REPLY
Treatment of Behcet Disease with Pentoxifylline
Kozo Yasui, MD;
Kouichi Ohta, MD; and
Atsushi Komiyama, MD
15 March 1997 | Volume 126 Issue 6 | Page 494
IN RESPONSE:
We agree with Dr. Wolchok that some inflammatory cytokines may play a substantial role in the pathogenesis of Behcet disease. Tumor necrosis factor-
and interleukin-8 may be the most likely candidates, but serum levels of TNF- measured in our patient 1 before pentoxifylline treatment was started were not significantly elevated. Other studies have also reported that TNF- levels were not elevated in patients with Behcet disease [1]. Thus, we did not mention the inhibitory effect of pentoxifylline on production of TNF- by mononuclear cells.
As Arici and associates mention, pathogenetic mechanisms underlying Behcet disease are multifactorial and still unknown. Electron microscopic studies on biopsy specimens have shown perivascular infiltration with many neutrophils and mast cells [2]. Increased amounts of immune complexes and autoantibodies can be detected in some patients with Behcet disease. Anticardiolipin antibodies should also be discussed in relation to the occurrence of vasculitis. In this respect, no detectable serum levels of anticardiolipin antibody were seen in our patient 3.
Hamuryudan and colleagues might be skeptical about the efficacy of pentoxifylline in Behcet disease. Information on baseline visual acuity was available for only one patient (patient 1), in whom acuity returned to the former level. In patient 3, iridocyclitis was mild and visual acuity did not decline. Hamuryudan and colleagues also assume that colchicine administration may have induced the higher O2-release by neutrophils in our patients. However, two of our patients were not given colchicine. Furthermore, it is well known that neutrophil function is enhanced in more than 80% of patients with Behcet disease who are positive for HLA-B51 [3]. We recently used pentoxifylline to treat two more patients with Behcet disease of recent onset. These patients responded well to treatment; genital ulcers promptly disappeared and ocular involvement improved. On the basis of our experience, we are convinced of the efficacy of pentoxifylline in Behcet disease.
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Author and Article Information
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Shinshu University School of Medicine, Matsumoto, Japan
1. al-Dalaan A, al-Sedairy S, al-Balaa S, al-Janadi M, Elramahi K, Bahabri S, et al. Enhanced interleukin 8 secretion in circulation of patients with Behcet's disease. J Rheumatol. 1995; 22:904-7.
2. Muller W, Lehner T. Quantitative electron microscopical analysis of leukocyte infiltration in oral ulcers of Behcet's syndrome. Br J Dermatol. 1982; 106:535-44.
3. Chajek-Shaul T, Pisanty S, Knobler H, Matzner Y, Glick M, Ron N, et al. HLA-B51 may serve as an immunogenetic marker for a subgroup of patients with Behcet's syndrome. Am J Med. 1987; 83:666-72.
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