Objective to study the clinical and immunopathologic findings of drug induced, rossapositive cutaneous lupus erythematosus cle. It was lampooned in a more recent sitcom as a magic elixir capable of transforming a friendless geek into the most popular kid at school. Drug induced lupus is also called drug induced lupus erythematosus dile. Because ethosuximide was rechallenged with recurrence of sle at age 24, there is a definite association between the drug and the development of the disease. My pharmacist was the one who figured it out because he took the time to read the fulllength medication documentation from the manufacturer. Drug induced lupus dil is a disorder with clinical, histological, and immunological features similar to idiopathic systemic lupus erythematosus, but that occurs when certain drugs are taken and resolved after discontinuation of the offending agent. While the exact cause of lupus is unknown, there is significant evidence that some medications may cause lupus in some cases.
A newbie asking about drug induced lupus and zoloft. When a patient presents with features suggestive of sle, the presence of anti nuclear antibodies ana in the patients serum is usually used as a screening test. Drug induced systemic lupus erythematosus sle is defined by the occurrence of sle symptoms following continuous administration of a drug 3 weeks to 2 years and by the immediate reversal of the. As lupus has become a paradigm for the study of autoimmune disease, immunologists investigating autoimmunity are becoming more interested in lupus. As in idiopathic or usualtype lupus erythematosus le, there are three categories recognised.
Lupus is an autoimmune condition caused by a combination of factors, both genetic and environmental. Acute interstitial nephritis and druginduced systemic lupus. We report the clinical case of an 80yearold woman in which a framework of dile was. Systemic lupus erythematosus sle, is the most common type of lupus. Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus. Patients with drug induced lupus have very high titers e. Alternative treatments for systemic lupus erythematosus. Oct 29, 2019 in this study, we aimed to measure the main differences in drug induced gene expression signatures across sle patients and to evaluate the potential for clinical data to build a machine learning. Stress, exhaustion, smoking or sun exposure can trigger lupus. This disorder has been described for the first time in 1945 by hoffman. The following products are considered to be alternative treatments or natural remedies for systemic lupus erythematosus. Drug induced lupus differs from sle by the following features.
Some lids induce a condition more akin to subacute cutaneous lupus erythematosus scle consequently, unless stated otherwise, reference to dil in this chapter means the term to encompass druginduced sle, scle and ccle chronic cutaneous lupus erythematosus. Related conditions are drug induced cutaneous lupus and drug induced anca vasculitis. Isoniazid, an antituberculosis drug, can cause systemic lupus erythematosus sle. Clinical features of patients with drug induced, rossapositive cutaneous lupus erythematosus cle. Related conditions are drug induced cutaneous lupus and drug induced. Surgery caused autoimmune disease or drug induced lupus. Systemic lupus erythematosus sle is the prototypic multisystem autoimmune.
Dil is reversible by discontinuation of the medication. The etiological mechanism underlying dil is linked to the inherent susceptibility of the adaptive immune system to lapse into auto. While lids can induce a syndrome similar to sle, this often has less severe, or no, involvement of selected organs, e. Development of drug induced systemic lupus erythematosus sle is an uncommon complication of the use of dpenicillamine and sulphasalazine. Acute interstitial nephritis and drug induced systemic lupus erythematosus due to chlorthalidone and amiodarone. There is no evidence that people who develop ana without symptoms are at increased risk for developing drug induced lupus in the future. List of systemic lupus erythematosus medications 41. Sep 17, 2008 drug induced lupus erythematosus dile is defined as a lupuslike syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Exposure to certain drugs may induce a lupuslike illness or exacerbate sle. However, measuring the ana because someone is getting a drug e. Drug induced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. However, various theories have been developed regarding the pathogenesis of druginduced lupus. Background sulphasalazine ssz has been reported to cause drug induced systemic lupus erythematosus sle, but diagnosis of this complication in the context of rheumatoid arthritis ra is difficult. The renal biopsy was important as it pointed to ain as the primary nephrological pathology, rather than lupus nephritis.
After cessation of amiodarone treatment, the patient recovered completely. I never had any side effects from this drug before,but god help me if i have to go off it. She had been taking antihypertensive medication for 15 years and was evaluated by the rheumatology department a year prior to her. Setting immunodermatology division of johns hopkins hospital baltimore, md. Although the signs and symptoms of druginduced lupus overlap with those of idiopathic. Before making a diagnosis of systemic lupus erythematosus sle, ruling out drugs as the cause of the condition is important. With drug induced, symptoms will resolve after stopping medications. Drug induced lupus which has resolved is not rated. It has been estimated that up to 10% of sle cases are drug induced.
Although ethosuximide is less often prescribed, it is a potential cause of sle. While symptoms can be severe, dil, unlike systemic lupus erythematosus sle, is fully reversible simply by discontinuation of the inducing medication, although full recovery can take several months. Although the term is frequently used alone to designate lupus vulgaris and sometimes lupus erythematosus, without a modifier it has no meaning. Learn about systemic lupus erythematosus sle, the most common type of lupus. Rheumatologists sometimes use specific criteria cdc pdf pdf 510kb external to classify sle for research purposes. Systemic lupus erythematosus sle is a prevalent autoimmune disorder. Drug induced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus.
While the recent and numerous television advertisements for the antitumor necrosis factor tnf agents. What was interesting was that the words autoimmune and drug induced lupus werent even in the documentation. In the 1950s and 1960s geritol tonic was heavily advertised on television as a fast cureall if youre feeling weak and rundown, tired or nervous. This means your body attacks healthy tissue by mistake. Acute interstitial nephritis and druginduced systemic. Manual of paper electrophoresis systems, model r, the beckman. Drug induced lupus is the presence of sle manifestations occurring after exposure to specific medications, listed in table 1084. Drug induced sle has been diagnosed as a result of a combination of clinical and biologic signs.
Drug induced lupus means that the disease systemic lupus erythematous was caused by a certain drug. Pdf systemic rheumatic symptoms occur with widely different. Sle is regarded as a prototype disease due to the significant overlap in its symptoms with other autoimmune diseases. The drugs most commonly connected with druginduced lupus are hydralazine. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those. Jul 10, 2018 drug induced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. Drug induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. Autoantibodies to myeloperoxidase in idiopathic and drug induced systemic lupus erythematosus and vasculitis. The phenothiazines are known to be oxidized to free radical interme. Drug induced lupus is also called druginduced lupus erythematosus dile what is drug induced lupus.
Druginduced, rossapositive cutaneous lupus erythematosus. This book is attractive to both the investigative community and clinicians. The symptoms of drug induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. Druginduced lupus erythematosus dile refers to a condition whose clinical. We report a case with typical clinical features of drug induced lupus erythematosus, together with verrucous endocarditis and pleuropericardial effusion, due to amiodarone treatment. Drug induced lupus is a lupuslike disease caused by certain prescription drugs. Sle is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. The occurrence of systemic lupus erythematosus sle as a result of pharmacological treatments is a condition named drug related lupus drl or drug induced lupus erythematosus dile. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. Certain clinical and laboratory features may distinguish these. Dile or dil can occur as a sideeffect of certain medications.
To access free multiple choice questions on this topic, click here. How is druginduced lupus erythematosus differentiated. There are no standardized diagnostic criteria for drug induced lupus erythematosus, but in such cases there must have been continuous exposure to a phar. The condition is much more than a positive antinuclear antibody ana. Systemic lupus erythematosus sle is a chronic, multisystem, autoimmune disease characterized by periods of increased disease activity caused by inflammation of blood vessels and connective tissue. You may also develop drug induced lupus after taking sunsensitizing tetracycline drugs, sulfa drugs, antiseizure medications, or alpha inhibitors. Systemic lupus erythematosus sle is a common autoimmune disease, with an incidence in europe and north america varying between 1 and 10 cases per 100 000 per year.
The mechanism or mechanisms involved in druginduced lupus remain uncertain. Drug induced lupus dile is a temporary form of lupus that is brought on by a reaction to medication. Pediatric systemic lupus erythematosus american academy. Similarly to idiopathic lupus, dile can be diveded into systemic sle, subacute cutaneous scle and chronic. The present report concerns a patient who developed a systemic lupuslike. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Specific classification criteria for drug induced lupus have not been published, and no published data address differences between adult and pediatric drug induced lupus. Medications such as hydralazine, procainamide, methyldopa, chlorpromazine, quinidine, and minocycline are known to cause sle. Druginduced lupus dil is an autoimmune phenomenon where a drug. Drug induced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. A 48 year old female presented to the hospital with new onset malar rash, arthralgias and other systemic symptoms after being started on sertraline for management of her depressive symptoms.
There are currently no standard diagnostic criteria for dile and the pathomechanisms are still unclear. Over 6,000 healthcare professionals follow the blog, why arent you. Drug induced lupus erythematosus is a generally reversible condition that usually occurs in people being treated for a longterm illness. Druginduced systemic lupus erythematosus definition of. Druginduced lupus erythematosus by amiodarone rheumatology. Drug induced sle can be ruled out if the ana is negative. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction.
A, the index patient shows scaly, annular, subacute cletype lesions on the lateral aspect of the right arm. I would change your recommendation about checking ana. The occurrence of malar rash, discoid lesions, alopecia, and oral ulcers is lower in traditional drug induced sle compared with idiopathic sle. Inherited differences in drug metabolism eg, acetylator status and immunogenetic characteristics are genetic factors that may influence the risk of developing disease. How is druginduced lupus erythematosus differentiated from. Druginduced lupus erythematosus associated with donepezil. Pdf among the numerous idiopathic immunemediated diseases that can be. We report two cases of patients with rheumatoid arthritis ra who developed symptoms and signs of sle and suggest that increasing use of these two agents as combination therapy in ra may cause an additive risk to the occurrence of this complication. It should be appreciated that criteria for reaching a diagnosis of drug induced lupuslike disease are not as rigorous as those for diagnosis of sle. However, various theories have been developed regarding the pathogenesis of drug induced lupus. It can occur with a wide variety of agents that result in the generation of antihistone or other types of antibodies.
Lupus is not like or related to hiv human immune deficiency virus or aids. Druginduced lupus erythematosus information mount sinai. Combination therapy for rheumatoid arthritis and druginduced. Evolving and expanding scope of lupusinducing drugs annals. Druginduced lupus erythematosus thearchangelmichaels blog.
Increased type i ifn in sle sera increased ifninduced genes in sle patients several sle risk gene variants in loci linked to type i ifn system slelike syndrome with ifna treatment hagberg n. The only drug i am on and have ever been on is zoloft. Druginduced lupus is probably mediated by reactive drug. Over the years, multiple other agents have been linked to immunemediated glomerular disease, often with associated autoantibody formation. Causes of systemic lupus erythematosus sle the most common. Druginduced lupus erythematosus with emphasis on skin. Systemic refers to ability to affect different systems. To get an idea of how a client with a history of systemic lupus erythematosus sle would be viewed in the underwriting process, feel free to use the ask rx pert underwriter on the attached page for an informal quote.
Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. The slow acetylator phenotype clearly increases the risk of hydralazine induced ana positivity and druginduced lupus but is less important in procainamide and isoniazidassociated druginduced lupus and does not appear to influence the risk of druginduced lupus owing to other drugs or idiopathic sle. The mechanism or mechanisms involved in drug induced lupus remain uncertain. Druginduced lupus definition of druginduced lupus by. Druginduced lupus erythematosus actas dermosifiliograficas. Drug induced lupus erythematosus is an uncommon, mild to moderately severe, a lupuslike syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. The use of the abbreviation sle means idiopathic sle throughout this chapter. While drug induced lupus is not a major clinical problem because it can be fully cured by discontinuing use of the medication, it is of mechanistic interest that a low molecular weight xenobiotic. Druginduced lupus erythematosus is an uncommon, mild to moderately severe, a lupuslike syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. Drug induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupuslike syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Joint inflammation and pain, skin rash, pleurisy, and fever are the most common manifestations. Does sulphasalazine cause drug induced systemic lupus. Drug induced lupus and sle sle is distinct from drug induced lupus, since dil generally has milder symptoms than sle, and no. Druginduced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs.
Druginduced lupus and systemic lupus erythematosus. Ain is an unexpected finding in dile but pointed to a drug induced process rather than classical sle. These drugs cause an autoimmune response the body attacks its own cells producing symptoms similar to those of sle. Drug induced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Differential treatments based on druginduced gene expression.
Druginduced lupus erythematosus statpearls ncbi bookshelf. On antitumor necrosis factorinduced systemic lupus. Antihistone antibodies are commonly found in drug induced lupus but are also seen in sle and, therefore, cannot distinguish between the two. Such anas are directed toward deoxyribonucleoproteins i. Systemic lupus erythematosus, fourth edition, provides an understanding of the basic mechanisms as well as the diagnostic and therapeutic aspects of lupus. Drug induced lupus dil is a side effect of longterm treatment with various medications, an idiosyncratic adverse drug reaction adr that has been documented for some seven decades. Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic. Drug induced lupus erythematosus dil or dile is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Drug induced lupus erythematosus dile is an autoimmune variant of systemic lupus erythematosus triggered by the acute or chronic use of a medication. Drug induced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. Druginduced subacute cutaneous lupus erythematosus discle is a dile variant with predominant skin involvement, temporally related to drug.