Mar 18, 2020 systemic lupus erythematosus sle is a chronic inflammatory disease that has protean manifestations and follows a relapsing and remitting course. This study compared the effects of procainamide pca and hydralazine hyd. Druginduced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. Marker dil sle antihistone antibodies 95% 50% antidna antibodies antissdna antidsdna burlingame rw. Druginduced lupus rarely is systemic and does not affect major internal organs. Druginduced lupus current medical diagnosis and treatment. The etiology of sle is unclear, but genetic predisposition is an important factor.
There are currently no standard diagnostic criteria for dile and the pathomechanisms are still unclear. Druginduced lupus is when its caused by taking certain prescription medicines for months or years at a time. Oct 17, 2018 lupus is a chronic, autoimmune disease that can damage any part of the body. It is usually diagnosed by finding antibodies to single stranded dna, not double stranded dna, as in sle. Druginduced lupus is the presence of sle manifestations occurring after exposure to specific medications, listed in table 1084. 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. Before making a diagnosis of systemic lupus erythematosus sle, ruling out drugs as the cause of the condition is important. Druginduced lupus erythematosus information mount sinai. A 45yearold woman developed polyarthralgia and muscle tenderness after 6 months therapy with labetalol 1800 mg daily. Sep 17, 2008 druginduced lupus erythematosus dile is defined as a lupuslike syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic. Systemic lupus erythematosus, often abbreviated sle, is a serious autoimmune syn drome that usually.
Symptoms usually occur 3 to 6 months after starting a medication, and disappear once the medicine is stopped. Systemic lupus erythematosus sle musculoskeletal and. 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 lupus is when its caused by taking certain prescription medicines for months or years at a time. A newbie asking about drug induced lupus and zoloft. Sle has a diverse array of clinical manifestations and, consequently, is often difficult to diagnose. Because the clinical expression, time course and natural history of drugs that exacerbate sle are so heterogeneous it is not readily possible to place them into either of these categories, and their. Both symptoms and anf titre improved when therapy was changed from labetalol to propranolol. For all implicated drugs, the incidence of druginduced ana positivity alone is far greater often two to fivefold more common than the actual druginduced lupus syndrome. 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. Autoantibodies reactive with chromatin in systemic lupus erythematosus and druginduced lupus. Systemic lupus erythematosus sle is a chronic autoimmune disease characterized by multisystemic involvement and diverse manifestations. Neuropsychiatric systemic lupus erythematosus npsle is a complex neurological disorder characterized by neuropsychological dysfunction.
Specific classification criteria for drug induced lupus have not been published, and no published data address differences between adult and pediatric drug induced lupus. Early reports suggested that procainamide and hydralazine were associated with the highest risk of developing lupus, quinidine with a moderate risk and all other drugs were considered low or very low risk. Drug induced lupus means that the disease systemic lupus erythematous was caused by a certain drug. Druginduced lupus affects a greater percentage of males, whites, and the elderly than does idiopathic sle table 12.
T he most frequently evoked theory to explain the pathogenesis of druginduced systemic lupus er ythematosus. Lupus is a chronic, autoimmune disease that can damage any part of the body. The patient declared irregular use of propylthiouracil ptu for the last 8 months. Sle is regarded as a prototype disease due to the significant overlap in its symptoms with other autoimmune diseases. Th e extreme heterogeneity of the disease has led some investigators to propose that sle represents a syndrome rather than a single disease. Druginduced lupus erythematosus statpearls ncbi bookshelf. In this depiction, the central player in initiating dil is the autoreactive thelper cell th. It occurs predominantly in women of reproductive age. It usually develops only after months and, quite commonly, years of treatment with the offending agent, although latencies of days or weeks have been described in some. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those. Druginduced systemic lupus erythematosus associated with etanercept therapy. Common manifestations may include arthralgias and arthritis, raynaud syndrome, malar and other rashes, pleuritis or pericarditis, renal or central nervous system involvement, and hematologic cytopenias. With drug induced, symptoms will resolve after stopping medications. Related conditions are drug induced cutaneous lupus and drug induced anca vasculitis.
Druginduced lupus dil is an autoimmune phenomenon where a drug exposure leads to the development of systemic lupus erythematosus. However, drug induced lupus usually occurs in males over 50 years old because they are more likely to develop chronic diseases i. 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. Druginduced lupus erythematosus is a generally reversible condition that usually occurs in people being treated for a longterm illness. Drug induced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. Drug induced lupus erythematosus symptoms, treatments. Drug induced lupus erythematosus dile is an autoimmune variant of systemic lupus erythematosus triggered by the acute or chronic use of a medication. Jul 10, 2018 most patients with druginduced lupus erythematosus dile have 1 or more clinical symptoms of systemic lupus erythematous sle, such as arthralgias, lymphadenopathy, rash, and fever, and have no prior history of autoimmune disease.
The only drug i am on and have ever been on is zoloft. Chemotherapy druginduced neutropenia has a very high incidence in oncology patients. Systemic dile presents as a milder version of idiopathic sle, and the drugs most frequently implicated are hydralazine, procainamide and quinidine. Related conditions are druginduced cutaneous lupus and. Check the latest reports from 143 drug induced lupus erythematosus patients, or browse all conditions. Lupus is more common among women of childbearing age ages 15 to 44 years. All 23 patients with druginduced lupus erythematosus le lost nuclear staining on acidextracted sections.
Because symptoms are nonspecific, subjective, and protean, diagnosis of drug induced lupus dil requires awareness of this risk of chronic. The nature of drug induced systemic lupus erythematosus, arthritis rheum 3. Most patients with druginduced lupus erythematosus dile have 1 or more clinical symptoms of systemic lupus erythematous sle, such as arthralgias, lymphadenopathy, rash, and fever, and have no prior history of autoimmune disease. Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. While lupus may damage your kidneys or lungs, drug induced lupus rarely affects your. Will you have drug induced lupus erythematosus with topamax. May 06, 2020 before making a diagnosis of systemic lupus erythematosus sle, ruling out drugs as the cause of the condition is important. Dec 08, 2017 chemotherapy druginduced neutropenia has a very high incidence in oncology patients. Nov 20, 2012 the generation of autoantibodies and autoimmune diseases such as systemic lupus erythematosus has been associated with the use of certain drugs in humans. Many pharmacologic agents have been associated with a lupuslike. More than 90% of cases of sle occur in women, frequently starting at childbearing age. A raised anf titre but normal dna binding levels suggested a drug induced sle syndrome. Antinuclear antibodies following infliximab treatment in patients with rheumatoid arthritis or spondylarthropathy. In contrast, only 12 of 20 with idiopathic sle lost nuclear staining on acidextracted tissues, and in the remaining 8, there was no significant fall in titer.
Medical mnemonics druginduced lupus causes rheumatology mnemonics internal medicine, usmle step 3 and usmle step 2 questions for the board exam. A 27 year old female with graves disease presented with fever, exertional dyspnea and polyarthralgia. The use of the abbreviation sle means idiopathic sle throughout this chapter. Druginduced lupus erythematosus dile is defined as a lupuslike syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Chest xray showed inhomogenous pulmonary opacities, left pleural.
Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus. Table 4 compares the overall features of druginduced lupus with classical drug hypersensitivity such as druginduced autoimmune hemolytic anemia. Druginduced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. Related conditions are druginduced cutaneous lupus and druginduced anca vasculitis. The high femaletomale ratio associated with sle is not seen with drug induced lupus. Antibodies to histones in druginduced and idiopathic lupus. Systemic lupus erythematosus sle is the prototypic multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues. Druginduced lupus erythematosus with emphasis on skin.
As a general rule, druginduced lupus presents with fever, arthralgia, myalgia, and serositis but not renal involvement. Druginduced lupus shares several clinical and serologic features with sle but is due to ongoing exposure to a drug and resolves when the offending drug is discontinued. Systemic lupus erythematosus sle is a multisystem autoimmune disorder characterized by the production of antibodies to components of the cell nucleus. Dil is reversible by discontinuation of the medication. In the druginduced le group, loss of nuclear staining was due to the absence. While lupus may damage your kidneys or lungs, druginduced lupus rarely affects your. This means your body attacks healthy tissue by mistake. Sle has a diverse array of clinical manifestations and, consequently, is. Th may arise when reactive drug metabolites figure 2 interfere. Lupus can affect almost any organ in your body, which can lead to a variety of different symptoms.
Jul 17, 2012 a 27 year old female with graves disease presented with fever, exertional dyspnea and polyarthralgia. Drug induced systemic lupus erythematosus associated with etanercept therapy. Characteristics of druginduced lupus erythematosus. Druginduced lupus erythematosus clinical presentation. Jan 20, 2012 druginduced lupus dil is one of the most widely described druginduced rheumatologic syndromes. As in idiopathic or usualtype lupus erythematosus le, there are three categories recognised. The generation of autoantibodies and autoimmune diseases such as systemic lupus erythematosus has been associated with the use of certain drugs in humans. These drugs cause an autoimmune response the body attacks its own cells producing symptoms similar to those of sle. How is druginduced lupus erythematosus differentiated from. Systemic lupus erythromatosus sle dr sylvia opanga introduction systemic lupus erythematosus sle is a.
Npsle is associated with increased morbidity and mortality. Binding to histone of an anomalous igg from patients with sle and druginduced. Neutropenia and microscopic hematuria developed in the second week of admission. Propylthiouracilinduced lupuslike or vasculitis syndrome. Induced lupus borchers 2007 annals of the new york. Chest xray showed inhomogenous pulmonary opacities, left pleural effusion. A new appearance of druginduced systemic lupus erythematosus author. Sle like syndrome 9 definition autoimmune disease involving musculoskeletal, skin, kidneys and cns epidemiology 15k20k cases year 3050k people have drug induced sle in us 510% of cases of sle are drug induced mechanism alterations in immunologic pathways or drug metabolism molecular mimecry rx like a nucleic. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle.
To our knowledge, there have been no published cases of dil associated with infliximab use in the pediatric population, on the basis of english and nonenglish literature obtained from medline searches through april 2008 using the key words infliximab, remicade, lupus, sle, dil, autoimmune, druginduced, child, pediatric, and adolescent. Drug induced lupus erythematosus an autoimmune disorder brought on by a reaction to medication has been reported by people with birth control, migraine with aura. Symptoms moderate with time, can be easily treated with lowdose steroids 510mg, and pain meds like naproxen. Drug induced lupus is the presence of sle manifestations occurring after exposure to specific medications, listed in table 1084. Drug induced lupus dile is a temporary form of lupus that is brought on by a reaction to medication. Specific classification criteria for druginduced lupus have not been published, and no published data address differences between adult and pediatric druginduced lupus. I never had any side effects from this drug before,but god help me if i have to go off it. A new appearance of drug induced systemic lupus erythematosus author. Similarly to idiopathic lupus, dile can be diveded into systemic sle, subacute cutaneous scle and chronic.
Systemic lupus erythematosus sle is a chronic inflammatory disease that has protean manifestations and follows a relapsing and remitting course. Pdf among the numerous idiopathic immunemediated diseases that can be druginduced, such as pemphigus, psoriasis, lichen, etc, druginduced lupus is. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit. Report of 35 cases with discussion of seven apparently induced by anticonvulsant medication, prognosis, and treatment, pediatrics 32. Systemic refers to ability to affect different systems. Dile or dil can occur as a sideeffect of certain medications.
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