Zahra Zakeri - Department of Internal Medicine, Shahidbeheshti University of Medical sciences, Tehran, Iran
Ali Davarian - Ischemic Disorders Research Center, Golestan University of Medical sciences, Gorgan, Iran.|Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran.
Seyyed Amirhossein Fazeli - Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
Mahnaz Sandoughi - Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

Treatment with tumor necrosis factor alpha inhibitors has been increasingly implicated in the management of autoimmune diseases.In spite of their promising effects, they are commonly associated with side effects. This issue indicates the need for newer drugs with the same efficacy and fewer serious adverse effects. Pentoxifylline is aphosphodiesterase which inhibits TNF secretion and exerts to some degree an anti-inflammatory effect. The purpose of this randomized clinical trial was to evaluate the effect of pentoxifylline as an adjunctive therapy in the management of ankylosing spondylitis.Twenty-five patients suffering from ankylosing spondylitis were randomly assigned to treatment or placebo groups having been matched for age and gender.The treatment group received pentoxifylline (1200 mg daily), and the placebo group received a placebo in addition to the standard treatment of sulfasalazine 2-3 gram daily and indomethacin 50-75 mg per day that were given to all the patients in both groups.Serum levels of TNF-α were measured before and after the study intervention.Serum levels of TNF-α were reduced significantly in both groups with a p-value of <0.001. However, the reduction was more prominent in the group receiving pentoxifylline than in the placebo group, although this between-group difference was not statistically significant.The results demonstrate the need for further studies on the use of pentoxifylline as a safe adjunctive therapy in controlling disease activity and reducing tumor necrosis factor-alpha levels in patients with ankylosing spondylitis.

ankylosing spondylitis, NSAIDs, pentoxifylline, spondyloarthritis, TNF-α