Sulphasalazine is an effective second-line agent in the management of rheumatoid arthritis. The risk:benefit ratio in the elderly is less well established. We studied the rislcbenefit ratio in relation to age, retrospectively combining five prospective studies of enteric coated sulphasalazine therapy in 352 patients with rheumatoid arthritis. Clinical and laboratory assessments of efficacy and toxicity were made by an independent assessor at 0, 12, 24 and 48 weeks. The only significant differences between young, middle aged and elderly patients at the initial assessment were in pain perception, ESR and C-reactive protein. Sulphasalazine was equally effective in all age groups. The toxicity profile was similar in all age groups. We conclude that sulphasalazine is equally effective in rheumatoid arthritis in the elderly as in the young. There was no significant change in the frequency or nature of side-effects with increasing age.
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