However, the clinical features of an isolated, individual case of druginduced lupus is not characteristic of a particular drug. Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic. The four different types of lupus lupus foundation of. The symptoms of drug induced lupus are similar to those of systemic lupus, but it rarely affects major organs. The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome, and lupus erythematosus. Pdf druginduced lupus erythematosus with emphasis on skin. Druginduced lupus erythematosus is an uncommon, mild to moderately severe, a lupus like syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. Drug induced lupus has anyone ever been diagnosed with dil drug induced lupus. Systemic lupus erythematosus sle, a multisystem autoimmune disorder occurring predominantly in women of reproductive age, has diverse clinical manifestations and is often difficult to diagnose.
Druginduced lupus erythematosus dile is a lupuslike syndrome temporally related to continuous drug exposure which resolves upon drug discontinuation. My pharmacist was the one who figured it out because he took the time to read the fulllength medication documentation from the manufacturer. The objective of this study is to summarize current knowledge on rheumatic diseases induced by drugs and environmental factors. These drugs cause an autoimmune response producing symptoms similar to those of sle. Systemic lupus erythematosus the devastatingly deceptive disease michael felz, md, mary bailey wickham, pas systemic lupus erythematosus sle is a chronic autoimmune disease that often goes undiagnosed initially. Druginduced lupus erythematosus definition of drug. Druginduced lupus erythematosus dile is defined as an entity. Druginduced lupus erythematosus dile is a disorder that exhibits symptoms similar to that of lupus. Unlike sle, drug induced lupus erythematosus does not have a gender preference. The symptoms of drug induced lupus usually resolve within days to weeks after discontinuing the offending drug without introduction of antiinflammatory medications. Rheumatic diseases induced by drugs and environmental factors. The recognition and management of discle can be challenging, as the condition may be triggered by different classes of drugs after variable lengths of time.
Anastrozoleinduced subacute cutaneous lupus erythematosus. List of systemic lupus erythematosus medications 41. Druginduced 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 resolves after discontinuation of the offending agent. Systemic lupus erythematosus, its treatment, and future. L systemic lupus erythematosus occurring during anticonvulsive drug. The armamentarium of therapies for sle include glucocorticoids, antimalarials, conventional synthetic immunosuppressive drugs as well as biologic therapies. These drugs cause an autoimmune response the body attacks its own cells producing symptoms similar to those of sle. Druginduced 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. Features of minocycline induced lupus include arthralgia, arthritis, fever, and rash.
An increasing number of drugs have been linked to druginduced subacute cutaneous lupus erythematosus discle. Druginduced lupus dil refers to an idiosyncratic side. Nonetheless, metformin had a favourable safety profile and our data present a basis for larger trials to investigate its potential effect on reducing the frequency of flares for patients with sle with lowgrade disease. Druginduced lupus erythematosus is a generally reversible condition that usually occurs in people being treated for a longterm illness. In this instance, the body starts attacking the healthy tissues by mistake. A few years ago, i began having lupus like symptoms that caused a lot of dysfunction in my life for over a year, and i had a positive ana test. Lindqvist, t lupus erythematosus disseminatus after administration of mesantoin. Druginduced lupus erythematosus dile is an autoimmune condition caused by the chronic use of certain drugs.
Symptoms usually occur 3 to 6 months after starting a medication, and disappear once the medicine is stopped. Signs and symptoms of druginduced lupus reported in extaviatreated patients have included rash, serositis, polyarthritis, nephritis, and raynauds phenomenon. Currently, more than 90 drugs that can cause sle have been described. 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. While the exact cause of lupus is unknown, there is significant evidence that some medications may cause lupus in some cases. Aug 19, 2019 sle is not to be confused with drug induced lupus erythematosus dile. Manual of paper electrophoresis systems, model r, the beckman. 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. This is mostly caused by the overreaction of certain medications. Rarely, kidney inflammation nephritis can develop with druginduced lupus caused by tnf inhibitors or with anca vasculitis due to hydralazine or levamisole. Most of the time, druginduced lupus erythematosus is not as severe as sle. Timely detection of sle is important, because prompt treatment.
Oral ulcers, hair loss, photosensitivity and central nervous system symptoms are also very rare in druginduced lupus. Dile can sometimes arise months to years after the exposure to drugs prescribed to treat various medical conditions. Druginduced scle associated with antifungals, however, usually is much more rapid in onset. No specific criteria have been established yet to arrive at a diagnosis of drug induced lupus. Systemic lupus erythematosus induced by antitumour. Jul 18, 2016 the most frequently mentioned rheumatic diseases caused by drugs and environmental factors include systemic lupus erythematosus, scleroderma, systemic vasculitis, polymyositis, dermatomyositis, and sjogrens syndrome. Caucasians are six times more likely to develop dile compared to other ethnicities. Druginduced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Another form of lupus follows exposure to certain drugs drug induced lupus including procainamide and hydralazine. The demographic characteristics of druginduced lupus largely depend upon the populations most likely to receive the relevant drugs.
During the last two decades, major improvements in the treatment of sle can be mainly attributed to a better use of traditional immunosuppressive drugs. Although the term is frequently used alone to designate lupus vulgaris and sometimes lupus erythematosus, without a modifier it has no meaning. Its clinical and laboratory features are similar to systemic lupus erythematosus, except that patients fully recover after the offending medication is discontinued. The terms drug induced lupus dil and drug induced lupus erythematosus dile are preferred, but other ones are also used drug related lupus, lupus like syndrome, and lupus erythematosus. No specific criteria have been established yet to arrive at a diagnosis of druginduced lupus. Aug 16, 2018 drug induced lupus erythematosus dile is a disorder that exhibits symptoms similar to that of lupus. Drug induced lupus is a lupus like disease caused by certain prescription drugs. Druginduced lupus erythematosus uf health, university of.
The subacute cutaneous lupus erythematosus scle rash is one of the. Drug induced subacute cutaneous lupus erythematosus on the back a and right arm b improved 1 month following treatment with hydroxychloroquine. While drug induced lupus may cause rash, arthritis and fever that appear similar to the systemic form of. Drug induced lupus erythematosus tends to affect individuals between the ages of 5070 years old. As in idiopathic or usualtype lupus erythematosus le, there are three categories recognised. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those agents that are metabolised by acetylation such as procainamide and hydralazine, with disease more likely to.
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. Cases of druginduced lupus erythematosus have been reported with some interferon beta products, including betaseron. Lupus is usually influenced by gene polymorphismseritematozjs of which have now been linked with the 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. Druginduced lupus erythematosus is an autoimmune disorder caused by chronic use of certain drugs. The drugs most commonly connected with drug induced lupus include. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in. Mary anne dooley, in systemic lupus erythematosus, 2016. The terms druginduced lupus dil and druginduced lupus erythematosus dile are preferred, but other ones are also useddrugrelated lupus, lupuslike syndrome, and lupus erythematosus medicamentosus. Oct 26, 2012 drug induced lupus is a syndrome resembling mild systemic lupus erythematosus which can complicate treatment with certain apparently unrelated therapies. A chronic, inflammatory autoimmune disorder that may affect many organ systems including the skin, joints, and internal organs. There are an estimated 15,000 to 30,000 cases of drug induced lupus per year in the united states. Druginduced subacute cutaneous lupus erythematosus on the back a and right arm b improved 1 month following treatment with hydroxychloroquine. Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus.
Sle is not to be confused with druginduced lupus erythematosus dile. Cases of druginduced lupus erythematosus have been reported with some interferon beta products, including extavia. There are an estimated 15,000 to 30,000 cases of druginduced lupus per year in the united states. Drugs like hydralazine, procainamide have been reported to induce lupus, but so far there is no case report of amiodaroneinduced lupus in indian literature. Drug induced lupus erythematosus is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient. Drugs that commonly cause dile include hydralazine, procainamide, isoniazid, minocycline, diltiazem, and tumor necrosis factor tnf inhibitors. Feb, 2020 some people develop a form of lupus that involves only the skin, called cutaneous lupus or discoid lupus erythematosus. Druginduced lupus erythematosus clinics in dermatology. However, the autoantibody pattern differs from those of most other forms of drug induced lupus.
Skin or musculo only, or druginduced lupus o poor prognosis. The diagnosis of systemic lupus erythematosus sle typically. Most of the time, drug induced lupus erythematosus is not as severe as sle. The symptoms of druginduced lupus usually resolve within days to weeks after discontinuing the offending drug without introduction of antiinflammatory medications.
Patients with druginduced lupus develop clinical manifestations and serologic markers similar to those for systemic lupus erythematosus sle, albeit milder. Druginduced lupus erythematosus dil or dile is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Druginduced lupus and sle sle is distinct from druginduced lupus, since dil generally has milder symptoms than sle, and no skin or kidney disease. Druginduced lupus erythematosus thearchangelmichaels blog. Druginduced lupus erythematosus dilesymptomstreatment. Systemic inflammatory response in many organ systems dysregulated autoimmune response involving many arms of the immune system including t cells, b cells and macrophages autoantibodies in sle. Drug induced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. The disease which is most often associated with taking drugs is sle. It is generally equally common in males and females, and more common in older people and white populations. The incidence of druginduced lupus in patients taking hydralazine for a year or longer is as high as 58%. Druginduced lupus erythematosus information mount sinai. Rarely, kidney inflammation nephritis can develop with drug induced lupus caused by tnf inhibitors or with anca vasculitis due to hydralazine or levamisole. 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. However, the clinical features of an isolated, individual case of drug induced lupus is not characteristic of a particular drug.
Pdf druginduced lupus erythematosus dile is a lupuslike syndrome temporally related to continuous drug exposure which resolves upon drug. An increasing number of drugs have been linked to drug induced subacute cutaneous lupus erythematosus discle. Systemic lupus erythematosus overview definition an autoimmune disease characterized by. Safety and efficacy of metformin in systemic lupus. Apr 15, 2005 drug induced lupus has been reported as a sideeffect of longterm therapy with over 40 medications. Drugs less frequently associated with the disease are chlorpromazine, isoniazid, methyldopa, penicillamine, quinidine and sulfasalazine. Druginduced lupus erythematosus definition of druginduced. Related conditions are druginduced cutaneous lupus and. What was interesting was that the words autoimmune and drug induced lupus werent even in the documentation. For the purpose of identifying patients in clinical studies, a person shall be said to have systemic lupus erythematosus if any 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation. Druginduced lupus erythematosus with emphasis on skin. Systemic lupus erythematosus knowledge for medical students.
Drug induced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Druginduced lupus has anyone ever been diagnosed with dil druginduced lupus. Such drugs may induce autoantibodies in some patients leading to a clinical syndrome similar to systemic lupus erythematosus. This trial was underpowered to draw a sound conclusion on the efficacy of metformin to reduce disease flares as an addon treatment to standard care in patients with sle. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Cns or renal involvement goals of treatment prevent disease flares and involvement of other organs confine lupus. The demographic characteristics of drug induced lupus largely depend upon the populations most likely to receive the relevant drugs. Druginduced lupus has been reported as a sideeffect of longterm therapy with over 40 medications. 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. The most common individual agents are procainamide and hydralazine.
It is well established that certain drugs induce autoantibodies in a signifi cant number of patients, most of whom do not develop signs of an autoantibody associated disease. Druginduced lupus erythematosus is a result of sideeffects, which occur due to prolonged usage of certain medications. Drug induced scle associated with antifungals, however, usually is much more rapid in onset. Amiodaroneinduced systemic lupus erythematosus ak kundu abstract druginduced lupus is not a very common entity. Do you know how to distinguish sle from other conditions with similar clinical characteristics. 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 resolves after discontinuation of the offending agent. Druginduced lupus is a syndrome resembling mild systemic lupus erythematosus which can complicate treatment with certain apparently unrelated therapies. A case of atrial fibrillation in an elderly man who came with systemic.
Hydrochlorothiazide has been recognized to cause subacute cutaneous lupus erythematosus, but very few cases of systemic drug induced lupus systemic erythematosus have been reported. Article information, pdf download for druginduced lupus. Drug induced lupus erythematosus dil or dile is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Rheumatic diseases induced by drugs and environmental. Between june and october 2003, 866 rheumatology and internal medicine practitioners from all french hospital centres prescribing antitnf in rheumatic diseases registered on the website of the club rhumatismes et inflammation were contacted by email to obtain the files of patients with tnfinduced systemic lupus erythematosus. Druginduced lupus current medical diagnosis and treatment. The incidence of lupus in the united states is estimated at 15 000 to 30 000 newly diagnosed cases annually. To report the occurrence of drug induced systemic lupus erythematosus sle with multisystem manifestations in a patient who was initiated on treatment with sertraline.
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 is an uncommon, mild to moderately severe, a lupus like syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. Druginduced lupus erythematosus statpearls ncbi bookshelf. Systemic lupus erythematosus sle is a prevalent autoimmune disorder. Druginduced lupus erythematosus uf health, university. The documents contained in this web site are presented for information purposes only. Drug induced lupus erythematosus is a result of sideeffects, which occur due to prolonged usage of certain medications. Druginduced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. In lupus, the bodys immune system, which normally functions to protect against foreign invaders, becomes. Druginduced lupus dil is an autoimmune phenomenon where a drug. Druginduced lupus definition of druginduced lupus by. This means your body attacks healthy tissue by mistake. Related conditions are drug induced cutaneous lupus and drug induced anca vasculitis.