title: Evidence of a local intestinal immunomodulatory effect of sulfasalazine in rheumatoid arthritis.
abstract: OBJECTIVE
  To analyze whether the intestinal mucosa in rheumatoid arthritis (RA) is immunologically abnormal and whether sulfasalazine (SSZ) possesses any local intestinal immunoregulatory effect.
  
  
  METHODS
  Lymphocyte subpopulations and HLA-DR expression were evaluated in biopsy specimens from the duodenal-jejunal mucosa and in peripheral blood samples obtained from 17 patients with RA, both before and after 16 weeks of SSZ treatment. The same mucosal assays were also performed in 7 controls.
  
  
  RESULTS
  The mucosa of the small intestine in RA patients showed no differences in morphology, HLA-DR expression, or the amounts and distribution of CD3+, CD4+, CD8+, and gamma/delta + lymphocytes compared with the control group. However, there was a reduction in mucosal CD3+ and gamma/delta + lymphocyte numbers after SSZ therapy, which did not correspond to a change in peripheral blood CD3+ lymphocyte number. SSZ treatment also tended to diminish the peripheral blood CD4+:CD8+ cell ratio (P = 0.05).
  
  
  CONCLUSIONS
  No signs of inflammation or immunologic abnormalities were seen in RA duodenal-jejunal mucosa. In this part of the intestine, however, SSZ exerted immunoregulatory effects that were not encountered in the peripheral blood.
authors.affiliation: Stockholm Söder Hospital, Karolinska Institute, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Kanerud
authors.forename: A
authors.initials: A
authors.lastname: Scheynius
authors.forename: I
authors.initials: I
authors.lastname: Hafström
mesh_terms: D000276:Adjuvants, Immunologic / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology*; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis; D015704:CD4 Antigens / Q000032:analysis; D016827:CD8 Antigens / Q000032:analysis; D004386:Duodenum; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000737:chemistry / Q000276:immunology* / Q000473:pathology; D007583:Jejunum; D007958:Leukocyte Count; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis; D012460:Sulfasalazine / Q000276:immunology* / Q000627:therapeutic use
chemical_list: D000276:Adjuvants, Immunologic; D017252:CD3 Complex; D015704:CD4 Antigens; D016827:CD8 Antigens; D006684:HLA-DR Antigens; D016692:Receptors, Antigen, T-Cell, gamma-delta; D012460:Sulfasalazine