Disease stateDrug-Induced Lupus due to Anti-Tumor Necrosis Factor α Agents
Section snippets
Methods
We performed a PubMed search with the following keywords: “drug-induced lupus and anti-TNFα,” “drug-induced lupus and biologics,” “drug-induced lupus and infliximab,” “drug-induced lupus and etanercept,” and “drug-induced lupus and adalimumab.” We also searched the Medline database with the headings “tumor-necrosis factor blockade/adverse effects,” “systemic lupus erythematosus/chemically induced,” and “antirheumatic agents/chemically induced.” We evaluated all series, reviews, and case reports
Patient 1
A 22-year-old woman was diagnosed with RA on the basis of symmetric polyarthritis, a positive rheumatoid factor (RF), and antibodies to cyclic citrullinated peptide (CCP). She had low titer (1:80) antinuclear antibodies (ANA) but no rash or other clinical evidence of systemic lupus erythematosus (SLE). She was initially treated with nonsteroidal anti-inflammatory drugs and low-dose prednisone. She began adalimumab 4 months after the onset of arthritis. Her joint symptoms responded promptly to
Discussion
The patients that we describe in the present report had findings similar to those in previous reports of DILE from anti-TNFα therapy. The first patient with RA had a low positive ANA before beginning adalimumab therapy. On adalimumab, she developed fever, rash, antibodies to dsDNA, and proteinuria, all of which resolved after discontinuation of anti-TNFα therapy. We believe this is the third well-described case of DILE due to adalimumab reported in the literature. Our second patient's case was
Acknowledgments
The authors acknowledge Drs. Edward V. Lally and Harald A. Hall for their thoughtful review of the manuscript and contribution of case material. We also appreciate the secretarial assistance provided by Kathy Poland and Marsha Potenza.
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The authors have no conflicts of interest to disclose.