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| | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Drug-induced lupus erythematosus}} |
| | {{CMG}}; {{AE}} {{CZ}} |
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| {{Infobox_Disease | | | {{SK}} Lupus - drug induced; drug-induced systemic lupus erythematosus |
| Name = Drug-induced lupus erythematosus |
| | == [[Drug-induced lupus erythematosus overview|Overview]] == |
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| Caption = |
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| ICD10 = {{ICD10|M|32.0||m|30}} |
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| ICD9 = {{ICD9|710.0}} |
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| DiseasesDB = 12782 |
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| ICDO = |
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| OMIM = 152700 |
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| MedlinePlus = 000435 |
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| eMedicineSubj = med |
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| eMedicineTopic = 2228 |
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| eMedicine_mult = {{eMedicine2|emerg|564}} |
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| MeshName = Drug-Induced+Lupus+Erythematosus |
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| MeshNumber = C17.300.480 |
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| }}
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| {{SI}}
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| {{CMG}}
| | == [[Drug-induced lupus erythematosus historical perspective|Historical Perspective]] == |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | == [[Drug-induced lupus erythematosus pathophysiology|Pathophysiology]] == |
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| {{Editor Join}}
| | == [[Drug-induced lupus erythematosus causes|Causes]] == |
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| ==Overview== | | == [[Differentiating drug-induced lupus erythematosus from other diseases|Differentiating Drug-induced lupus erythematosus from other Diseases]] == |
| '''Drug-induced lupus erythematosus''' (DIL or DILE) is an [[autoimmune]] disorder, similar to [[systemic lupus erythematosus]] (SLE), which is induced by chronic use of certain drugs. These drugs cause an autoimmune response (the body attacks its own cells) producing symptoms similar to those of SLE. There are 38 known medications to cause DIL but there are three that report the highest number of cases: [[hydralazine]], [[procainamide]], and [[isoniazid]].<ref name=Rubin>{{cite web
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| | last = Rubin
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| | first = Robert L.
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| | title = Drug-Induced Lupus Erythematosus
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| | publisher = Lupus Foundation of America
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| | date = February 4, 2005
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| | url = http://www.lupus.org/education/brochures/drug.html
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| | accessdate = 2006-11-03 }}</ref> While the criteria for diagnosing DIL has not been thoroughly established, symptoms of DIL include [[fever]], elevated [[blood pressure]], skin lesions, and [[arthritis]]. Generally, the symptoms recede after discontinuing use of the drugs.<ref name=Schur221>{{cite book
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| | last = Schur
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| | first = Peter H. (ed.)
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| | coauthors = ''et al.''
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| | title = The Clinical Management of Systemic Lupus Erythematosus
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| | publisher = Grune & Stratton
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| | year = 1983
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| | month = July
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| | location = New York
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| | pages = p. 221
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| | id = ISBN 0-8089-1543-6}}</ref>
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| [Note the term "generally." There are reported cases of DIL that do not go away completely after the offending drug is removed.] | | == [[Drug-induced lupus erythematosus epidemiology and demographics|Epidemiology and Demographics]] == |
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| While this may not be a prevailing illness in this age of heritable and non-transmittable diseases, research on drug-induced lupus could lead to a greater understanding on the immune system. This greater understanding of our immune systems could lead to breakthroughs in many other diseases such as [[HIV]], [[influenza]], and other communicable diseases. Research on this topic also has pharmaceutical implications as to avoid immune reactions from future drugs.
| | == [[Drug-induced lupus erythematosus risk factors|Risk Factors]] == |
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| == Causes == | | == [[Drug-induced lupus erythematosus natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| The processes that lead to drug-induced lupus erythematosus are not entirely understood. The exact processes that occur are not known even after 50 years since its discovery, but many studies present theories on the mechanisms of DIL.
| | == Diagnosis == |
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| A predisposing factor to developing DIL is N-acetylation speed, or the rate at which the body can metabolize the drug. [[Acetylation]] speed is generally a genetic factor. A study showed that 29 of 30 patients with DIL were slow acetylators. In addition, these patients had more hydralazine [[metabolites]] in their urine than fast acetylators.<ref name=Lahita>{{cite book
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| | last = Lahita
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| | first = Robert G.
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| | title = Systemic Lupus Erythematosus
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| | publisher = John Wiley & Sons
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| | year = 1987
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| | location = New York
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| | pages = p. 859
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| | id = ISBN 0-471-87388-8}}</ref> These metabolites (byproducts of the interactions between the drug and constituents in the body) of hydralazine are said to have been created when [[leukocyte]]s (white blood cells) have been activated, meaning they are stimulated to produce a [[respiratory burst]].<ref name=Uetrecht>{{cite journal
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| | author = Uetrecht J, Zahid N, Rubin R
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| | title = Metabolism of procainamide to a hydroxylamine by human neutrophils and mononuclear leukocytes
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| | journal = Chem Res Toxicol
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| | volume = 1
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| | issue = 1
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| | pages = 74–8
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| | year = 1988
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| | id = PMID 2979715
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| }}</ref> Respiratory burst in white blood cells induces an increased production of free radicals and oxidants such as [[hydrogen peroxide]].<ref name=Stites>{{cite book
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| | author = Stites, Daniel P.
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| | coauthors = Terr, Abba I., Parslow, Tristram G. (eds.)
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| | title = Basic & Clinical Immunology
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| | publisher = Appleton & Lange
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| | location = Norwalk, CT
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| | pages = 373
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| | year = 1994
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| | id = ISBN 0-8385-0561-9
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| }}</ref> These oxidants have been found to react with hydralazine to produce a reactive species that is able to bond to protein.<ref name=Hofstra1991>{{cite journal
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| | author = Hofstra A, Matassa L, Uetrecht J
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| | title = Metabolism of hydralazine by activated leukocytes: implications for hydralazine induced lupus
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| | journal = J Rheumatol
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| | volume = 18
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| | issue = 11
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| | pages = 1673–80
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| | year = 1991
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| | id = PMID 1664857
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| }}</ref> [[Monocytes]], one type of leukocyte, detect the antigen and relay the recognition to [[T helper cell]]s, creating [[antinuclear antibodies]] leading to an immune response.<ref name=Hoftra1994>{{cite journal
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| | author = Hofstra A
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| | title = Metabolism of hydralazine: relevance to drug-induced lupus
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| | journal = Drug Metab Rev
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| | volume = 26
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| | issue = 3
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| | pages = 485-505
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| | year = 1994
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| | id = PMID 7924901
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| }}</ref> Further studies on the interactions between oxidants and hydralazine are necessary to understand the processes involved in DIL.
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| Of the drugs that cause DIL, [[hydralazine]] has been found to cause a higher incidence. Hydralazine is a medication used to treat high blood pressure. Approximately 12% of the patients who have taken hydralazine over long periods of time and in high doses have shown DIL-like symptoms.<ref name=Schur223>Schur, Peter H. ''et al.'' (1983), p. 223.</ref> Many of the other drugs have a low to very low risk to develop DIL. The following table shows the risk of development of DIL of some of these drugs on a very to high scale.<ref name=Rubin/>
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| * High risk:
| | [[Drug-induced lupus erythematosus history and symptoms|History and Symptoms]] | [[Drug-induced lupus erythematosus physical examination|Physical Examination]] | [[Drug-induced lupus erythematosus laboratory findings|Laboratory Findings]] | [[Drug-induced lupus erythematosus electrocardiogram|Electrocardiogram]] | [[Drug-induced lupus erythematosus chest x ray|Chest X Ray]] | [[Drug-induced lupus erythematosus CT|CT]] | [[Drug-induced lupus erythematosus MRI|MRI]] | [[Drug-induced lupus erythematosus echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Drug-induced lupus erythematosus other imaging findings|Other Imaging Findings]] | [[Drug-induced lupus erythematosus other diagnostic studies|Other Diagnostic Studies]] |
| ** [[Procainamide]] ([[antiarrhythmic]])
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| ** [[Hydralazine]] ([[antihypertensive]])
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| ** [[Isoniazid]] ([[antibiotic]])
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| * Moderate to low risk:
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| ** [[Quinidine]] ([[antiarrhythmic]])
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| ** [[D-Penicillamine]] ([[anti-inflammatory]])
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| ** [[Carbamazepine]] ([[anticonvulsant]])
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| ** [[Infliximab]] ([[immunosuppressive drug|immunosuppressant]])
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| == Symptoms ==
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| Symptoms of drug-induced lupus erythematosus include:
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| * [[Arthralgia|joint pain]]/[[arthritis]]
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| * Fever
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| * Inflammation of the heart and lungs
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| * [[Hypertension|Elevated blood pressure]]
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| * Skin rashes
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| These signs and symptoms are not side effects of the drugs taken which occur during short term use. DIL occurs over long-term and chronic use of the medications listed above. While these symptoms are similar to those of systemic lupus erythematosus, they are generally not as severe unless they are ignored which leads to more harsh symptoms, and in some reported cases, death.
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| == Treatment == | | == Treatment == |
| It is important to recognize early that these drugs are causing DIL like symptoms and discontinue use of the drug. Symptoms of drug-induced lupus erythematosus generally disappear days to weeks after medication use is discontinued. [[Non-steroidal anti-inflammatory drugs]] (NSAIDs) will quicken the healing process. [[Corticosteroid]]s may be used if more severe symptoms of DIL are present.
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| == Frequency ==
| | [[Drug-induced lupus erythematosus medical therapy|Medical Therapy]] | [[Drug-induced lupus erythematosus surgery|Surgery]] | [[Drug-induced lupus erythematosus primary prevention|Primary Prevention]] | [[Drug-induced lupus erythematosus secondary prevention|Secondary Prevention]] | [[Drug-induced lupus erythematosus cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Drug-induced lupus erythematosus future or investigational therapies|Future or Investigational Therapies]] |
| (Excerpt from eMedicine – Lupus Erythematosus http://www.emedicine.com/derm/topic107.htm)
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| *In the U.S.: As many as 10% of the approximately 500,000 cases of SLE may be DIL.
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| *Mortality/morbidity: Death from DIL is extremely rare and may result from renal (kidney) involvement and other complications.
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| *Race: More whites than blacks develop DIL; more blacks than whites present with SLE.
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| *Sex: In DIL, no significant statistical difference is apparent in the prevalence for males versus females. In contrast, SLE affects women with considerably higher frequency than men (female-to-male ratio of 9:1).
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| *Age: Patients with DILE tend to be older (50–70 years old) than those with SLE (average age 29 years at diagnosis). Elderly persons generally are more susceptible to DILE.
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| == References == | | ==Case Studies== |
| {{reflist|2}}
| | :[[Drug-induced lupus erythematosus case study one|Case #1]] |
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| == See also == | | == Related Chapters == |
| *[[Systemic Lupus Erythematosus]] | | *[[Systemic Lupus Erythematosus]] |
| *[[Hydralazine]] | | *[[Hydralazine]] |
| *[[Discoid lupus erythematosus]] | | *[[Discoid lupus erythematosus]] |
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| == External links ==
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| *[http://www.lupusny.org/ S.L.E. Lupus Foundation]
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| *[http://www.lupus.org/ Lupus Foundation of America, Inc.]
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| *[http://www.lupusresearchinstitute.org/ Lupus Research Institute]
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| *[http://www.emedicine.com/DERM/topic107.htm eMedicine]
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
| {{SIB}}
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| | [[Category:Disease]] |
| [[Category:Autoimmune diseases]] | | [[Category:Autoimmune diseases]] |
| [[Category:Rheumatology]] | | [[Category:Rheumatology]] |
| | | [[Category:Mature chapter]] |
| | [[Category:Needs Overview]] |
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