RESEARCH - Drug-induced lupus due to anti-TNF-alpha agents

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Semin Arthritis Rheum. 2008 Jun;37(6):381-7. Epub 2007 Oct 30.

Drug-induced lupus due to anti-tumor necrosis factor alpha agents.

Costa MF, Said NR, Zimmermann B.

Medical Center, Boston University School of Medicine,

Providence, RI 02908, USA.

PURPOSE: To evaluate the reported cases of drug-induced lupus

erythematosus (DILE) due to anti-tumor necrosis factor (TNF) alpha

therapy and to compare " classic " DILE with DILE secondary to

anti-TNFalpha therapy. We also add 3 case reports related to 3

different anti-TNFalpha drugs to the literature. METHODS: We searched

the Medline database for cases published in English and evaluated 53

cases in 27 papers purported to be TNFalpha-induced DILE. We compared

the clinical and laboratory features of cases that fulfilled our

criteria for TNFalpha DILE to those of DILE due to non-TNFalpha drugs

as found in standard texts. We also report the clinical and laboratory

findings of our 3 patients with drug-induced lupus related to

anti-TNFalpha drugs, 1 each in patients treated with adalimumab,

etanercept, and infliximab. RESULTS: Of the 53 purported cases of DILE

due to anti-TNFalpha therapy, we excluded 17 with cutaneous

manifestations alone and 3 with overlap syndromes and mixed connective

tissue disease. In the 33 cases that met our criteria for systemic

DILE, 21 cases were due to infliximab, 10 cases were due to

etanercept, and only 2 cases were related to adalimumab.

TNFalpha-blocker-induced DILE cases had a higher prevalence of

antibodies to double-stranded DNA, rash, and hypocomplementemia than

DILE due to other drugs. Fever is common in both types of DILE. Renal

disease, which is rare in classic DILE, has been reported in cases of

TNFalpha DILE.

CONCLUSIONS: TNFalpha DILE has significant clinical and laboratory

manifestations which distinguish it from DILE due to drugs other than

anti-TNF agents and may be difficult to diagnose in patients treated

for autoimmune diseases. It is appropriate to consider whether all

patients who are begun on anti-TNF therapy should have pretreatment

serologic evaluation for systemic lupus erythematosus.

PMID: 17977585

http://www.ncbi.nlm.nih.gov/pubmed/17977585

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