Thalidomide is an immunomodulatory agent; although its mechanisms of action are 
not fully understood, many authors have described its anti-inflammatory and 
immunosuppressive properties. More interestingly, thalidomide has shown the 
ability to suppress tumor necrosis factor alpha (TNF alpha) production and to 
modify the expression of TNF alpha induced adhesion molecules on endothelial 
cells and on human leukocytes. Thalidomide has been used in several diseases 
(i.e. dermatological, autoimmune, gastrointestinal). In this review we focus 
specifically on the use of this drug in disorders with rheumatological features 
such as lupus erythematosus, rheumatoid arthritis and Still's disease, 
ankylosing spondylitis, and Behçet's disease. Despite its well known side 
effects, first of all peripheral nerve involvement and teratogenesis, which can 
be avoided by following strict guidelines, thalidomide could represent an 
alternative drug in some rheumatological conditions, particularly in patients 
who show resistance, contraindication or toxicity with other conventional 
treatments.