FRI0483 Sulfasalazine as a potential treatment for iga-vasculitis (HENOCH-SCHÖNLEIN PURPURA) in adults
Authors: S. Giliaev, A. Semenovykh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Primary IgA-vasculitis and inflammatory bowel diseases (IBD) share many clinical, endoscopic, and radiological signs. It may suggest a common pathogenetic background for both pathological conditions. While sulfasalazine (SASP) is one of the well-known potential agents able to improve symptoms in IBD, the usefulness of SASP in treatment of the primary IgA-vasculitis remains unclear. <h3>Objectives</h3> Retrospective study to assess a therapeutic value of the SASP in primary IgA-vasculitis. <h3>Methods</h3> Totally 78 adult patients with primary IgA-vasculitis were enrolled in this study. Diagnosis was made on the basis of EULAR/PRES criteria<sup>1</sup> after thorough screening to exclude a secondary nature of the disease, including colonoscopy. Purpura/petechia was present in all patients being mandatory diagnostic criterion. Arthritis/arthralgia was seen in 48 patients (61,5%). There were no patients with abdominal syndrome just before enrollment, although 46 (59%) patients had transient abdominal pains in the history. Mild to moderate signs of renal involvement (hematuria and/or proteinuria) was seen in 35 (45%) patients without renal impairment. There were 20 (25%) drug-naïve patients, 40 (51%) patients after unsuccessful immunosuppressive treatment and 18 (23%) patients failed to respond to anticoagulants or antiplatelet agents. Initially SASP was prescribed in a daily dose 1 g followed with gradual titrating up to the 2 g/day depending on tolerability and clinical response. Most patients (96%) have been taking SASP longer than 6 month and about a half of the patients (56%) – longer than year. The longest treatment was 5 years. <h3>Results</h3> Complete clinical remission of the skin rash was achieved in 48 patients (58,9%). In 27 patients (35%), there was partial improvement of the skin eruptions, characterised with less quantity of the skin purpura or longer periods free of symptoms (see table 1). Four patients failed to improve at all. Persistent remission of the arthritis/arthralgia was found in 41 patients (85%). One patient did not improve. Complete resolution of the urinary abnormalities were registered in 14 patients (40%), improvement – in 17 cases (48,5%), further deterioration in 4 patients (11,5%). There were side effects in 13 patients (16%). In 4 (5,1%) cases there were headache and nausea, respectively. In 2 (2,5%) cases treatment was accompanied with skin itching and urticarial rash. Most severe complication presented with reversible cytolysis, characterised with increase of AST and ALT up to the 2–5 normal limits in 3 cases (2,5%). <h3>Conclusions</h3> To our knowledge, this is the first experience of SASP in treatment of primary IgA-vasculitis not reported before. Preliminary results look promising and worthy of further evaluation. <h3>Reference</h3> [1] Ozen S, et al., EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010May;69(5):798–806. <h3>Disclosure of Interest</h3> None declared