İlaca bağlı lupus

İlaca bağlı lupus, suçlu ilacın kesilmesiyle klinik bulguların geri dönebildiği, sistemik lupus eritematozun kendini sınırlayan bir formudur. En sık neden olan ilaçlar hidralazin ve prokainamiddir, bunları takiben klorpromazin, izoniazid, metildopa, penisilamin, kinidin ve sulfasalazin sık suçlanan ilaçlar arasındadır. Yeni biyolojik ajanların ve antisitokin tedavilerin gündemde olmasıyla birlikte ilaca bağlı lupus görülme sıklığı artmıştır. En sık görülen klinik bulgular; artralji, artrit, miyalji, serozit ve ateştir. Antihiston antikorları hastalarda çoğunlukla bulunmaktadır. İlaca bağlı lupusta, suçlu ilacın kesilmesi ile hastalık bulguları ortadan kalkmasına rağmen, bazen kısa dönem kortikosteroid tedavisine ihtiyaç olmaktadır.

Drug-induced lupus

Drug-induced lupus is a self-limited form of systemic lupus erythematosus which resolves clinical manifestations when the offending drug is discountinued. The most common precipitants are hydralazine and procainamide, followed by chlorpromazine, isoniazid, methyldopa, penicillamine, quinidine and sulfasalazine. Some of the newer biologic and anticytokine therapies appear to be associated with an increased incidence of drug-induced lupus. The most common presentations of drug-induced lupus are arthralgias, arthritis, myalgias, serositis and fever. Anti-histone anitibodies are commonly found. Clinical manifestations of drug-induced lupus resolve on drug cessation, although short-term corticosteroid treatment is sometimes required.

PDF

___

1. Uramato KM, Michet CJJ, Thumboo J. Trends in the incidence and mortality of systemic lupus erythematosus. Arthritis Rheum 1999;42:46-50.
2. Calvo-Alen J, Bastian HM, Straaton KV. Identification of patient subsets among those presumptively diagnosed with, referred, and/or followed up for systemic lupus erythematosus at a large tertiary care center. Arthritis Rheum 1995;38:1475-1484.
3. Olsen NJ. Drug-induced autoimmunity. Best Practice Research Clinical Rheumatology 2004;18:677- 682.
4. Fritzler MJ. Drugs recently associated with lupus syndromes. Lupus 1994;3:455-459.
5. Yung RL, Richardson BC. Drug-induced lupus. Rheum Dis Clin North Am 1994;20:61-86.
6. Yung R, Powers D, Johnson K. Mechanism of druginduced lupus. T cells overexpressing lymphocyte function- associated antigen 1 become autoreactive and induce a lupus-like disease disease in syngeneic mice. J Clin Invest 1996;97:2866-2871.
7. Lu Q, Kaplan M, Ray D. Demethylation of ITGAL (CD11a) regulatory sequences in systemic lupus erythematosus. Arthritis Rheum 2002;46:1282-1291.
8. Deng C, Lu Q, Zhang Z. Hydralazine may induce autoimmunity by inhibiting extracellular signal-regulated kinase pathway signaling. Arthritis Rheum 2003;48:746- 756.
9. McKinnon RA, Nebert DW. Possible role of cytochrome P450 in lupus erythematosus and related disorders. Lupus 1994;3:473-477.
10. Grant DM, Morike K, Eichelbaum M, Meyer UA. Acetylation pharmacokinetics. The slow acetylator phenotype is caused by decreased or absent arylamine Nacetyltransferase in human liver. J Clin Invest 1990; 85: 968-972.
11. Yung RL, Johnson KJ, Richardson BC. New concepts in the pathogenesis of drug-induced lupus. Lab Invest 1995; 73:746-759.
12. Rubin RL, Bell SA, Burlingame RW. Autoantibodies associated with lupus induced by diverse drugs target a similar epitope in the (H2A-H2B)-DNA complex. J Clin Invest 1992; 90:165-173.
13. Kretz-Rommel A, Duncan SR, Rubin RL. Autoimmunity caused by disruption of central T cell tolerance. A murine model of drug-induced lupus. J Clin Invest 1997;99:1888- 1896.
14. De Rycke L, Kruithof E, Van Damme N, Hoffman IE. Antinuclear antibodies following infliximab treatment in patients with rheumatoid arthritis or spondylarthropathy. Arthritis Rheum 2003;48:1015-1023.
15. Cameron HA, Ramsay LE. The lupus syndrome induced by hydralazine: a common complication with low dose treatment. Br Med J 1984;289:410-415.
16. Speirs C, Fielder AH, Chapel H. Complement system protein C4 and susceptibility to hydralazine-induced systemic lupus erythematosus. Lancet 1989;1:922-924.
17. Hess E. Drug-induced lupus. N Engl J Med 1988; 318:1460-1467.
18. Ronnblom LE, Alm GV, Oberg KE. Autoimmunity after alpha-interferon therapy for malignant carcinoid tumors. Ann Intern Med 1991;115:178-183.
19. Ioannou Y, Isenberg DA. Current evidence for the induction of autoimmune rheumatic manifestations by cytokine therapy. Arthritis Rheum 2000;43:1431-1442.
20. Charles PJ, Smeenk RJ, De Long J. Assessment of antibodies to double-stranded DNA induced in rheumatoid arthritis patients following treatment with infliximab, a monoclonal antibody to tumor necrosis factor alpha: findings in opel-label and randomized placebo-controlled trials. Arthritis Rheum 2000;43:2383-2890.
21. Targan SR, Hanauer SB, van Deventer SJH. A short term study of chimeric monoclonal antibody CA2 to tumor necrosis factor alpha for Crohn’s disease. N Engl J Med 1997;337: 1029-1035.
22. De Bandth M, Sibilla J, Le Loet X. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther 2005;7:545-551.
23. Gough A, Chapman S, Wagstaff K. Minocycline induced autoimmune hepatitis and systemic lupus erythematosus- like syndrome. BMJ 1996;312:169-172.
24. Lawson TM, Amos N, Bulgen D, Williams BD. Minocyline- induced lupus: clinical features and response to rechallenge. Rheumatology (Oxford) 2001;40:329-335.
25. Mohan AK, Edwards ET, Cote TR. Drug-induced systemic lupus erythematosus and TNF-a blockers. Lancet 2002;360:646-650.
26. Yung R, Richardson B. Drug-induced rheumatic syndromes. Bull Rheum Dis 2002;3:51-57.