[Salazopyrine in the treatment of rheumatoid arthritis].

In several reports (1941a, b, 1942, 1944, 1948) published during recent years Professor Nanna Svartz has -claimed good results in the treatment of rheumatic polyarthritis from the use of a sulphapyridine compound. The drug, which has been given the name salazopyrin, is obtained by the chemical combination of salicylic acid and sulphapyridine and has the formula 4-/pyridyl (2) amido sulphonyl/-3'-Carbody-4'-oxyazobenzene. It is claimed that the drug has a specific affinity for connective tissue, where subsequent disintegration gives rise to amino-salicylic acid and sulphapyridine. Svartz (1948) believes that the essential lesion in rheumatic disease is located in connective tissue and is inflammatory in nature. On this basis she argues that drugs with an affinity for connective tissue are most likely to be of value in treatment. The value of salicylates in ameliorating the symptoms of rheumatic fever is accepted. Unless organisms are present in the inflamed connective tissue, the desirability of attaining a high local concentration of sulphapyridine is more in doubt. Few observers believe that there is such a disseznination of bacteria in rheumatic fever or in rheumatoid arthritis. The initial dosage recommended by Svartz was 6 g. in twenty-four hours. This was reduced to 1 to 1g. daily as the condition improved. In chronic rheumatoid arthritis she advocates the use of the drug over a long period. Some of her patients have consumed 5,000 to 6,000 J-g. tablets in one to two years. Toxic effects are said to be relatively rare, the commonest being fever, skin rashes, nausea, and vomiting. These symptoms subside quickly when the drug is withdrawn. Svartz divided her cases into acute and chronic rheumatic polyarthritis, and claimed that benefit was obtained in both instances. This classification makes it difficult to assess her results. For the chronic group she also uses the term " chronic rheumatoid arthritis " so the effects of the drug in this group will be considered in more detail.