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Two distinct quinidine-induced rheumatic syndromes
M G Cohen1, S Kevat, M V Prowse
1Sydney University Department of Rheumatology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia.
Annals of Internal Medicine
|March 1, 1988
Summary
Quinidine can cause polyarthropathy and lupus erythematosus in patients. Antihistone antibodies were detected in all cases, confirming a link between quinidine and drug-induced lupus.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Quinidine is a medication used to treat cardiac arrhythmias.
- Drug-induced lupus erythematosus (DILE) is a condition that can be caused by certain medications.
- Polyarthropathy is a condition characterized by joint pain and inflammation.
Purpose of the Study:
- To investigate the association between quinidine use and the development of polyarthropathy and lupus erythematosus.
- To identify potential biomarkers for quinidine-induced lupus erythematosus.
Main Methods:
- Case series of seven patients with quinidine-induced polyarthropathy.
- Serological testing for antinuclear antibodies (ANA) and antihistone antibodies.
- Drug rechallenge in three patients to confirm causality.
Main Results:
- Four out of seven patients presented with features of quinidine-induced lupus erythematosus, characterized by positive ANA.
- Three patients had milder symptoms without ANA but developed recurrent symptoms upon quinidine rechallenge.
- All patients with quinidine-induced lupus erythematosus tested positive for antihistone antibodies.
- Two patients exhibited high levels of IgG antibodies to histone H1 and histone complexes (H2A.H2B, H3.H4) without antibodies to individual core histones.
Conclusions:
- Quinidine can induce polyarthropathy and lupus erythematosus.
- Antihistone antibodies are a characteristic marker of quinidine-induced lupus erythematosus.
- The antibody profile in some patients suggests a unique immunogenic response to quinidine-associated histone modifications.