Drug Induced Lupus (DIL)
• Epidemiology: -10% of all lupus cases, drug-dependent, 4:1 to 1:1 F:M
• Clinical Manifestations: Constitutional symptoms, Arthritis, myalgia, serositis, Kidney & NPSLE rare, Malar rash is rare in DIL, SCLE-DIL (terbinafine, thiazidic, PPI, ACE, calcium-b)
• Laboratory Manifestations:
- CRP - Usually normal (except with serositis)
- Cytopenia - Less common (drug-dependent)
• Immunologic Workup:
- ANA > 95% (IgG anti-chromatin)
- Anti-ENA - Rare (SSA+ for cutaneous DIL), anti-Sm rare
- Anti-dsDNA - Rarely positive (common with anti-TNF)
- Anti-histone - Positive in >90%
- Low complement - Rare
- pANCA anti-MPO - Seen with PTU (50%) and minocycline (65-100%)
• Prognosis: Usually mild forms with constitutional symptoms
• Treatment: Discontinuation of causal drug +++, Hydroxychloroquine, csDMARDs and/or bDMARDs (rare), Topics for cutaneous-DIL
• Evolution: Disappearance of manifestations (weeks to months) and of autoantibodies (months to years)
Dr. Laurent ARNAUD @Lupusreference
#DrugInduced #Lupus #DIL #rheumatology #diagnosis #treatment #management
