From the Guidelines
Lupus-like syndrome presents with symptoms similar to systemic lupus erythematosus (SLE), including joint pain, skin rashes, fever, fatigue, and general malaise, and can be managed by removing the underlying cause and using anti-inflammatory medications like NSAIDs, antimalarials, or corticosteroids, as recommended by the 2019 EULAR guidelines 1.
Symptoms of Lupus-like Syndrome
The symptoms of lupus-like syndrome can vary but often include:
- Joint pain and swelling
- Skin rashes, particularly a butterfly-shaped rash across the cheeks and nose
- Unexplained fever
- Fatigue and general malaise
- Photosensitivity
- Hair loss
- Mouth sores
- Raynaud's phenomenon, where fingers turn white or blue in cold temperatures More severe manifestations can include:
- Chest pain
- Shortness of breath
- Kidney problems
- Neurological symptoms like headaches, confusion, or seizures
Diagnosis and Treatment
Blood tests often show positive antinuclear antibodies (ANA) but may lack other specific lupus markers. If medication-induced, symptoms typically improve after discontinuing the triggering drug, which may include hydralazine, procainamide, isoniazid, minocycline, or certain anti-seizure medications. Treatment focuses on removing the underlying cause and managing symptoms with anti-inflammatory medications, as outlined in the 2019 EULAR recommendations for the management of SLE 1.
Management
The management of lupus-like syndrome involves:
- Removing the underlying cause, such as discontinuing the triggering medication
- Using anti-inflammatory medications like NSAIDs, antimalarials such as hydroxychloroquine 1, or corticosteroids depending on severity
- Monitoring for and managing potential co-morbidities, such as cardiovascular disease and osteoporosis, as recommended by the 2008 EULAR guidelines 1
From the FDA Drug Label
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 The symptoms of lupus-like syndrome include:
- Arthralgia
- Pleural or abdominal pain
- Arthritis
- Pleural effusion
- Pericarditis
- Fever
- Chills
- Myalgia
- Hematologic lesions
- Skin lesions 2
From the Research
Symptoms of Lupus-like Syndrome
The symptoms of lupus-like syndrome, also known as drug-induced lupus erythematosus (DILE), can vary depending on the drug causing the condition. Some common symptoms include:
- Musculoskeletal symptoms, such as arthritis in the hands and wrists 3
- Skin signs, such as rashes 4
- Systemic involvement, such as fever, fatigue, and weight loss 5
- Positive antinuclear antibody (ANA) titers and positive LE cell preparations 5, 3
- Pancytopenia, a condition characterized by a decrease in all blood cell types 6
- Serositis, or inflammation of the lining surrounding the lungs, heart, or abdomen 4
- Cytopenia, a condition characterized by a decrease in one or more blood cell types 4
Laboratory Abnormalities
Laboratory abnormalities associated with lupus-like syndrome include:
- Elevated erythrocyte sedimentation rate (ESR) 3
- Positive anti-histone antibodies 4, 6
- Positive anti-double strand (ds) DNA antibodies, although this is rare in DILE 4
- Low serum complement levels, which are rarely present in classic DILE but more common in anti-TNFalpha DILE 4
Drug-Induced Lupus Erythematosus
DILE can be caused by a variety of drugs, including: