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Fry L. Fine points in the management of dermatitis herpetiformis. SEMINARS IN DERMATOLOGY 1988; 7:206-11. [PMID: 3153446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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27
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Kettler AH, Bean SF, Duffy JO, Gammon WR. Systemic lupus erythematosus presenting as a bullous eruption in a child. ARCHIVES OF DERMATOLOGY 1988; 124:1083-7. [PMID: 3291780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An 8-year-old girl presented with a generalized bullous eruption clinically resembling bullous pemphigoid or chronic bullous disease of childhood. Further study revealed immunopathologic findings seen in patients with epidermolysis bullosa acquisita or bullous systemic lupus erythematosus (SLE). Although she did not fulfill the American Rheumatism Association (Atlanta) criteria for SLE at her presentation, one year later she went on to do so. As well as being the youngest patient reported with bullous SLE, our patient is noteworthy because the bullous eruption was the initial manifestation of her SLE. Bullous SLE should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.
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Astbury C, Hill J, Bird HA. Co-trimoxazole in rheumatoid arthritis: a comparison with sulphapyridine. Ann Rheum Dis 1988; 47:323-7. [PMID: 3284488 PMCID: PMC1003514 DOI: 10.1136/ard.47.4.323] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The antirheumatoid activity of sulphasalazine and sulphapyridine may result from their antibacterial properties. The second line activity of sulphamethoxazole, in the form of cotrimoxazole (CTZ), has been investigated by treatment of 13 patients with RA for 24 weeks with CTZ (480 mg three times a day). The drug was found to be poorly tolerated, only five of the thirteen patients recruited completing the study. High circulating concentrations of sulphamethoxazole were found, with mean (SD) steady state serum concentrations reaching 54.02 (23.38) micrograms/ml. A significant reduction in serum IgM from 280 to 130 IU/l was observed, but otherwise disease activity remained unchanged or deteriorated throughout the course of the study. In contrast, patients with RA treated with sulphapyridine (1.25 g a day) showed improvement in disease activity. The results argue against an antibacterial mechanism of action for sulphasalazine and sulphapyridine in rheumatoid arthritis, unless this occurs at a site inaccessible to sulphamethoxazole.
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Sheldon PJ, Webb C, Grindulis KA. Sulphasalazine in rheumatoid arthritis: pointers to a gut-mediated immune effect. BRITISH JOURNAL OF RHEUMATOLOGY 1987; 26:318-9. [PMID: 2886178 DOI: 10.1093/rheumatology/26.4.318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Neumann VC, Taggart AJ, Le Gallez P, Astbury C, Hill J, Bird HA. A study to determine the active moiety of sulphasalazine in rheumatoid arthritis. J Rheumatol 1986; 13:285-7. [PMID: 2873245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Thirty patients with active rheumatoid arthritis (RA) participated in an open study of 6 months' treatment with either 5-aminosalicylic acid (5-ASA) or sulphapyridine (SP), the two moieties of sulphasalazine (SASP). Patients were assessed at regular intervals using clinical and biochemical tests designed to detect specific antirheumatic activity. Patients taking SP showed significant improvement in disease activity, but those taking 5-ASA did not improve, despite the fact that high serum concentrations of 5-ASA and acetyl 5-ASA were achieved. These results suggest that SP is the active moiety of SASP. Its possible mode of action is discussed. Nausea was a frequent problem in patients taking SP. Unless this can be overcome, SP is unlikely to offer any therapeutic advantages over SASP in the treatment of RA.
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Taggart AJ, Neumann VC, Hill J, Astbury C, Le Gallez P, Dixon JS. 5-Aminosalicylic acid or sulphapyridine. Which is the active moiety of sulphasalazine in rheumatoid arthritis? Drugs 1986; 32 Suppl 1:27-34. [PMID: 2877851 DOI: 10.2165/00003495-198600321-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Thirty patients with active rheumatoid arthritis participated in an open study of 6 months' treatment with either 5-aminosalicylic acid or sulphapyridine, the two moieties of sulphasalazine. Patients were assessed at regular intervals using a number of clinical and biochemical tests designed to detect specific antirheumatic activity. Patients taking sulphasalazine showed significant improvement in most parameters of disease activity, but those taking 5-aminosalicylic acid did not improve despite the fact that high serum concentrations of 5-aminosalicylic acid and acetyl 5-aminosalicylic acid were achieved. These results suggest that sulphapyridine is the active moiety of sulphasalazine. Its possible mode of action is discussed. Nausea was a frequent problem in patients taking sulphapyridine. Unless this problem can be overcome, sulphapyridine is unlikely to offer any therapeutic advantages over sulphasalazine in the treatment of rheumatoid arthritis.
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Abstract
Malignant pyoderma is a destructive, ulcerating skin disease that occurs chiefly in young adults. Only eight cases of this rare disease have been reported. The head and neck have been involved in all cases, and a predilection for the periauricular region has been noted in several of the cases. Although the disease is progressive and chronic, responses to high-dose systemic corticosteroids have been noted, but usually a flare is associated with a reduction in dose. An additional case is described in which therapy with isotretinoin and sulfapyridine led to complete remission.
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Situnayake RD, McConkey B. Which component of sulphasalazine is active in rheumatoid arthritis? BRITISH MEDICAL JOURNAL 1985; 291:138. [PMID: 2861878 PMCID: PMC1416264 DOI: 10.1136/bmj.291.6488.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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36
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Pullar T, Hunter JA, Capell HA. Which component of sulphasalazine is active in rheumatoid arthritis? BRITISH MEDICAL JOURNAL 1985; 290:1535-8. [PMID: 2860942 PMCID: PMC1415752 DOI: 10.1136/bmj.290.6481.1535] [Citation(s) in RCA: 108] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sulphasalazine is known to be effective as a second line agent in the treatment of rheumatoid arthritis. The two chemical constituents of sulphasalazine (sulphapyridine and 5-aminosalicylic acid) were assessed separately in the treatment of rheumatoid arthritis. Over 24 weeks sulphapyridine showed a pronounced second line effect comparable with sulphasalazine and with a similar toxicity profile, whereas 5-aminosalicylic acid showed only a weak first line effect. Thus sulphapyridine appears to be the active moiety responsible for the second line effect of sulphasalazine in rheumatoid arthritis. The efficacy of the antibacterial component of sulphasalazine yet again permits speculation about the role of a bacterial pathogen in the aetiopathogenesis of rheumatoid disease.
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Abstract
We followed three children who met the clinical, histologic, and immunologic criteria for chronic bullous disease of childhood (linear IgA dermatosis). All patients were able to discontinue therapy after two months to two years. Two have continued to experience transient mild episodes of blistering that have not required reinstitution of systemic therapy. In our opinion, children with this condition have a benign course with disease-free remissions and can be expected to discontinue all therapy eventually.
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Donowitz M. Arachidonic acid metabolites and their role in inflammatory bowel disease. An update requiring addition of a pathway. Gastroenterology 1985; 88:580-7. [PMID: 2856909 DOI: 10.1016/0016-5085(85)90525-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Griffing CC, Bligard C, Russell R, Frye L, Millikan LE, Storer JS. Recurring chronic bullous dermatosis of childhood in a black child. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 1984; 136:13-6. [PMID: 6381651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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40
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Berenguer J. [Crohn's disease. Has there been progress in its treatment?]. Med Clin (Barc) 1984; 83:61-4. [PMID: 6147447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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41
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Abstract
Chronic blistering dermatosis of childhood (CBDC) in a 1-year-old black girl responded to the administration of sulfapyridine. CBDC is a rare blistering skin disease characterized by the presence of tense bullae and the linear deposition of IgA at the dermal-epidermal junction of lesional and perilesional skin. The disease may resemble bullous impetigo, bullous erythema multiforme, dermatitis herpetiformis, or pemphigus. The treatment involves the use of either dapsone or sulfapyridine.
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Rogers M, Bartlett B, Walder B, Cains G. Chronic bullous disease of childhood--aspects of management. Australas J Dermatol 1982; 23:62-9. [PMID: 6758754 DOI: 10.1111/j.1440-0960.1982.tb00603.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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44
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Moskalewska K, Dabrowski J. [Cutis laxa acquisita]. PRZEGLAD DERMATOLOGICZNY 1982; 69:265-73. [PMID: 7184055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ahmed AR, Moy R. Chronic bullous dermatosis of childhood. Linear iga bullous dermatosis. AMERICAN JOURNAL OF DISEASES OF CHILDREN (1960) 1982; 136:214-7. [PMID: 7039304 DOI: 10.1001/archpedi.1982.03970390028009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 21/2-year-old boy had large, tense bullae on the groin, buttocks, legs and abdomen. A subepidermal vesicle was seen on histological study. Immunofluorescent studies revealed linear IgA at the basement membrane zone. There was no associated gastrointestinal abnormality or any other systemic feature. The patient responded dramatically to sulfapyridine. He has had no recurrence of the disease and negative immunofluorescence study results during two years of follow-up.
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Abstract
In addition to proctocolectomy, new surgical techniques for treating ulcerative colitis include the Kock internal ileal reservoir and endorectal pullthrough of the ileum. In children three forms of Crohn's disease requiring operation have been identified. Ileocecal disease may be treated with resection and anastomosis; colorectal disease is best managed by primary proctocolectomy cutaneous ileostomy; and Crohn's disease of the small bowel should be managed by medical therapy in most cases.
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Järnerot G. [Appearance of sulfasalazine and sulfapyridine in breast milk and in the placental barrier as well as the effect of both substances on bilirubin binding to albumin]. ZEITSCHRIFT FUR GASTROENTEROLOGIE. VERHANDLUNGSBAND 1981; 19:27-8. [PMID: 6168129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Järnerot G, Into-Malmberg MB, Esbjörner E. Placental transfer of sulphasalazine and sulphapyridine and some of its metabolites. Scand J Gastroenterol 1981; 16:693-7. [PMID: 6119765 DOI: 10.3109/00365528109182032] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In eleven pregnant patients with ulcerative colitis or Crohn's disease who were treated with sulphasalazine (SASP) the serum concentrations of SASP and sulphapyridine (SP) were measured at delivery. The concentrations of SASP and SP were almost identical in the cord serum and the maternal serum. In seven of the women the same concentrations were measured at a later occasion when they were not pregnant. The serum SASP concentration remained the same, but the SP concentration was higher in the non-pregnant women. This probably reflects the different degree of protein binding of SASP and SP, respectively, and the change of distribution volume that occurs in pregnancy. In the newborn the concentrations of SASP and SP were 4.6 +/- 3.1 microgram/ml and 18.2 +/- 8.7 microgram/ml, respectively. Current studies have shown that neither SASP nor SP in these concentrations causes significant displacement of bilirubin from albumin. Thus, SASP can be given to the pregnant patient up to delivery without risks for the newborn full-term infant.
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Klotz U, Maier K, Fischer C, Heinkel K. Therapeutic efficacy of sulfasalazine and its metabolites in patients with ulcerative colitis and Crohn's disease. N Engl J Med 1980; 303:1499-502. [PMID: 6107853 DOI: 10.1056/nejm198012253032602] [Citation(s) in RCA: 213] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We studied the therapeutic efficacy of sulfasalazine and its metabolites sulfapyridine and 5-aminosalicylic acid in nine patients with Crohn's disease and in 23 patients with ulcerative colitis. In a randomized, controlled trial, we treated 11 patients for six weeks with 1 g of sulfasalazine three times a day, seven patients with 0.5 g of sulfapyridine three times a day, and 14 patients with 0.5 g of 5-aminosalicylic acid suppositories three times a day. The clinical state of the disease was characterized by an activity index, quality of stool, and remission rate. In addition, we monitored plasma levels of sulfapyridine, 5-aminosalicylic acid, and their acetylated metabolites. The initial activity index (mean +/- S.D.) was significantly reduced by sulfasalazine (from 245 +/- 129 to 100 +/- 71; P < 0.001) and by 5-aminosalicylic acid (from 251 +/- 65 to 90 +/- 93; P < 0.0001), but sulfapyridine was without benefit. Stool quality was also improved by sulfasalazine (82 per cent of the cases) and by 5-aminosalicylic acid (79 per cent). The highest remission rate was achieved with 5-aminosalicylic acid (86 per cent), followed by sulfasalazine (64 per cent) and sulfapyridine (14 per cent). Our investigations show that 5-aminosalicylic acid is the active moiety of sulfasalazine and that this effective metabolite may be an alternative to sulfasalazine in inflammatory bowel disease.
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