symptom onset using Cox regression.

Results: Of 670 SpA patients, 469 maintained pure axial involvement throughout follow-up, while 201 developed peripheral symptoms during follow-up. had pure ax-SpA. The SSZ plus NSAIDs group demonstrated significantly lower Axial Spondyloarthritis Disease Activity Score than NSAIDs-only in both pure axial (1.2 vs. 1.8; p = 0.015) and axial-with-peripheral subgroups (1.1 vs. 1.8; p = 0.011). New peripheral symptoms occurred in 33.2% of the NSAIDs group and 15.1% of the SSZ plus NSAIDs group. SSZ reduced the risk of peripheral symptom development (hazard ratio [HR] = 0.489, p = 0.0028). In the Cox proportional hazards model adjusted for age, sex, smoking status, body mass index, and Human Leukocyte Antigen B27 status, male gender (HR = 0.64, p = 0.020) and SSZ use (HR = 0.47, p = 0.004) emerged as protective factors, whereas smoking significantly increased risk (HR = 1.97, p < 0.001).

Conclusions: SSZ reduces disease activity, improves quality of life among ax-SpA patients, reduces the incidence of peripheral symptoms, and delays their onset. About one-third of ax-SpA patients develop peripheral symptoms over time, which are associated with poorer functional status and quality of life. Smoking increases this risk, while male gender and SSZ use offer protection.

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柳氮磺胺吡啶治疗中轴性脊柱炎还有治疗价值吗？一项来自中国的真实世界队列研究。

目的：磺胺吡啶（SSZ）治疗满足2009年ax-SpA和2011年外周血SpA （p-SpA）标准的中轴型脊柱炎（ax-SpA）患者的疗效尚不清楚。本研究旨在评估SSZ在纯ax-SpA和重叠ax-SpA患者中的临床疗效，并确定影响周围症状发展的因素。方法：2016 - 2023年解放军总医院第一医疗中心SpA患者分为纯ax-SpA和具有外周特征的ax-SpA患者。他们单独或与SSZ联合使用非甾体抗炎药（NSAIDs）。采用Cox回归法评估SSZ的疗效、外周症状发生时间和患病率以及影响症状发生的因素。结果：670例SpA患者中，469例在随访期间保持单纯轴向受累，201例在随访期间出现外周症状。有纯ax-SpA。SSZ加非甾体抗炎药组在纯轴向亚组（1.2 vs 1.8, p = 0.015）和轴向伴外周亚组（1.1 vs 1.8, p = 0.011）中均比仅使用非甾体抗炎药组表现出更低的轴向脊椎炎疾病活动评分。非甾体抗炎药组出现新外周症状的比例为33.2%，SSZ加非甾体抗炎药组为15.1%。SSZ降低了周围症状发展的风险（风险比[HR] = 0.489, p = 0.0028）。在校正了年龄、性别、吸烟状况、体重指数和人白细胞抗原B27状况的Cox比例风险模型中，男性（HR = 0.64, p = 0.020）和SSZ使用（HR = 0.47, p = 0.004）成为保护因素，而吸烟显著增加风险（HR = 1.97, p < 0.001）。结论：SSZ降低了ax-SpA患者的疾病活动性，改善了患者的生活质量，降低了外周症状的发生率，并延缓了患者的发病。随着时间的推移，大约三分之一的ax-SpA患者会出现外周症状，这与较差的功能状态和生活质量有关。吸烟增加了这种风险，而男性和使用SSZ则提供了保护。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.