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VOLUME 5 , ISSUE 2 ( May-August (2018), 2018 ) > List of Articles


Thalidomide in Axial Spondyloarthropathy: An Eastern Indian Experience

Rudrajit Paul, Arijit Sarkar, Urmimala Bhattacharjee, Ritasman Baisya, Pallab Biswas, Rathindranath Sarkar, Chandan K Das

Citation Information : Paul R, Sarkar A, Bhattacharjee U, Baisya R, Biswas P, Sarkar R, Das CK. Thalidomide in Axial Spondyloarthropathy: An Eastern Indian Experience. Bengal Physician Journal 2018; 5 (2):3-6.

DOI: 10.5005/jp-journals-10070-5202

License: NA

Published Online: 01-04-2018

Copyright Statement:  NA



Axial spondyloarthropathy (SpA) is seronegative arthritis which mainly affects young adults and causes much morbidity. Tumor necrosis factor-alpha (TNF-α) is one of the main mediators of inflammation in joints and enthuses in SpA. Nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologics like TNF-α inhibitors are the mainstay of therapy in SpA. However, in India, the cost is one limiting factor in the use of biologics for the treatment of SpA in eligible patients. Thalidomide is an oral TNF-α inhibitor which has reported benefit in axial SpA, and it is a cheap option in the Indian setting. However, there is almost no Indian data on its efficacy.

Materials and methods

This is a retrospective analysis of patients receiving thalidomide for axial SpA in the rheumatology clinic of a tertiary care hospital of Kolkata. In this clinic, thalidomide was used at 100 mg/day. Patients receiving thalidomide, who had completed at least one year follow up were included in the analysis. Assessment of SpondyloArthritis International Society (ASAS)-20, ASAS-40, and ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) were measured three monthly during the follow-up. Side effect profile of thalidomide was also recorded.


The completed data of 66 patients were analyzed. All patients were human leukocyte antigen (HLA) B27 positive. Ninety-five point percent fulfilled ASAS-20 criteria at 12 months and 71.2% fulfilled the ASAS-40 criteria at 12 months. Three patients were nonresponders. The average ASDAS-CRP score also decreased from 2.9 to 1.5 over one year.


In our study, oral thalidomide resulted in significant improvements in axial SpA. Further randomized controlled trials are needed to find the relative efficacy of thalidomide with respect to other forms of treatment.

  1. Ankylosing Spondylitis and axial spondyloarthritis. N Engl J Med 2016;374:2563-2574.
  2. A systematic literature review of the economic impact of ankylosing spondylitis. Clin Exp Rheumatol. 2012;30:S136-S141.
  3. Pathophysiology of spondyloarthritis. Curr Rheumatol Rep. 2011;13:416-420.
  4. The pathogenesis of ankylosing spondylitis. Neurosurg Focus. 2008;24:E3.
  5. Understanding the role of tumor necrosis factor inhibition in ankylosing spondylitis. Semin Arthritis Rheum. 2005;34:668-677.
  6. Cytokines in the seronegative spondyloarthropathies and their modification by TNF blockade: a brief report and literature review. Ann Rheum Dis 2003;62:1128-1132.
  7. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2016;68: 151-166.
  8. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev. 2015 Apr 18;(4):CD005468.
  9. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-α therapy and other novel approaches. Arthritis Res. 2002;4:307-321
  10. One year open label trial of thalidomide in ankylosing spondylitis. Arthritis Care and Research 2002;47:249-254.
  11. Classification criteria for spondyloarthropathies. World J Orthop. 2011;2:107-115.
  12. Thalidomide for severe refractory ankylosing spondylitis: A 6-month open-label trial. J Rheumatol. 2003;30:2627-2631.
  13. Efficacy and Safety of Thalidomide as Adjunct Therapy in Refractory Systemic Juvenile Idiopathic Arthritis Patients. Bangladesh Medical Research Council Bulletin 2016;42: 49-52.
  14. Thalidomide for systemic onset juvenile idiopathic arthritis. Indian Pediatrics. 2013 Feb 1;50(2):237-239.
  15. Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept. Rheumatol Int. 2013;33:1409-1413.
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