Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study

Arthritis Rheum. 1996 Aug;39(8):1400-5. doi: 10.1002/art.1780390819.


Objective: To compare the efficacy of sulfasalazine (SSZ) with its two moieties, 5-aminosalicylic acid (ASA) and sulfapyridine (SP), in patients with active ankylosing spondylitis (AS).

Methods: A 26-week randomized, observer-blinded, 2-center, controlled study of treatment with either SSZ, ASA, or SP was conducted in 90 patients with active AS. Patients were evaluated at baseline and at monthly intervals, using several clinical and laboratory measures of disease activity. A global assessment of treatment efficacy was made by both patients and observers at the end of the study period.

Results: There were no significant changes in any of the parameters of disease activity in the ASA treatment group. Levels of serum IgG, IgA, and IgM fell significantly during treatment with SP, but none of the other changes reached statistical significance. Plasma viscosity and IgG and IgA levels fell significantly during treatment with SSZ, as did nocturnal spinal pain and overall spinal pain. Patients and observers reported a favorable outcome after treatment with SSZ or SP significantly more often than with ASA treatment.

Conclusion: SP appears to be the active moiety in AS, although there was a trend suggesting a better outcome in the SSZ group compared with the SP group, perhaps suggesting the importance of a common sulfonamide structure for efficacy.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aminosalicylic Acids / pharmacology
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology
  • Binding Sites
  • Dermatologic Agents / pharmacology
  • Female
  • Humans
  • Male
  • Mesalamine
  • Middle Aged
  • Pain / drug therapy
  • Single-Blind Method
  • Spondylitis, Ankylosing / drug therapy*
  • Sulfapyridine / pharmacology
  • Sulfasalazine / chemistry*
  • Sulfasalazine / pharmacology*


  • Aminosalicylic Acids
  • Anti-Inflammatory Agents, Non-Steroidal
  • Dermatologic Agents
  • Sulfasalazine
  • Mesalamine
  • Sulfapyridine