Author: Charles Frank

What is drug-induced lupus? Lupus Foundation of America

Not everyone who takes these drugs will develop drug-induced lupus. Unfortunately, at this time, there is no test to identify the drug apart from noting improvement when the drug is ceased and recurrence of symptoms within 1–2 days when rechallenged. Rechallenge, however, may not be recommended especially if internal organs have been affected. Symptoms of drug-induced lupus tend to occur after taking the drug for at least 3 to 6 months. A person should speak with a doctor if they think they may be experiencing drug-induced lupus. Investigations would usually be done, including blood tests and skin biopsy.

The health care provider will do a physical exam and listen to your chest with a stethoscope. The provider may hear a sound called a heart friction rub or pleural friction rub. There are approximately 15,000–30,000 new cases of this type of lupus annually in the United States. Several broad drug categories have been linked to DILE, including those described below. For patient education resources, see Lupus (Systemic Lupus Erythematosus) and Drug Allergy. Sun protection should be advised where there is a sun-sensitive pattern to the rash.

The symptoms will typically recede within weeks after a person stops taking the triggering medication. Typically, after a person stops taking the medication, the symptoms of drug-induced lupus improve within a few weeks, and blood tests reveal a return to their natural state. There is no specific test to identify which drugs may be the cause of the condition, except for noting improvements in symptoms as a person stops and starts particular medications. This can be challenging, especially if a person takes several different medications.

Publication types

While the symptoms of drug-induced lupus are similar to those of systemic lupus, only rarely will any major organs be affected. Intrinsic genetic susceptibility may help explain why some patients experience DILE as a reaction to drug therapies, whereas others do not. For example, the rate of acetylation is genetically predetermined. In the United States, the population is almost evenly divided between those who are fast and those who are slow acetylators.

Drug-induced lupus erythematosus is an autoimmune disorder that is triggered by a reaction to a medicine. Various drugs can cause drug-induced lupus, including the high blood pressure medication hydralazine, antibiotics minocycline and isoniazid, and procainamide, which treats cardiac arrhythmias. This article explores the symptoms, causes, diagnosis, and treatment of drug-induced lupus. Death from DILE is extremely rare and may result from renal involvement (see Complications). In diagnosing this condition, it is extremely crucial to first exclude the possibility that the patient has renal idiopathic lupus rather than DILE with renal involvement. DILE may be induced by medications or caused by other compounds in the environment.

It appears on average, eight months after starting the trigger medication. Males and females have been equally affected, and the mean age of onset has been 59 years. The skin rash is typical of SCLE with symmetric nonscarring annular or polycyclic (ring-shaped) or papulosquamous (raised scaly) lesions usually on sun-exposed areas. However, in drug-induced SCLE the rash can be more widespread than in the idiopathic form, including involvement of the lower legs. The rash may be blistering, particularly at the edges of active lesions. Clinically relevant internal organ involvement as seen in SLE has been absent or minimal in reported cases.

1. Not everyone who takes these drugs will develop drug-induced lupus.
2. However, this can be difficult to identify if the patient is on many medications as the incubation period is so variable and can be very long.
3. Virtually all lupus-inducing drugs undergo oxidative metabolism, whereas analogous non–lupus-inducing drugs do not.
4. Symptoms of DILE usually clear within weeks of stopping the culprit drug.
5. More than 50% of laboratory results in anti–TNF-α–induced DILE patients show low serum complement levels and anti-dsDNA antibodies, which are usually absent or rare findings in classic DILE.

Drug-induced lupus may develop from 1 month to over 10 years after a person starts taking the triggering medication. You may feel these as soon as 3 weeks after you start taking the drug. But usually, it takes from several months to 2 years of regular use before you have symptoms.

Is there a disease that mimics lupus?

It usually takes several months or even years of continuous therapy with the medication before symptoms appear. With most of the other drugs the risk is less than 1% and usually less than 0.1% of those taking the medication will develop drug-induced lupus. In most cases, no specific treatment is required as the drug-induced LE has been mild and resolves with drug withdrawal. The most important treatment is to stop the trigger drug as this leads to resolution of the symptoms and blood test abnormalities. However, this can be difficult to identify if the patient is on many medications as the incubation period is so variable and can be very long. It may require carefully supervised ‘drug holidays’ of at least three months for each drug.

The most common drugs that cause drug-induced SLE are hydralazine (rate roughly 20%), procainamide (rate roughly 20%, 5-8% if taken for 1 y), quinine, isoniazid, and minocycline. Symptoms of DILE usually clear within weeks of stopping the culprit drug. Low doses of systemic corticosteroids may be prescribed for short periods if the symptoms are severe (see Treatment). No specific criteria establish the diagnosis of DILE, and excluding underlying autoimmune disease is not a simple process.

Antithyroid agents

Those with slow rates have a higher prevalence of DILE than those with faster rates. In contrast, SLE affects individuals with slow and fast rates approximately equally. Lesions resembling discoid lupus erythematosus (DLE) have been the most common presentation, but LE tumidus has been reported. Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop the disease. The most crucial treatment is for a person to stop taking the medication that triggers the condition under the supervision of their doctor.

If you have any concerns with your skin or its treatment, see a dermatologist for advice. DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. Watch for signs of a reaction if you are taking any of the drugs that can cause this problem.

Drug-induced subacute cutaneous LE

Unlike drug hypersensitivity reactions, this process takes months to years of drug exposure for symptoms to develop. In drug-induced lupus, certain medications can trigger a person’s immune system to mistakenly attack healthy cells, which can cause symptoms similar to the most common type of lupus, SLE. A doctor may suggest supervised “drug holidays,” in which a person stops specific drugs for several months at a time.

Cholesterol-lowering agents

Diagnosis can be difficult, as laboratory evaluation may not always provide doctors with enough information to clearly distinguish between drug-induced lupus and SLE. In some cases, a doctor may refer a person to a rheumatologist or another specialist. They may also order blood tests and urinalysis to check for certain antibodies, which can suggest an autoimmune process. To diagnose drug-induced lupus, a doctor may perform a physical examination to check for swollen and tender joints and skin rashes. Prognosis is excellent once the causative medication is discontinued.