EFFECT OF SULFASALAZINE ON GASTROINTESTINAL MICROFLORA AND ON MUCOSALHEAT-SHOCK PROTEIN EXPRESSION IN PATIENTS WITH RHEUMATOID-ARTHRITIS

This study was performed in order to elucidate a possible association between mucosal heat shock protein expression, the gastrointestinal mi croflora and disease activity in 17 patients with RA before and after 16 weeks of sulphasalazine (SASP) treatment. The duodenal-jejunal muco sal binding of the monoclonal antibody ML30, recognizing the 65 kDa he at shock protein of mycobacteria, was increased (P = 0.048) in the unt reated RA patients compared to controls, but did not correlate to dise ase activity or microflora and was not altered by SASP therapy. There was no convincing evidence for bacterial overgrowth in the jejunum and the faecal microflora was normal. SASP treatment altered the faecal m icroflora, with significant reductions of the total aerobic bacteria, Escherichia coli and Bacteroides, and increased numbers of Bacillus. S ASP had only minor effects on the jejunal microflora. A high carriage frequency of Candida albicans was found in saliva and the counts corre lated negatively with the unstimulated whole salivary secretion rate. These results suggest that the gut may be involved in the aetiopathoge nesis of RA but do not substantiate the hypothesis that the anti-rheum atic effects of SASP are mediated via its anti-microbial properties. H owever, the possibility that a micro-organism, not detected in this st udy, may be of crucial importance in RA, cannot be ruled out.