Features of drug-induced lupus

Key distinguishing features of drug-induced versus idiopathic lupus
Feature	Drug-induced	Idiopathic
Anti-dsDNA+	<5% (rare)	50 to 80%
Anti-Smith+	<5% (rare)	20 to 30%
Antihistone+	90 to 95%*	60 to 80%
Discoid rash	Rare	20%
Malar rash	2%	42%
Kidney involvement	0 to 5%	30 to 50%
Drug-specific clinical patterns
Drug	Clinical features	Laboratory findings
Procainamide	1 to 2 months after initiation Arthralgia, arthritis, myalgia, pleuritis, fever, weight loss	ANA in 95% Antihistone antibodies Anti-H2A-H2B DNA antibodies in 96%
Minocycline	3 months to 6 years after initiation Female:male ratio 5:1 Polyarthralgias, myalgias, fever, Raynaud phenomenon, mouth ulcers, hepatic damage	ANA in 82% P-ANCA in 67% Occasional anti-dsDNA
TNF-alpha inhibitors	1.5 to 18 months after initiation Predilection for females Decreased complement Cutaneous lupus erythematosus (SCLE > DLE)	ANA^¶ Anti-dsDNA Anti-Sm Anticardiolipin antibodies
Terbinafine	4 to 8 weeks after initiation SCLE	ANA speckled/homogeneous pattern Anti-Ro/SSA Antihistone antibodies

dsDNA: double-stranded deoxyribonucleic acid; ANA: antinuclear antibody; DNA: deoxyribonucleic acid; P-ANCA: perinuclear antineutrophil cytoplasmic antibodies; TNF: tumor necrosis factor; SCLE: subacute cutaneous lupus erythematosus; DLE: discoid lupus erythematosus.

* Reported rates of antihistone antibodies with drug-induced lupus overall are 90 to 95%, but the incidence varies by agent, and lower rates have been reported for minocycline, propylthiouracil, and statins.

¶ A large proportion of patients using TNF inhibitors develop autoantibodies, but clinical signs and symptoms of a drug-induced lupus syndrome are rare.

References:

Merola JF. Lupus-like syndromes related to drugs. In: Lupus Erythematosus: Clinical Evaluation and Treatment, Schur PH, Massarotti EM (Eds), Springer 2012.
Rubin RL. Drug-induced lupus. Toxicology 2005; 209:135.
Antonov D, Kazandjieva J, Etugov D, et al. Drug-induced lupus erythematosus. Clin Dermatol 2004; 22:157.

Graphic 69467 Version 8.0

خرید پکیج

Features of drug-induced lupus