AN OPEN STUDY OF PENTOXIFYLLINE IN THE TREATMENT OF SEVERE REFRACTORYRHEUMATOID-ARTHRITIS

Objective. Recent data implicates the cytokine, tumor necrosis factor alpha (TNF-alpha), in the pathophysiology of rheumatoid arthritis (RA) . In vitro data suggest that pentoxifylline may possess anti-TNF-alpha properties. We have therefore carried out a prospective 3-month open evaluation of pentoxifylline in a group of adult patients with RA refr actory to conventional disease remittive therapies. Methods. Nineteen patients with RA were included and clinical assessments were performed according to the World Health Organization/International League of As sociations for Rheumatology (WHO/ILAR) criteria at baseline, and one a nd 3 months after the initiation of therapy. Laboratory assessments in cluded a complete blood count, erythrocyte sedimentation rate (ESR), a nd whole blood assays of TNF-alpha production. TNF-alpha was assayed u sing ELISA and semiquantitative polymerase chain reaction methodologie s. Results. A significant diminution in number of tender and swollen j oints as well as the ESR was noted after 3 months (p < 0.05) although no consistent effects on TNF-alpha production were observed. Furthermo re, whole blood assays of TNF-alpha production shortly after initiatio n of pentoxifylline therapy were not predictive of the clinical respon se to this agent. Conclusion. Although pentoxifylline may possess ther apeutic properties in RA, any beneficial effects appear to be unrelate d to changes in TNF-alpha generation in whole blood assays.