Drug-induced lupus erythematosus: incidence, management and prevention
- PMID: 21513360
- DOI: 10.2165/11588500-000000000-00000
Drug-induced lupus erythematosus: incidence, management and prevention
Abstract
The generation of autoantibodies and autoimmune diseases such as systemic lupus erythematosus has been associated with the use of certain drugs in humans. 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. More recently, drug-induced lupus has been associated with the use of the newer biological modulators such as tumour necrosis factor (TNF)-α inhibitors and interferons. The clinical features and laboratory findings of TNFα inhibitor-induced lupus are different from that of traditional drug-induced lupus or idiopathic lupus, and standardized criteria for the diagnosis of drug-induced lupus have not been established. The mechanism(s) responsible for the development of drug-induced lupus may vary depending on the drug or even on the patient. Besides lupus, other autoimmune diseases have been associated with drugs or toxins. Diagnosis of drug-induced lupus requires identification of a temporal relationship between drug administration and symptom development, and in traditional drug-induced lupus there must be no pre-existing lupus. Resolution of symptoms generally occurs after cessation of the drug. In this review, we will discuss those drugs that are more commonly associated with drug-induced lupus, with an emphasis on the new biologicals and the difficulty of making the diagnosis of drug-induced lupus against a backdrop of the autoimmune diseases that these drugs are used to treat. Stimulation of the immune system by these drugs to cause autoimmunity may in fact be associated with an increased effectiveness in treating the pathology for which they are prescribed, leading to the dilemma of deciding which is worse, the original disease or the adverse effect of the drug. Optimistically, one must hope that ongoing research in drug development and in pharmacogenetics will help to treat patients with the maximum effectiveness while minimizing side effects. Vigilance and early diagnosis are critical. The purpose of this review is to summarize the most recent developments in our understanding of the incidence, pathogenesis, diagnosis and treatment of drug-induced lupus.
Similar articles
-
Diagnosis and classification of drug-induced autoimmunity (DIA).J Autoimmun. 2014 Feb-Mar;48-49:66-72. doi: 10.1016/j.jaut.2014.01.005. Epub 2014 Jan 21. J Autoimmun. 2014. PMID: 24456934 Review.
-
Drug-induced lupus erythematosus.Arch Dermatol Res. 2009 Jan;301(1):99-105. doi: 10.1007/s00403-008-0895-5. Epub 2008 Sep 17. Arch Dermatol Res. 2009. PMID: 18797892 Review.
-
Drug-induced lupus erythematosus.Actas Dermosifiliogr. 2014 Jan-Feb;105(1):18-30. doi: 10.1016/j.ad.2012.09.007. Epub 2012 Nov 17. Actas Dermosifiliogr. 2014. PMID: 23164669 Review. English, Spanish.
-
Drug-induced lupus erythematosus: an update on drugs and mechanisms.Curr Opin Rheumatol. 2018 Sep;30(5):490-497. doi: 10.1097/BOR.0000000000000522. Curr Opin Rheumatol. 2018. PMID: 29870500 Free PMC article. Review.
-
Drug-induced lupus: an update on its dermatologic aspects.Lupus. 2009 Oct;18(11):935-40. doi: 10.1177/0961203309106176. Lupus. 2009. PMID: 19762393 Review.
Cited by
-
Understanding Autoimmunity: Mechanisms, Predisposing Factors, and Cytokine Therapies.Int J Mol Sci. 2024 Jul 12;25(14):7666. doi: 10.3390/ijms25147666. Int J Mol Sci. 2024. PMID: 39062908 Free PMC article. Review.
-
Recurrence of Drug-Induced Lupus Secondary to Vedolizumab Use in a Patient With Crohn's Disease.ACG Case Rep J. 2024 Jan 25;11(1):e01270. doi: 10.14309/crj.0000000000001270. eCollection 2024 Jan. ACG Case Rep J. 2024. PMID: 38274296 Free PMC article.
-
Paclitaxel-Induced Cutaneous Lupus Erythematosus and Raynaud's Phenomenon.Cureus. 2023 Dec 22;15(12):e50974. doi: 10.7759/cureus.50974. eCollection 2023 Dec. Cureus. 2023. PMID: 38259408 Free PMC article.
-
Incidence of immune-mediated inflammatory diseases following COVID-19: a matched cohort study in UK primary care.BMC Med. 2023 Sep 21;21(1):363. doi: 10.1186/s12916-023-03049-5. BMC Med. 2023. PMID: 37735654 Free PMC article.
-
IFN-α induced systemic lupus erythematosus complicated with hemophagocytic lymphohistiocytosis: a case report and literature review.Front Immunol. 2023 Aug 4;14:1223062. doi: 10.3389/fimmu.2023.1223062. eCollection 2023. Front Immunol. 2023. PMID: 37600795 Free PMC article. Review.
References
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical