Can certain medications cause Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Yes, certain medications can cause drug-induced lupus erythematosus (DILE), which is a significant concern in terms of morbidity, mortality, and quality of life. According to the evidence from 1, hydralazine, a medication used for hypertension, is associated with a drug-induced lupus-like syndrome at higher doses. This is crucial because it directly impacts patient outcomes, particularly in terms of avoiding unnecessary exposure to medications that could induce lupus-like symptoms. The key medications implicated in drug-induced lupus include:

• Hydralazine, used for hypertension, as noted in 1
• Other medications such as procainamide, isoniazid, minocycline, and certain anti-seizure medications like phenytoin and carbamazepine, although these are not mentioned in the provided studies, they are known culprits based on general medical knowledge. It's essential to recognize that drug-induced lupus typically develops after months or years of continuous medication use and usually resolves within weeks to months after stopping the triggering drug. Symptoms of DILE include joint pain, muscle aches, fever, chest pain, and skin rashes, but unlike traditional lupus, DILE rarely affects the kidneys or nervous system, as would be a concern in managing systemic lupus erythematosus, discussed in 1. The mechanism involves the medication altering how the immune system functions, leading to the production of autoantibodies that attack the body's own tissues. If you develop lupus-like symptoms while taking any medication, it is crucial to consult your healthcare provider immediately rather than stopping the medication on your own, to ensure proper management and minimize potential harm. In the context of managing hypertension, as discussed in 1, and considering the broader implications of systemic lupus erythematosus management from 1, it's clear that medication choices must be carefully considered to avoid inducing lupus-like symptoms, thereby prioritizing patient outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

In a few patients hydrALAZINE may produce a clinical picture simulating systemic lupus erythematosus including glomerulonephritis. A lupus erythematosus-like syndrome of arthralgia, pleural or abdominal pain, and sometimes arthritis, pleural effusion, pericarditis, fever, chills, myalgia, and possibly related hematologic or skin lesions is fairly common after prolonged PA administration

Yes, some medicines can cause a lupus-like syndrome, as seen with hydralazine 2 and procainamide 3. These drugs may produce symptoms simulating systemic lupus erythematosus, and discontinuation of the drug may be necessary to reverse the symptoms.

From the Research

Drug-Induced Lupus

• Drug-induced lupus erythematosus (DILE) is a lupus-like syndrome that is temporally related to continuous drug exposure and resolves after discontinuation of the offending drug 4, 5.
• The syndrome is characterized by arthralgia, myalgia, pleurisy, rashes, and fever in association with antinuclear antibodies in the serum 6.
• The most common individual agents associated with DILE are procainamide and hydralazine 7, 6.
• Other drugs that have been implicated in DILE include:
  • Calcium channel blockers
  • Angiotensin-converting enzyme inhibitors
  • Thiazide diuretics
  • Terbinafine
  • Tumour necrosis factor (TNF)-alpha antagonists
  • Fluorouracile agents
  • Non-steroidal anti-inflammatory drugs
  • Proton pump inhibitors (PPIs)
  • Chemotherapeutic drugs 4, 5, 8
• The pathogenesis of DILE is unknown, but it is thought to be due to interactions between the drug and DNA or histones, rendering them immunogenic 6.
• Recognition of DILE is important because it reverts within a few weeks of stopping the drug 6.
• The clinical and laboratory manifestations of DILE are similar to those of idiopathic lupus, but central nervous system and renal involvement are rare in DILE 7.

Types of Drug-Induced Lupus

• Systemic DILE is characterized by typical lupus-like symptoms, including skin signs, usually mild systemic involvement, and a typical laboratory profile with positive antinuclear and anti-histone antibodies 4, 5.
• Subacute cutaneous lupus erythematosus (SCLE) is a type of DILE that is very similar to idiopathic SCLE in terms of clinical and serologic characteristics 4, 5.
• Chronic cutaneous lupus erythematosus (CCLE) is a rare type of DILE that is usually associated with fluorouracile agents or TNF-alpha antagonists 4, 5.

Diagnosis and Treatment

• There are currently no standard diagnostic criteria for DILE, and the diagnosis is often made based on a temporal association between the offending drug and characteristic or suggestive symptoms 5.
• Discontinuation of the offending drug usually results in improvement of drug-induced manifestations 8.
• Topical and/or systemic corticosteroids and other immunosuppressive agents may be reserved for resistant cases 4.