From the Guidelines
Drug-induced lupus (DIL) can be caused by several medications, with the most common culprits being procainamide, hydralazine, and isoniazid, as well as other medications such as minocycline, quinidine, chlorpromazine, methyldopa, and TNF-alpha inhibitors like infliximab, etanercept, and adalimumab, with the risk of developing DIL typically increasing with higher doses and longer duration of treatment 1. The medications that can cause DIL include:
- Procainamide
- Hydralazine, which is associated with a lupus-like syndrome at higher doses 1
- Isoniazid
- Minocycline
- Quinidine
- Chlorpromazine
- Methyldopa
- TNF-alpha inhibitors like infliximab, etanercept, and adalimumab 1
- Sulfasalazine
- Penicillamine
- Carbamazepine
- Phenytoin
- Propylthiouracil
- Statins, particularly simvastatin and atorvastatin
- Interferon-alpha
- Certain antihypertensives like captopril and enalapril These medications can trigger autoimmune responses by altering how the immune system recognizes self-antigens, causing the production of autoantibodies, and the symptoms of DIL usually resolve within weeks to months after discontinuing the offending medication 1. Common symptoms of DIL include:
- Joint pain
- Muscle aches
- Fever
- Skin rashes Organ involvement is less common in DIL than in idiopathic lupus, and the diagnosis is mainly based on clinical and serological grounds 1. It is essential to note that the risk of developing DIL increases with higher doses and longer duration of treatment, often requiring months to years of exposure, and that DIL can be distinguished from other conditions, such as autoimmune hepatitis, based on the patient's history and the pattern of injury 1.
From the Research
Medications that Cause Drug-Induced Lupus
The following medications have been associated with drug-induced lupus:
- Hydralazine 2, 3, 4, 5
- Procainamide 2, 3, 4, 6
- Isoniazid 3, 4
- Methyldopa 3
- Chlorpromazine 3
- Quinidine 3
- Sulfasalazine 3
- Minocycline 5
- Anticonvulsants 3
- Beta-blockers 3
- Sulfonamides 3
- Interferons 3
- Antibodies to tumour necrosis factor-alpha 3
- Estrogen-containing oral contraceptives 2
- Ibuprofen 2
Characteristics of Drug-Induced Lupus
Drug-induced lupus is characterized by:
- Arthralgia 3
- Myalgia 3
- Pleurisy 3
- Rashes 3
- Fever 3
- Antinuclear antibodies in the serum 3
- Elevated erythrocyte sedimentation rate 2
- False-positive serologic test for syphilis 2
Factors that Influence the Development of Drug-Induced Lupus
The development of drug-induced lupus is influenced by: