REVIEW - Anti-TNF-induced lupus

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Rheumatology Advance Access published online on May 4, 2009

Rheumatology, doi:10.1093/rheumatology/kep080

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Review

Anti-TNF-induced lupus

Emma L. 1, Stephan Gadola1,2 and J. 1

1Department of Rheumatology, Southampton University Hospitals NHS

Trust and 2Division of Infection, Inflammation and Repair, School of

Medicine, Southampton University, Southampton, UK.

Abstract

The use of protein-based anti-TNF- therapies such as antibodies and

soluble TNF- receptors is commonly associated with the induction of

autoantibodies, whereas anti-TNF-induced lupus (ATIL) is rare. ATIL

can occur with any of the available TNF inhibitors, but the frequency

and clinical characteristics of ATIL vary between different drugs.

Cutaneous, renal and cerebral involvement as well as dsDNA antibodies

are more common in ATIL compared to classical drug-induced lupus

(DIL), suggesting different pathogenic mechanisms of ATIL and DIL.

True ATIL must be clinically differentiated from mixed CTD, SLE or

overlap syndromes unmasked, but not induced, by anti-TNF- treatment of

unclassified polyarthritis. The pathogenesis of ATIL is still unknown.

Concomitant immunosuppression can reduce autoantibody formation in

ATIL, and withdrawal of anti-TNF- therapy usually leads to resolution

of symptoms. Steroids and/or immunosuppressive therapy may be required

in severe cases.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep080v1?papetoc

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