title: Evidence for differential effects of sulphasalazine on systemic and mucosal immunity in rheumatoid arthritis.
abstract: OBJECTIVE
  To study the effects of sulphasalazine (SASP) on the systemic and mucosal humoral immune systems in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Serum concentrations of interleukin 6 (IL-6), class and subclass specific IgG, IgA and IgM, IgA and IgG antigliadin antibodies and rheumatoid factors (RF) of IgG, IgA (including IgA1 and IgA2 subclasses) and IgM isotypes were measured before and 16 weeks after sulphasalazine (SASP) therapy in 15 female and three male patients with RA. Amounts of immunoglobulins in saliva and jejunal fluid were measured as estimates of mucosal humoral immunity.
  
  
  RESULTS
  Serum concentrations of IgA and IgG decreased significantly during SASP therapy and correlated with reduced concentrations of IL-6. In addition, levels of circulating IgA RF, IgA anti-gliadin antibodies and IgM RF decreased significantly after the treatment. In contrast, immunoglobulin levels in saliva and jejunal fluid were unaltered.
  
  
  CONCLUSIONS
  SASP exerts powerful but selective inhibitory effects on systemic immunoglobulin production, whereas no effects on mucosal immunoglobulin production were observed. The decreased systemic B cell activity may be mediated by downregulation of the production of IL-6, a cytokine with Ig switching properties.
authors.affiliation: Department of Rheumatology, Karolinska Institute, Stockholm Söder Hospital, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Kanerud
authors.forename: G N
authors.initials: GN
authors.lastname: Engström
authors.forename: A
authors.initials: A
authors.lastname: Tarkowski
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects*; D007070:Immunoglobulin A / Q000097:blood; D007071:Immunoglobulin A, Secretory / Q000032:analysis; D007074:Immunoglobulin G / Q000097:blood; D007136:Immunoglobulins / Q000378:metabolism*; D015850:Interleukin-6 / Q000097:blood; D007583:Jejunum / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D012463:Saliva / Q000276:immunology; D012460:Sulfasalazine / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D007070:Immunoglobulin A; D007071:Immunoglobulin A, Secretory; D007074:Immunoglobulin G; D007136:Immunoglobulins; D015850:Interleukin-6; D012460:Sulfasalazine; D005903:Gliadin; D012217:Rheumatoid Factor