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Pastimes : Don't Ask Rambi -- Ignore unavailable to you. Want to Upgrade?

To: Krowbar who wrote (37348)	9/7/1999 5:32:00 PM
From: Ilaine	Read Replies (1) \| Respond to of 71178

Thalidomide has been investigated as a treatment for rheumatoid arthritis for at least a decade, and for autoimmune diseases in general, for longer than that. And the side effects are more serious than simple constipation and dryness of mouth, for example, irreversible neurotoxicity, hard swelling of the lower limbs, peripheral sensory neuropathy, erythema and pruritis. Methotrexate, the current "treatment of choice," does not have those side effects. As I stated, thalidomide inhibits tumor necrosis factor alpha, which is a trigger of the cascade of inflammatory cytokines which cause many different types of diseases. >>>>>J Rheumatol 1989 Feb;16(2):158-63 Treatment of refractory rheumatoid arthritis--the thalidomide experience. Gutierrez-Rodriguez O, Starusta-Bacal P, Gutierrez-Montes O Department of Medicine, Facultad de Salud, Universidad del Valle, Hospital Universitario del Valle, Evaristo Garcia, Cali, Colombia. In an open study, 17 patients (16 women, 1 man) with refractory or severe rheumatoid arthritis were treated with thalidomide. Two withdrew from the study in the first weeks. Thirteen patients received 531 +/- 63 mg/day of thalidomide for 18.8 +/- 8.8 weeks; in 2 the dose was 300 mg/day during 62 and 65 weeks. Seven patients attained complete remission, 5 partial remission, and the last 3 no improvement at all. Remissions lasted 6 years in 1 patient, 2 years in 3, 1 year in one, and varied between 8 months and 8 weeks in 7. After relapse, 5 patients received a 2nd course of treatment and attained remission again. This lasted 24, 10, and 9 months in 3; two are taking 100 mg/day of thalidomide as a maintenance dose and remain asymptomatic after 36 and 30 months. The side effects were drowsiness, constipation, hard swelling of the lower limbs, erythema of the face and limbs with local pruritus or burning sensation, hair loss, cough, nasal obstruction, fever, and skin and mucosal dryness. In 8 patients there was mild eosinophilia (less than 10%) and in 2 leukopenia. A 33-year-old woman showed amenorrhea up to 2 months after stopping treatment. After a 2nd course of treatment, 2 patients developed peripheral sensory neuropathy, which resolved spontaneously in 6 months. We believe these findings justify controlled trials with this agent. PMID: 2746563, UI: 89311270<<<<< >>>>>Arch Dermatol 1984 Mar;120(3):338-41 Thalidomide neurotoxicity. Clemmensen OJ, Olsen PZ, Andersen KE Of six patients treated with thalidomide for either prurigo nodularis or discoid lupus erythematosus, four had paresthesias in the hands and feet and one also complained of muscular pain and stiffness. Clinical neurological findings in all four patients were normal. Subsequent electrophysiological examination disclosed a peripheral neuropathy in five of the six patients; two had electrophysiological signs of a polyneuropathy and three of a carpal tunnel syndrome. Symptoms and abnormal electrophysiological findings were still present in one patient one year after the discontinuation of thalidomide therapy. Since reports on thalidomide neurotoxicity have shown that the neurological symptoms are long standing and possibly irreversible, it is obviously important to inform patients of this possible side effect and to evaluate them closely for the symptoms and electrophysiological signs of evolving neurological changes. PMID: 6703734, UI: 84152863<<<<<