Drug-induced lupus is a rare autoimmune disorder that is caused by continuous exposure to certain medications and generally goes away within months of stopping the medication.
What are risk factors for drug-induced lupus?
Experts are unsure why some people develop drug-induced lupus while taking certain prescribed medications, whereas others do not. However, certain factors that may contribute to the disorder include:
- Genetic predisposition
- Environmental factors
- Comorbidities
- Interactions with other medications
What are the symptoms of drug-induced lupus?
Symptoms of drug-induced lupus erythematosus may include:
- Muscle pain
- Joint pain and swelling
- Flu-like symptoms
- Butterfly shaped rash over face
- Serositis, which is inflammation around the heart or lungs
How is drug-induced lupus diagnosed?
There are no standard diagnostic tests for drug-induced lupus erythematosus. Your doctor may conduct a physical exam to check for a rash or swollen joints and listen to your chest with a stethoscope to listen for a heart friction rub or pleural friction rub.
Tests that may be ordered include:
- Antihistone antibody
- Antinuclear antibody panel
- Antineutrophil cytoplasmic antibody panel
- Complete blood count with differential
- Comprehensive chemistry panel
- Urinalysis
- Chest X-ray, which may indicate signs of pleuritis or pericarditis (inflammation around the lining of the lung or heart)
- Electrocardiogram, which may show that the heart is affected
How is drug-induced lupus treated?
Treatment of drug-induced lupus involves stopping the trigger drug, which can help resolve symptoms and blood test abnormalities. This can be difficult if the patient is on many medications at the same time. Patients may need carefully supervised “drug holidays” of at least 3 months for each drug.
Symptomatic relief of drug-induced lupus includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis
- Topical steroids for rashes
- Systemic medications including hydroxychloroquine
- Oral corticosteroids such as prednisolone for internal organ involvement
In most cases, specific treatment is not required because symptoms typically resolve with drug withdrawal.
What are possible complications of drug-induced lupus?
Possible complications of drug-induced lupus include:
- Infection
- Thrombocytopenia purpura (bleeding near the skin surface) resulting from low platelet counts in the blood
- Hemolytic anemia
- Myocarditis
- Pericarditis
- Nephritis
Rarely, kidney complications can develop due to drugs such as tumor necrosis factor inhibitors. Antineutrophil cytoplasmic autoantibody vasculitis can develop due to hydralazine or levamisole.
Nephritis may need to be treated with prednisone and immunosuppressive medications. However, if the patient consumes the drug that had caused the reaction in the future, symptoms are likely to return.
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Solhjoo M, Goyal A, Chauhan K. Drug-Induced Lupus Erythematosus. [Updated 2022 Apr 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441889/
The Lupus Foundation of America. What is drug-induced lupus? https://www.lupus.org/resources/about-drug-induced-lupus
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