Drug induced lupus erythematosus

Drug-Induced Lupus Erythematosus (DILE) is a form of lupus erythematosus triggered by certain pharmaceutical agents. DILE shares similar clinical features with systemic lupus erythematosus (SLE) but typically has a more favorable prognosis once the causative drug is discontinued.

Overview

• Classification: Autoimmune disease
• Specialty: Rheumatology, Dermatology
• Symptoms: Arthralgia, fever, serositis, skin rashes
• Causes: Certain medications
• Diagnosis: Clinical features, laboratory tests, drug history
• Treatment: Drug discontinuation, symptomatic treatment

Pathophysiology

DILE is thought to result from a complex interplay between genetic predisposition, environmental factors, and immune dysregulation. Certain medications can trigger autoimmune responses by altering immune regulation or by acting as haptens, leading to an inflammatory cascade akin to SLE.

Causes

Drugs Commonly Associated with DILE

• 1. Hydralazine
• 2. Procainamide
• 3. Isoniazid
• 4. Quinidine
• 5. Minocycline
• 6. Anti-TNF agents (e.g., infliximab)
• 7. Other drugs, including certain anticonvulsants and blood pressure medications, have also been implicated.

Clinical Features

Symptoms

• Arthralgia and Myalgia: Joint and muscle pain are common.
• Skin Manifestations: Rashes, particularly photosensitive rashes, may occur.
• Serositis: Inflammation of serous membranes leading to pleuritis or pericarditis.
• Fever
• Fatigue

Differences from SLE

• Renal and CNS involvement is less common in DILE compared to SLE.
• Antinuclear antibodies (ANA) are often present, but anti-dsDNA antibodies are less common.
• Typically, symptoms resolve upon discontinuation of the offending drug.

Diagnosis

Diagnosis of DILE involves a combination of clinical assessment, laboratory tests, and a thorough drug history. Key components include:

• 1. Clinical Presentation: Similar to SLE but often with fewer organ systems involved.
• 2. Laboratory Tests: Positive ANA, other autoantibodies may be present. Routine blood tests may show elevated inflammatory markers.
• 3. Drug History: Identification of drug exposure known to cause DILE.
• 4. Exclusion of Other Causes: Other causes of lupus-like symptoms should be ruled out.

Treatment

The cornerstone of DILE management is the identification and discontinuation of the causative drug. Additional treatments may include:

• 1. NSAIDs: For arthralgia and myalgia.
• 2. Corticosteroids: In cases of severe inflammation or organ involvement.
• 3. Antimalarials: In refractory cases or when symptoms persist after drug withdrawal.

Prognosis

The prognosis of DILE is generally favorable, with most patients experiencing symptom resolution within weeks to months after discontinuing the offending drug. Long-term outcomes are typically good, with a low risk of developing classic SLE.

Conclusion

Drug-Induced Lupus Erythematosus is a significant clinical entity that mirrors systemic lupus erythematosus but is precipitated by certain medications. Recognition of DILE is crucial for prompt management, primarily involving the withdrawal of the offending drug. Understanding DILE's pathophysiology, clinical features, and management strategies is essential for healthcare professionals in providing optimal patient care.

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