Druginduced lupus erythematosus dile is defined as an entity characterized by clinical manifestations and immunopathological serum. For the purpose of identifying patients in clinical studies, a person shall be said to have systemic lupus erythematosus if any 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation. Druginduced lupus erythematosus dile is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. A 26yearold chinese woman with a 2day history of pharyngalgia, fever, and 3day joint pain presented to the first affiliated hospital of cheng du medical college in feb 20 th, 2012. Druginduced lupus erythematosus statpearls ncbi bookshelf. Druginduced lupus is probably mediated by reactive drug metabolites, not the ingested medications, and susceptibility to neutrophilmediated oxidative transformation is. Labcorp test master test account 5450 millstream road mcleansville nc 27301 sample report, 164962 patient details dob. Drug induced lupus is also called druginduced lupus erythematosus dile what is drug induced lupus.
Druginduced lupus erythematosus is an uncommon, mild to moderately severe, a lupuslike syndrome related in time to continuous exposure to a specific medication and which resolves after the trigger drug is ceased. Th e extreme heterogeneity of the disease has led some investigators to propose that sle represents a syndrome rather than a single disease. It occurs predominantly in women of reproductive age. There are an estimated 15,000 to 30,000 cases of druginduced lupus per year in the united states. Clinical features of patients with druginduced, rossapositive cutaneous lupus erythematosus cle. Specific classification criteria for druginduced lupus have not been published, and no published data address differences between. Her medical history included a 1month history of thyrotoxicosis and medications as mmi 20 mg orally per day. While druginduced lupus is not a major clinical problem because it can be fully cured by discontinuing use of the medication, it is of mechanistic interest that a low molecular weight. Systemic lupus erythematosus sle is a multisystem autoimmune disorder characterized by the production of antibodies to components of the cell nucleus. Druginduced systemic lupus erythematosus disle is a lupuslike syndrome that can be differentiated from discle by virtue of its clinical and serological presentation. Drug induced lupus dile is a temporary form of lupus that is brought on by a reaction to medication.
Unlike healthy individuals, patients with sle have t and b cells that react to the patients own nucleic acids and binding proteins. Onset of sle typically occurred within days to years after initiating treatment primarily in patients ranging from young adults to the elderly. It is generally equally common in males and females, and more common in older people and white populations. Druginduced lupus erythematosus information mount sinai. Systemic lupus erythematosus sle is a common autoimmune disease, with an incidence in europe and north america varying between 1 and 10 cases per 100 000 per year. Sle has a diverse array of clinical manifestations and, consequently, is often difficult to diagnose. As in idiopathic or usualtype lupus erythematosus le, there are three categories recognised. In contrast, antinuclear antibodies in druginduced le are less heterogeneous and mainly consist of antibodies to histones.
Pdf dil is an autoimmune mediated vasculitis against certain drugs. Related conditions are drug induced cutaneous lupus and drug induced anca vasculitis. Article information, pdf download for druginduced lupus. Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which. The armamentarium of therapies for sle include glucocorticoids, antimalarials, conventional synthetic immunosuppressive drugs as well as biologic therapies. Druginduced lupus is similar to sle, but occurs as the result of an overreaction to certain medications. Druginduced lupus erythematosus clinical presentation. Systemic lupus erythematosus overview treatment principles goals. Similarly to idiopathic lupus, dile can be diveded into. Such drugs may induce autoantibodies in some patients leading to a clinical. The use of the abbreviation sle means idiopathic sle throughout this chapter.
These drugs cause an autoimmune response the body attacks its own cells producing symptoms similar to those of sle. Sle was less common then cle and, in general, was milder than nondrug induced sle outbreaks. Sle events due to ppi therapy typically occurred days to years after initiation of therapy and were most frequently seen in all ages. Druginduced lupus erythematosus dil is a subset of lupus defined as a lupuslike syndrome that develops in temporal relation to exposure to a drug and resolves after cessation of the drug exposure. Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of. Ppi associated sle is usually milder than nondrug induced sle. Systemic lupus erythematosus induced by antitumour necrosis factor alpha therapy. Systemic lupus erythematosus knowledge for medical. Full text get a printable copy pdf file of the complete article 1. Druginduced lupus erythematosus dile is a lupuslike syndrome temporally related to continuous drug exposure which resolves upon drug discontinuation. Drugs like hydralazine, procainamide have been reported to induce lupus, but so far there is no case report of amiodaroneinduced lupus in indian literature.
The exact cause is still unknown, but hormonal and immunological influences as well as genetic predisposition are. With drug induced, symptoms will resolve after stopping medications. Included in these were 11 cases reported in the literature. Amiodaroneinduced systemic lupus erythematosus ak kundu abstract druginduced lupus is not a very common entity. Systemic lupus erythematosus, its treatment, and future.
Druginduced lupus erythematosus with emphasis on skin. Druginduced lupus erythematosus dile is defined as an entity. Druginduced lupus is the presence of sle manifestations occurring after exposure to specific medications, listed in table 1084. A common cause of late mortality related to sle is an accelerated atherosclerosis that is associated with either the disease or the treatment. During the last two decades, major improvements in the treatment of sle can be mainly attributed to a better use of traditional immunosuppressive drugs. Labcorp test master test account 5450 millstream road mcleansville nc 27301 sample report, 165092 patient details dob. List genetic and environmental factors that can predispose to, precipitate, or exacerbate sle. Muscle and joint pain and swelling flulike symptoms of fatigue and fever serositis inflammation around the lungs or heart. A, the index patient shows scaly, annular, subacute cletype lesions on the lateral aspect of the right arm. Because symptoms are nonspecific, subjective, and protean, diagnosis of druginduced lupus dil requires awareness of this risk of chronic. Marker dil sle antihistone antibodies 95% 50% antidna antibodies antissdna antidsdna burlingame rw. It usually develops only after months and, quite commonly, years of treatment with the offending agent, although latencies of days or weeks have been described in some instances. Systemic lupus erythematosus sle is the prototypic multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues.
Druginduced lupus dil refers to an idiosyncratic side effect of numerous, apparently unrelated, medications, in which symptoms overlap with those of systemic lupus erythematosus. While the exact cause of lupus is unknown, there is significant evidence that some medications may cause lupus in some cases. Druginduced lupus erythematosus also known as dile or dil can occur as a sideeffect of certain medications. We report a case with typical clinical features of druginduced lupus erythematosus, together with verrucous endocarditis and pleuropericardial effusion, due to amiodarone treatment. Druginduced lupus erythematosus dile is an autoimmune variant of systemic lupus erythematosus triggered by the acute or chronic use of a medication. Open access systemic lupus erythematosus induced by anti. The terms drug induced lupus dil and drug induced lupus erythematosus dile are preferred, but other ones are also used drug related lupus, lupuslike syndrome, and lupus erythematosus medicamentosus. The demographic characteristics of druginduced lupus largely depend upon the populations most likely to receive the relevant drugs.
Because symptoms are nonspecific, subjective, and protean, diagnosis of drug induced lupus dil requires awareness of this risk of chronic. Systemic lupus erythematosus sle is less commonly reported than cle in patients receiving ppis. Identify manifestations of sle and prepare a plan for monitoring disease activity. Although the pathogenesis of dil is not well understood, a genetic predisposition may play a role in the case of certain drugs, particularly those.
These were assessed in light of the current concepts of both idiopathic and druginduced forms of. Anastrozoleinduced subacute cutaneous lupus erythematosus. Lupus is not like or related to hiv human immune deficiency virus or aids. Some lids induce a condition more akin to subacute cutaneous lupus erythematosus scle consequently, unless stated otherwise, reference to dil in this chapter means the term to encompass druginduced sle, scle and ccle chronic cutaneous lupus erythematosus. Highly specific for sle and present in 70% of patients, it directly correlates with disease activity so it can be monitored for disease progression, affects the. To control and reverse ongoing inflammation to limit irreversible endorgan damage tailor therapy based on extent of the disease and the specific organs involved potential toxicities of immunosuppressive drugs require vigilance. Autoantibodies reactive with chromatin in systemic lupus erythematosus and druginduced lupus. The sensitivity of the ana test for sle was high, but overall the positive predictive value was low for sle or other rheumatic diseases. Druginduced lupus dil is an autoimmune phenomenon where a drug exposure leads to the development of systemic lupus erythematosus. Some symptoms overlap with those of systemic lupus erythematosus sle.
Describe the effects of sex, ethnicity, and race on the epidemiology of systemic lupus erythematosus sle. Slelike syndrome 9 definition autoimmune disease involving musculoskeletal, skin, kidneys and cns epidemiology 15k20k cases year 3050k people have drug induced sle in us 510% of cases of sle are drug induced mechanism alterations in immunologic pathways or drug metabolism molecular mimecry rx like a nucleic. Symptoms usually occur 3 to 6 months after starting a medication, and disappear once the medicine is stopped. Druginduced lupus erythematosus is similar but not identical to systemic lupus erythematosus sle. Related conditions are druginduced cutaneous lupus and druginduced anca vasculitis. Systemic lupus erythematosus sle is a chronic autoimmune disease that is challenging to diagnose and manage owing to its clinical heterogeneity and unknown cause. Over 100 drugs have been reported to cause druginduced lupus dil, including a number of the newer biologics and antiviral agents. Sensitivity was low for ana testing among patients with nonsle rheumatic disease. Druginduced lupus erythematosus is an autoimmune disorder similar to systemic lupus erythematosus sle caused by chronic use of certain drugs. It has been estimated that up to 10% of sle cases are druginduced. To study the clinical and immunopathologic findings of druginduced. Dil is not likely to cause kidney damage while systemic lupus erythematosus usually does. It differs from discle in that disle typically does not present with skin. Dile can arise months to years after exposure to drugs prescribed to treat various medical conditions eg, antihypertensives, antibiotic.
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