Drug-induced lupus erythematosus

Drug-induced lupus erythematosus (DILE), also known as drug-induced lupus or drug-related lupus, is an autoimmune condition that closely resembles systemic lupus erythematosus (SLE) but is triggered by exposure to certain medications. Unlike idiopathic SLE, DILE typically resolves after discontinuation of the offending drug. The condition occurs when specific medications provoke an immune response that leads the body to attack its own tissues. More than 100 drugs have been implicated, with the most commonly associated agents including hydralazine, procainamide, isoniazid, minocycline, tumor necrosis factor (TNF)-alpha inhibitors, and certain anticonvulsants such as phenytoin and carbamazepine. DILE primarily affects the musculoskeletal system, skin, and serosal membranes. Key clinical features include arthralgia and myalgia, serositis (pleuritis and pericarditis), fever, malaise, and skin rashes. A hallmark laboratory finding is the presence of antihistone antibodies, which are found in the majority of patients. Unlike idiopathic SLE, severe renal involvement and central nervous system disease are uncommon in DILE. The condition affects men and women more equally compared to idiopathic SLE, which has a strong female predominance. The primary treatment for drug-induced lupus is discontinuation of the causative medication, which typically leads to resolution of symptoms within days to weeks, although serological abnormalities such as antinuclear antibodies (ANA) may persist for months or even years. Symptomatic management may include nonsteroidal anti-inflammatory drugs (NSAIDs) for mild symptoms, and short courses of corticosteroids for more severe manifestations such as significant serositis. In rare cases where symptoms persist after drug withdrawal, immunosuppressive therapy may be considered. Prognosis is generally excellent once the offending drug is identified and discontinued.

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