Drug-induced lupus: an update

To review and update drug-induced lupus (DIL) with emphasis on the characteristics of anti-TNF-induced lupus.

DIL is an autoimmune phenomenon triggered by a given drug and resulting in a syndrome sharing several features of systemic lupus erythematosus (SLE). Drugs like procainamide and hydralazine have been strongly associated with the development of DIL. During the past years several cases of DIL related to biologic therapy with anti-TNF drugs were reported. From the analysis of the unusual characteristics of these cases some conclusions may be drawn: anti-TNF-induced DIL may present with classical SLE dermatologic symptoms, hypocomplementemia, an increased frequency of significant anti-dsDNA antibody titers and a decreased incidence of anti-histone antibodies, all these atypical findings in classical DIL.

Anti-TNF-induced DIL may be a unique form of the disease or may possibly result from the unmasking of latent idiopathic SLE.