Any test to confirm the drugs really induce lupus?

By SWA

 

Yes, certain medications have been known to induce a syndrome that resembles systemic lupus erythematosus (SLE). This condition is referred to as drug-induced lupus erythematosus (DILE). The presentation of DILE is similar to idiopathic SLE but is usually milder and resolves upon discontinuation of the offending drug.

To determine if a patient has DILE rather than idiopathic SLE, the following steps and considerations are typically taken:

  1. History and Medication Review: The most crucial step in diagnosing DILE is a thorough patient history, especially a detailed medication review. Common drugs associated with DILE include:

    • Hydralazine
    • Procainamide
    • Isoniazid
    • Quinidine
    • Anti-TNF medications (like etanercept, infliximab)
    • Certain anticonvulsants
    • Others

    The list of potential drugs is extensive, and newer drugs can also be implicated. The onset of symptoms typically occurs weeks to months after starting the medication.

  2. Laboratory Tests:

    • Antinuclear antibody (ANA) test: Almost all patients with DILE have a positive ANA test.
    • Histone antibodies: The presence of anti-histone antibodies is highly suggestive of DILE, as these are found in a significant percentage of DILE cases (but they can also be found in idiopathic SLE).
    • Other autoantibodies associated with idiopathic SLE, like anti-Sm or anti-dsDNA, are usually absent in DILE.

  3. Symptom Review: Patients with DILE often present with arthralgias, arthritis, and myalgias. Some might have fever or serositis (like pleurisy or pericarditis). However, they usually do not exhibit severe organ damage such as kidney disease, central nervous system involvement, or discoid rash, which are more common in idiopathic SLE.

  4. Resolution upon Discontinuation: One of the hallmark features of DILE is the improvement or resolution of symptoms after stopping the offending drug. Symptoms usually begin to improve within days to weeks after discontinuation and typically resolve completely within several months.

  5. Rechallenge: If there is uncertainty, rechallenging the patient with the suspected drug can induce symptoms again. However, this is generally not done due to the potential risks involved.

  6. Differential Diagnosis: Other conditions that may mimic DILE or SLE need to be considered and ruled out. This includes infections, other rheumatic diseases, and malignancies.

It's essential to differentiate DILE from idiopathic SLE because the management is different. The main treatment for DILE is discontinuing the causative drug, whereas SLE often requires more aggressive and prolonged immunosuppressive therapy.

Always consult with a rheumatologist or appropriate medical specialist when suspecting DILE or SLE in a patient.

Comments

Post a Comment

Popular posts from this blog

Is ME CFS connected to Spinal Muscular Atrophy (SMA) or Post Polio?

By SWA
Image
Today, I understand why Spinal Muscular Atrophy (SMA) received little attention, particularly in the mid-50s. This complex and debilitating genetic illness was poorly understood, and patients' symptoms were often minimized or even dismissed. For more information, please visit the Spinal Muscular Atrophy (SMA) page on MalaCards . Even now, many neurologists lack detailed knowledge of SMA, and comprehensive examinations mentioned in research are rarely pursued. In 2008, while investigating permanent adrenal insufficiency, an MRI ordered by my endocrinologist unexpectedly revealed Chiari Malformation II. However, surgery in 2009 brought no improvement. In 2010, a DNA test showed a genetic marker in the ACTN3 gene: https://www.malacards.org/search/results?q=ACTN3%20gene%20and%20Spinal%20Muscular%20Atrophy%20(SMA) A 2015 MRI revealed ankylosing spondylitis, multiple Tarlov cysts, stenosis at L4 and L5, spinal canal narrowing, and widespread degenerative changes. Surgery on L4 and L5 ...
Read more

Cytokine Storm, Mast Cell Activation Syndrome (MCAS), Endothelial Dysfunction and microclots/thrombosis?

By SWA
Could a virus be the stimulus for cytokine production?   It is well established, but rarely  tested, that a cytokine storm is an overactive immune response characterized by the excessive release of pro-inflammatory cytokines. ( ANA, CRP, and CBC tests are necessary) It can occur in various conditions, such as severe infections (e.g., COVID-19), (and other viruses), autoimmune diseases, and after certain treatments.  Serositis and lymphopenia are common features of systemic lupus erythematosus following SARS-CoV-2 infection: A case report and literature review These cells are called NKG2D+CD8+ T cells and researchers say their aggressive response is responsible for neurological damage suffered from infections beyond just Zika, like COVID-19 and even septic shock. The aggressive response is the result of the body producing large amounts of inflammatory proteins called cytokines, which in moderation help to coordinate the body’s response in battling an infection...
Read more

Toxic Skin Condition Post-mRNA COVID-19 Vaccination

By SWA
Image
Identifying Severe Skin Conditions Post-Vaccination Following administration of the BioNTech mRNA vaccine, a small subset of individuals may develop severe and complex reactions. These reactions are often misdiagnosed or misunderstood due to their rarity and diverse presentation. This essay examines a case characterized by severe skin conditions, systemic symptoms, and complications such as hypercalcemia and crystal formation. It highlights the need for accurate diagnosis, holistic management, and increased awareness of these rare but significant vaccine-related adverse events. Initial Symptoms and Misdiagnoses Severe symptoms began shortly after the first dose of the BioNTech vaccine, initially presenting as petechiae, diagnosed by a rheumatologist. However, following the second dose, symptoms rapidly escalated, resulting in intense burning pain and thinning of the skin. The skin on the legs and thighs became paper-thin and could tear with the slightest touch, with the affected area e...
Read more