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Sulfasalazine for treating rheumatoid arthritis

Sulfasalazine has become a common second line drug (DMARD) for the treatment of rheumatoid arthritis (RA).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Sulfasalazine for ankylosing spondylitis

We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. Our findings are summarised below.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Leflunomide for the treatment of rheumatoid arthritis

‐ Leflunomide probably improves pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for treating psoriatic arthritis

It has been estimated that arthritis occurs in 5‐7 % of those with psoriasis, which can cause substantial disability in some patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Curcumin for maintenance of remission in ulcerative colitis

Curcumin is a natural anti‐inflammatory agent that is often used in many chronic inflammatory conditions including rheumatoid arthritis, esophagitis and post‐surgical inflammation. The purpose of this systematic review was to examine the effectiveness and safety of curcumin therapy for the maintenance of remission in patients with ulcerative colitis (UC), a chronic inflammatory condition of the colon. Currently available agents for the management of this condition have been reported to result side effects, particularly when used for prolonged periods. This review includes one randomized trial with a total of 89 participants. All patients received treatment with sulfasalazine or mesalamine (drugs containing 5‐aminosalicylic acid). Fewer patients in the curcumin group relapsed at six months compared to patients who received placebo (e.g. fake drug). However, this result was not statistically significant. Patients in the curcumin group had significantly lower disease activity index and endoscopic index scores at six months than patients in the placebo group. No serious side effects were reported. A total of nine mild side effects were reported in seven patients. These side effects included a sensation of abdominal bulging, nausea, a brief increase in blood pressure, and a brief increase in the number of stools. The results of this systematic review suggest that curcumin may be a safe and effective therapy for maintenance of remission in ulcerative colitis when given as additional therapy with mesalamine or sulfasalazine. Further research is needed to confirm any possible benefit of curcumin for maintenance therapy in ulcerative colitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Azathioprine and 6‐mercaptopurine for maintenance of remission in ulcerative colitis

Studies of azathioprine and 6‐mercaptopurine for maintenance treatment of ulcerative colitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐aminosalicylic acid for the treatment of active ulcerative colitis

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 53 randomized trials with a total of 8548 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug). Although oral 5‐ASA drugs are effective for treating active ulcerative colitis, they are no more effective than SASP therapy. Patients taking 5‐ASA are less likely to experience side effects than patients taking SASP. Side effects associated with 5‐ASA are generally mild in nature, and common side effects include gastrointestinal symptoms (e.g. flatulence, abdominal pain, nausea, and diarrhea), headache and worsening ulcerative colitis. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA compounds are more expensive than SASP, so SASP may be the preferred option where cost is an important factor. 5‐ASA dosed once daily appears to be as effective and safe as conventionally dosed (two or three times daily) 5‐ASA. There do not appear to be any differences in effectiveness or safety among the various 5‐ASA formulations. A daily dosage of 2.4 g appears to be a safe and effective therapy for patients with mild to moderately active ulcerative colitis. Patients with moderate disease may benefit from an initial dose of 4.8 g/day.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐aminosalicylic acid drugs for maintenance of medically‐induced remission in Crohn's disease

Crohn's disease is a chronic inflammatory disorder that can involve any part of the gastrointestinal tract. It can affect people of any age. When people have active Crohn's disease they experience symptoms such as abdominal pain, diarrhoea and weight loss. When symptoms stop, people are considered to be in remission. Active Crohn's disease can be treated by medical therapy (e.g. drugs such as steroids, immunosuppressives or biologics) or by surgery to removed the diseased portions of the intestine. The goal of medical therapy of Crohn's disease is to induce remission and to maintain this remission for as long as possible.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Aminosalicylates for treatment of active Crohn's disease

Crohn's disease is a chronic inflammatory disease of the intestines. Although Crohn's disease is often found in the ileum (the lower part of the small intestine), it can occur in any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are diarrhea and abdominal pain which often occurs in the lower right region of the abdomen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐ASA compounds for maintaining remission in ulcerative colitis

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 41 randomized trials with a total of 8928 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug) for maintaining remission. Although oral 5‐ASA preparations are effective for maintaining remission in ulcerative colitis, they are no more effective than sulfasalazine (SASP) therapy. People who have become well can remain so by continuing to take either medication. There is no evidence that side effects are more frequent with one or the other medication. However, the side effects of 5‐ASA may be notably less than those associated with SASP therapy. Common side effects associated with 5‐ASA included flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia (indigestion), and nasopharyngitis (inflammation of the nasal passages). Most of the trials comparing 5‐ASA with SASP enrolled patients who were known to tolerate SASP. This may have reduced SASP‐related side effects in these trials. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA therapy is more expensive than SASP, so SASP may be the preferred option where cost is an important factor. Oral 5‐ASA administered once daily is as effective and safe as conventional dosing (two or three times daily) for maintaining remission in ulcerative colitis. There does not appear to be any difference in efficacy or safety between the various formulations of 5‐ASA. Patients with extensive ulcerative colitis or with frequent relapses may benefit from a higher dose of maintenance therapy. High dose therapy appears to be as safe as low dose and is not associated with a higher incidence of side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Medicines for Rheumatoid Arthritis: A Review of the Research for Adults

This summary will tell you about two types of medicine to treat RA: DMARDs and corticosteroids. It will explain what research has found about how well DMARDs work when taken alone or with corticosteroids to treat RA. It will also tell you what research says about the side effects of these medicines. You can use this summary to talk with your doctor about whether one of these medicines may be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 20, 2012

Medication for the treatment of rheumatoid arthritis

People with rheumatoid arthritis typically have permanent inflammation in several joints. The joints are painful and swollen, and gradually stiffen. Rheumatoid arthritis usually progresses slowly over many years. The aim of treatment with medication is to relieve the symptoms and prevent the progression of the disease as much as possible.In rheumatoid arthritis, various kinds of medication are used to relieve the symptoms, reduce the inflammation and to keep the joints working properly for as long as possible. There are two types of therapy: disease-modifying therapy and symptomatic therapy.Disease-modifying therapy: These medications are taken regularly for longer periods of time independent of any acute symptoms. They are known as “disease-modifying anti-rheumatic drugs” or “DMARDs” for short. Disease-modifying drugs inhibit inflammatory responses in the joints of people with rheumatoid arthritis. In this way they can at best stop – or at least delay – the progression of the disease, preventing damage to the joints. Their effect is often only noticeable after one to four months of treatment. DMARDs can be divided up into “conventional” and “biological” disease-modifying drugs.Symptomatic therapy: Medications used in symptomatic therapy are taken to relieve acute pain and inflammation. The main ones are non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (also called paracetamol), and steroids (corticosteroids).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 27, 2016

Azathioprine or 6‐mercaptopurine for the treatment of active Crohn's disease

Azathioprine and 6‐mercaptopurine are immunosuppressive drugs that are thought to reduce inflammation by blocking the immune system. This review includes 13 randomized trials with a total of 1211 participants. Azathioprine and 6‐mercaptopurine were found to be no more effective than placebo (fake medicine) for inducing remission in Crohn's disease. There is evidence to suggest that the combination of azathioprine and infliximab is superior to infliximab used as a single drug for induction of steroid‐free remission in active Crohn's disease. Tumor necrosis factor (TNF) alpha blocking drugs like infliximab may provide an alternative treatment for patients who do not respond to corticosteroid or immunosuppressive drug treatment. Azathioprine and 6‐mercaptopurine may reduce the need for steroid treatment and their use may therefore lead to a lower incidence of steroid related side effects. However, these drugs are slow acting and are associated with some rare, but serious side effects. In some patients they suppress formation of blood cells that fight off infection and allow blood to clot and they occasionally cause inflammation of the pancreas. These drugs have also been associated with an increased risk of lymphoma. For these reasons careful consideration needs to be given to the use of these drugs in patients with active Crohn's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Methotrexate for keeping ulcerative colitis inactive   

We reviewed the evidence about the effects and safety of methotrexate for maintaining remission in patients with ulcerative colitis, with the medical literature up to June 26, 2014.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Methotrexate alone or in combination with other medications for rheumatoid arthritis

‐The combination of methotrexate + sulfasalazine + hydroxychloroquine and methotrexate + most biologic DMARDs improves disease activity. Other treatment combinations (methotrexate + hydroxychloroquine, methotrexate + leflunomide, methotrexate + gold injections) may improve disease activity in people who do not respond to methotrexate alone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Azathioprine or 6‐mercaptopurine for maintenance of remission in Crohn's disease

Crohn's disease is a long‐term chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus. Symptoms include abdominal pain, diarrhea and weight loss. When people with Crohn's disease are experiencing symptoms of the disease it is said to be ‘active’. Periods when the symptoms stop are called ‘remission’.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Combining two or more drugs vs one drug for pain control in inflammatory arthritis

This summary of a Cochrane review presents what we know from research about the effect of a combination of two pain relieving drugs for pain control in inflammatory arthritis (IA).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Probiotics for the treatment of active ulcerative colitis

Ulcerative colitis (UC) is a common condition resulting in inflammation of the colon. Current treatments for this condition result in side effects in a significant proportion of patients and consequently alternative treatments are being sought. Probiotics are live microorganisms which have been used to treat other inflammatory conditions such as gastroenteritis and pouchitis. This review investigated the evidence for the use of probiotics for the treatment of active UC. The current research suggests that conventional treatment combined with probiotic therapy does not provide any additional benefit over conventional treatment alone in patients with mild to moderate ulcerative colitis. There is limited evidence that probiotics may reduce disease activity. However there is not enough evidence to recommend the use of probiotics for the treatment of active UC. Larger, well designed randomised controlled trials are needed to determine whether probiotics are of benefit for the treatment of active UC.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Corticosteroids for induction of remission in Crohn's disease

Corticosteroids have been used for decades to treat active Crohn's disease. Controlled clinical studies that evaluated the effect of systemic corticosteroids to induce remission in Crohn's disease were reviewed. For inclusion in this analysis, studies could compare any form of corticosteroid that is systemically absorbed (e.g. prednisone, prednisolone, 6‐methylprednisolone or hydrocortisone) to either placebo (fake medicine) or 5‐aminosalicylates (e.g. mesalazine, mesalamine or sulfasalazine). Corticosteroids were found to be more effective than either placebo or 5‐aminosalicylates at inducing remission in Crohn's disease. Although corticosteroids caused side effects more often in patients compared with placebo and 5‐aminosalicylates, these side effects were not serious enough to cause withdrawal from the studies reviewed. In summary, corticosteroids are effective at inducing remission in patients with Crohn's disease. While they cause frequent side effects, these side effects were relatively minor in the reviewed studies, some of which followed patients for up to 24 weeks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Cyclophosphamide for treating rheumatoid arthritis

This review included 31 patients taking cyclophosphamide and 39 patients taking placebo. Patients taking cyclophosphamide had improved tender and swollen joint scores. Patients receiving placebo were six times more likely to discontinue treatment because of lack of treatment effect than patients receiving cyclophosphamide. Withdrawals from adverse reactions were higher in the cyclophosphamide group. Side effects from cyclophosphamide included hemorrhagic cystitis, nausea, vomiting, leucopenia, thrombocytopenia, alopecia, amenorrhea and herpes zoster infections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

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