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Lupus, Drug-Induced

For further information, see CMDT Part 20-08: Drug-Induced Lupus

Key Features

  • Shares several clinical and serologic features with systemic lupus erythematosus (SLE) but is due to ongoing exposure to a drug

  • Symptomatic during exposure to offending drug; symptoms resolve when drug is stopped

  • Elevated ANA but unlikely to have anti-DNA antibodies unless secondary to TNF inhibitors

  • The sex ratio is nearly equal

  • Incidence of drug-induced lupus

    • 5–8% in patients taking hydralazine for ≥ 1 year

    • < 1% for most other medications

Clinical Findings

  • Fever

  • Arthralgia

  • Myalgia

  • Serositis

  • Unlike in SLE, renal involvement and neurologic symptoms are unlikely

Diagnosis

  • Serologic testing reveals elevated titers of antinuclear antibodies in all patients, but antibodies to DNA, Sm, RNP, SS-A, and SS-B are rare (Table 20–7)

  • Antibodies to histones are common but also are seen in SLE and thus do not distinguish drug-induced lupus from SLE; their absence, however, makes either diagnosis unlikely

  • Complement levels are usually normal

Table 20–7.Frequency (%) of autoantibodies in rheumatic diseases.1
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Table 20–7. Frequency (%) of autoantibodies in rheumatic diseases.1
  ANA Anti- DNA Rheumatoid Factor Anti-Sm Anti-SS-A Anti-SS-B Anti-SCL-70 Anti-Centromere Anti-Jo-1 ANCA Anti-CCP
Rheumatoid arthritis 30–60 0–5 70 0 0–5 0–2 0 0 0 0 70–80
SLE 95–100 50 20 20 15–20 5–20 0 0 0 0–1 10–15
Sjögren syndrome 95 0 75 0 65 65 0 0 0 0 0
Diffuse systemic sclerosis > 95 0 30 0 0 0 33 3 0 0 10
Limited systemic sclerosis > 95 0 30 0 0 0 20 50 0 0 10
Polymyositis/dermatomyositis 80 0 33 0 0 0 0 0 20–30 0 3
Granulomatosis with polyangiitis 0–15 0 50 0 0 0 0 0 0 93–961 0

1Frequency for generalized, active disease.

ANA, antinuclear antibodies; Anti-Sm, anti-Smith antibody; Anti-SCL-70, anti-scleroderma antibody; ANCA, antineutrophil cytoplasmic antibody; anti-CCP, anti-cyclic citrullinated peptides.

Treatment

  • Discontinue the offending drug

  • Drug-induced lupus generally resolves within weeks to months after drug discontinuation

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