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It is estimated that about 10 percent of systemic lupus cases can be drug-induced. The disease develops even two years after the first administration of the drug that causes symptoms and is much more common in people over 50 years of age. It is very difficult to make a diagnosis, although it cannot be overestimated. It is enough to discontinue the drug and the symptoms disappear, sparing the patient with the consequences of immunosuppressive treatment.
It is difficult to estimate the prevalence of drug-induced lupus in Poland. This is due to the fact that the drugs that are the most common cause of the disease are either unavailable or rarely used in Poland. Statistics from the United States indicate that approximately one in 10 cases of visceral lupus may be caused by the type of medication used. Visceral lupus erythematosus (SLE) is a systemic (generalized) disease of the connective tissue in which, due to immunological abnormalities, antibodies are produced that attack the body’s own tissues and lead to disease symptoms affecting various organs of our body. In SLE, the skin, kidneys, joints and abnormalities in the blood composition are most often affected. It is known, however, that similar symptoms can occur with certain medications. This develops what is known as drug-induced lupus, which differs somewhat from visceral lupus, which is a disease primarily caused by a malfunction in the immune system.
The symptoms of drug-induced lupus are similar to some of the symptoms of SLE. In patients with drug-induced lupus, symptoms usually appear suddenly and are mostly joint and muscle pains, accompanied by general symptoms such as fever, weakness, malaise or weight loss. Involvement of the serous membranes is also a fairly common symptom, which leads to the appearance of fluid in the pleural cavities and / or in the pericardial sac surrounding the heart. There may also be various types of skin changes in the form of often uncharacteristic rashes appearing on the skin exposed to sunlight. In very exceptional cases, drug-induced lupus may involve kidney involvement, which is the most serious complication of the disease, and in extreme cases may require dialysis of the patient. Very few deaths have also been reported.
Symptoms of drug-induced lupus can appear almost at any time after starting the disease-causing drug (from 3 weeks to even two years). In contrast to SLE, drug-induced lupus usually develops in people between the ages of 50 and 70, and it affects both men and women equally. It has been suggested that this distribution of drug-induced lupus incidence may result, on the one hand, from the way drug metabolism changes with age, and from the simple reason that the frequency of using drugs causing the disease increases with age. In addition to clinical symptoms, in patients with drug-induced lupus, laboratory tests – as in the case of SLE – show the presence of antinuclear antibodies, in particular one type of antibodies, namely antibodies against histones (proteins that build chromosomes).
The list of drugs that have the potential to cause drug-induced lupus is long. The most common culprit is procainamide, a drug used to treat abnormal heart rhythms. Drug-induced lupus can develop in up to 20 percent of patients undergoing treatment. A very typical symptom in the course of poprocainamide lupus is the involvement of the serosa with the presence of fluid in the pleural cavities and the pericardium. Polish patients, however, may not be afraid of this treatment complication, as this drug is not available from us. Another substance that causes the disease is hydralazine, an antihypertensive drug, treatment of which leads to lupus symptoms in approximately 10% of patients. This drug is unique in that in the case of drug-induced lupus, renal involvement with its potentially life-threatening complications may occur significantly more often than in the case of other drugs. In Poland, this drug is sometimes used to treat hypertension in pregnant women (dihydralazine). Other medications that can cause disease include anti-tuberculosis drugs, anti-malarial drugs, certain antipsychotics and anticonvulsants, diltiazem, methyldopa, and new biological drugs used in, inter alia, in the treatment of rheumatodial arthritis (infliximab, adalimumab and etanercept). It is assumed that even such frequently used drugs as captopril, hydrochlorothiazide or sulfasalazine may cause lupus symptoms in a small percentage of patients.
It can be very difficult to make a diagnosis. The appearance of general symptoms, joint pains, skin lesions and exudates in people over 50 with positive titers of antinuclear antibodies should be suspicious. In such a case, careful inquiry should be made about the medications used. The risk of drug-induced lupus is significantly greater if the drug is used for more than one month. Correct diagnosis is confirmed when symptoms disappear after drug discontinuation. This is usually a sufficient method of treatment. In the case of severe joint changes and / or the presence of persistent pleural or pericardial fluid, small doses of steroid drugs are administered. Kidney involvement may require intensive immunosuppressive treatment.
Text: lek. Paulina Jurek
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