CASE REPORT - Development of SLE with focal proliferative lupus nephritis during anti-TNF-alpha therapy for psoriatic arthritis

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Med Klin (Munich). 2007 Oct 15;102(10):852-7.

[Development of systemic lupus erythematosus with focal proliferative

lupus nephritis during anti-TNF-alpha therapy for psoriatic

arthritis][Article in German]

Haake H, Köneke J, Amann K, vom Dahl J, Janssen U.

Abteilung für Kardiologie, Nephrologie und Intensivmedizin,

Medizinische Klinik II, Krankenhaus St. Franziskus, Kliniken

Hilf, Mönchengladbach.

BACKGROUND: Treatment with tumor necrosis factor-(TNF-)alpha-blocking

agents is used in a variety of autoimmune diseases. In anti-TNF-alpha

therapy for rheumatoid arthritis, occasionally, the development of

autoantibodies as well as lupus-like syndromes have been observed,

rarely, glomerulonephritides are also induced. The authors first

report the development of lupus erythematosus with renal involvement

in a patient with psoriatic arthritis during therapy with the soluble

TNF-alpha receptor etanercept. CASE REPORT: A 70-year-old patient with

long-standing psoriatic arthritis developed pleuritis, pericarditis,

as well as marked arthralgias during therapy with etanercept.

Laboratory investigation showed markedly increased parameters of

inflammation, antinuclear antibodies (ANA), a proteinuria of 3.2

g/day, mild impairment of renal function, as well as a nephritic

urinary sediment. A subsequently performed renal biopsy was diagnostic

for focal proliferative lupus nephritis. After withdrawal of

etanercept and initiation of a cyclophosphamide pulse therapy in

combination with oral steroids, parameters of inflammation and renal

function rapidly normalized; pleuritis and pericarditis were not

detectable anymore.

CONCLUSION: Anti-TNF-alpha therapy in patients with psoriatic

arthritis or other autoimmune diseases may lead to induction of

systemic lupus with renal involvement.

PMID: 17928969

http://www.ncbi.nlm.nih.gov/pubmed/17928969

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