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Drug-induced lupus erythematosus

Definition

Drug-induced lupus erythematosus is an autoimmune disorder that is triggered by a reaction to a medicine.

Alternative Names

Lupus - drug induced

Causes

Drug-induced lupus erythematosus is similar but not identical to systemic lupus erythematosus (SLE). It is an autoimmune disorder. This means your body attacks healthy tissue by mistake. It is caused by a reaction to a medicine. Related conditions are drug-induced cutaneous lupus and drug-induced ANCA vasculitis.

The most common medicines known to cause drug-induced lupus erythematosus are:

  • Isoniazid
  • Hydralazine
  • Procainamide
  • Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab)
  • Minocycline
  • Quinidine

Other less common drugs may also cause the condition. These may include:

  • Anti-seizure medicines
  • Capoten
  • Chlorpromazine
  • Methyldopa
  • Sulfasalazine
  • Levamisole, typically as a contaminant of cocaine

Cancer immunotherapy drugs such as pembrolizumab can also cause a variety of autoimmune reactions including drug-induced lupus.

Symptoms of drug-induced lupus tend to occur after taking the drug for at least 3 to 6 months.

Symptoms

Symptoms may include:

Exams and Tests

The health care provider will do a physical exam and listen to your chest with a stethoscope. The provider may hear a sound called a heart friction rub or pleural friction rub.

A skin exam shows a rash.

Joints may be swollen and tender.

Tests that may be done include:

A chest x-ray may show signs of pleuritis or pericarditis (inflammation around the lining of the lung or heart). An ECG may show that the heart is affected.

Treatment

Most of the time, symptoms go away within weeks after stopping the medicine that caused the condition.

Treatment may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat arthritis and pleurisy
  • Corticosteroid creams to treat skin rashes
  • Antimalarial drugs (hydroxychloroquine) to treat skin and arthritis symptoms

If the condition is affecting your heart, kidney, or nervous system, you may be prescribed high doses of corticosteroids (prednisone, methylprednisolone) and immune system suppressants (azathioprine or cyclophosphamide). This is rare.

When the disease is active, you should wear protective clothing and sunglasses to guard against too much sun.

Outlook (Prognosis)

Most of the time, drug-induced lupus erythematosus is not as severe as SLE. The symptoms often go away within a few days to weeks after stopping the medicine you were taking. Rarely, kidney inflammation (nephritis) can develop with drug-induced lupus caused by TNF inhibitors or with ANCA vasculitis due to hydralazine or levamisole. Nephritis may require treatment with prednisone and immunosuppressive medicines.

Avoid taking the drug that caused the reaction in future. Symptoms are likely to return if you do so.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Call your provider if:

  • You develop new symptoms when taking any of the medicines listed above.
  • Your symptoms do not get better after you stop taking the medicine that caused the condition.

Prevention

Watch for signs of a reaction if you are taking any of the drugs that can cause this problem.

Gallery

Systemic lupus erythematosus
Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder which may affect many organ systems including the skin, joints and internal organs. The disease may be mild or severe and life-threatening. African-Americans and Asians are disproportionately affected.
Stomach
The stomach is the portion of the digestive system most responsible for breaking down food. The lower esophageal sphincter at the top of the stomach regulates food passing from the esophagus into the stomach, and prevents the contents of the stomach from reentering the esophagus. The pyloric sphincter at the bottom of the stomach governs the passage of food out of the stomach into the small intestine.

References

Benfaremo D, Manfredi L, Luchetti MM, Gabrielli A. Musculoskeletal and rheumatic diseases induced by immune checkpoint inhibitors: a review of the literature. Curr Drug Saf. 2018;13(3):150-164. PMID: 29745339 pubmed.ncbi.nlm.nih.gov/29745339/.

Radhakrishnan J, Perazella MA. Drug-induced glomerular disease: attention required. Clin J Am Soc Nephrol. 2015;10(7):1287-1290. PMID: 25876771 pubmed.ncbi.nlm.nih.gov/25876771/.

Richardson BC. Drug-induced lupus. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 141.

Rubin RL. Drug-induced lupus. Expert Opin Drug Saf. 2015;14(3):361-378. PMID: 25554102 pubmed.ncbi.nlm.nih.gov/25554102/.

Rubin RL. Drug-induced lupus. In: Tsokos GC, ed. Systemic Lupus Erythematosus. 2nd ed. Cambridge, MA: Elsevier Academic Press; 2021:chap 56.

Vaglio A, Grayson PC, Fenaroli P, et al. Drug-induced lupus: traditional and new concepts. Autoimmun Rev. 2018;17(9):912-918. PMID: 30005854 pubmed.ncbi.nlm.nih.gov/30005854/.

Last reviewed May 2, 2021 by Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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