Abstract

Non-steroidal anti-inflammatory drugs and biologic therapy are recognized as standard treatments for ankylosing spondylitis. However, in developing countries like Turkey, the cost of biological treatments can escalate to significant levels. Our study aims to assess the effectiveness of sulfasalazine in axial symptoms, typically considered a secondary treatment in ankylosing spondylitis. We conducted a retrospective analysis of the medical records of patients diagnosed with ankylosing spondylitis. These patients were prescribed sulfasalazine due to the persistence of axial symptoms. After a 3 mo course of sulfasalazine treatment, patients were assessed for changes in sediment and C-reactive protein values, ankylosing spondylitis disease activity score-sedimentation rate and ankylosing spondylitis disease activity score-C-reactive protein values, visual analog scale, bath ankylosing spondylitis disease activity index, and bath ankylosing spondylitis functional index results and morning stiffness durations. In this study, conducted with sulfasalazine treatment, significant improvements were observed across multiple parameters. Morning stiffness duration decreased in 22 patients. Median C-reactive protein levels decreased from 9.99 mg/l (range: 2-53, interquartile range: 12.21) to 6.81 mg/l (range: 1-18, interquartile range: 8.16). Similarly, the median ESR reduced from 20.53 mm/h (range: 4-48, interquartile range: 15.47) to 12.81 mm/h (range: 2-33, interquartile range: 10.57). Ankylosing spondylitis disease activity score-C-reactive protein scores improved from 3.62±0.732 to 2.67±0.93, and ankylosing spondylitis disease activity score-ESR scores improved from 3.54±0.66 to 2.57±0.80. Moreover, patients reported lower visual analogue scale scores, decreasing from 7.39±1.44 to 5.58±1.97. The global disease evaluation by doctors showed a decrease from an average score of 6.33±1.47 (range: 4-10) to 5.11±1.68 (range: 2-8). Ankylosing spondylitis quality of life questionnaire scores improved from 7.92±2.41 to 5.36±2.73. Bath ankylosing spondylitis disease activity index scores decreased from 6.31±1.70 to 4.37±1.76, and bath ankylosing spondylitis functional index scores improved from 3.76±1.98 to 2.79±1.63. These improvements were statistically significant across all measured parameters before and after sulfasalazine treatment (p<0.05). In developing countries like ours, where access to biological drugs which derived from living organisms, can be challenging for economically disadvantaged individuals with limited socioeconomic resources, and where the probability of inducing side effects such as infections, an elevated risk of cancer, and neurological diseases is a concern, sulfasalazine could be considered a more affordable and relatively safer option before resorting to biological treatments for managing ankylosing spondylitis.