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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