Sulphasalazine was first introduced for the treatment of rheumatoid arthritis in 1942. Following initial enthusiasm, interest waned until 1978 when a large open study suggested that it might have a ‘second-line effect’. Since then further studies have confirmed this effect and once again rheumatologists are starting to use sulphasalazine in the treatment of rheumatoid arthritis. In this review we examine the pharmacology of sulphasalazine and its metabolites, comment upon the possible modes of action and review the recent literature pertaining to its use in rheumatoid arthritis.