Drug-induced lupus erythematosus

Drug-induced lupus erythematosus (DILE) is a form of lupus erythematosus that is caused by the chronic use of certain pharmaceutical drugs. Unlike systemic lupus erythematosus (SLE), which is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs, DILE is caused by a hypersensitivity reaction to a drug. The symptoms of DILE are similar to those of SLE, but they are generally less severe and resolve once the offending drug is discontinued.

Causes

DILE is most commonly associated with the use of certain drugs, including hydralazine, procainamide, and isoniazid. Other drugs that have been linked to DILE include quinidine, phenytoin, minocycline, and several antibiotics, antifungals, and biologic agents. The mechanism by which these drugs induce lupus is not fully understood, but it is believed to involve alterations in immune system regulation, leading to an autoimmune response.

Symptoms

The symptoms of DILE can vary but often mimic those of SLE. Common symptoms include arthralgia (joint pain), myalgia (muscle pain), fever, and serositis (inflammation of tissues lining the lungs, heart, and inner abdomen). Skin manifestations, such as a rash, particularly a photosensitive rash, and alopecia (hair loss), are also common. Unlike SLE, DILE rarely affects major organs such as the kidneys and central nervous system.

Diagnosis

Diagnosis of DILE involves a combination of clinical evaluation and laboratory tests. A detailed medical history focusing on medication use is crucial. Laboratory tests may show certain abnormalities common in lupus, such as antinuclear antibodies (ANA), but with a different antibody pattern compared to SLE. Anti-histone antibodies are particularly associated with DILE. It is important to differentiate DILE from SLE to guide treatment and prognosis.

Treatment

The primary treatment for DILE is the discontinuation of the offending drug. Symptoms usually resolve within days to months after stopping the drug. In cases where symptoms are severe, corticosteroids or other immunosuppressive medications may be used temporarily to control symptoms. Patient education on the importance of avoiding the causative drug and similar agents is crucial.

Prevention

Prevention of DILE involves careful selection of medications, especially in individuals with a history of drug sensitivities or autoimmune diseases. Regular monitoring and patient education on the potential side effects of drugs known to cause DILE are important preventive measures.

See also

• Lupus erythematosus
• Systemic lupus erythematosus
• Cutaneous lupus erythematosus
• Pharmaceutical drug
• Autoimmune disease