Drug Induced Lupus vs SLE
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)
Systemic Lupus Erythematosus (SLE):
• Epidemiology: 10-180/100,000, Typically Age 20-40, F:M 9:1
• Clinical Manifestations: Malar rash, Photosensitivity, Alopecia, oral ulcers, Lupus nephritis, NPSLE - If present, are evocative of SLE versus DIL
• Laboratory Manifestations:
- CRP: Usually normal (except with serositis)
- Cytopenia: Common
• Immunologic Workup:
- ANA >
- Anti-ENA - Positive in up to 30%
- Anti-dsDNA - Positive in 60-80% of cases
- Anti-histone - Positive in 60-80%
- Low complement - 50-60%
- pANCA anti-MPO - Negative
• Prognosis: Minor to life-threatening
• Treatment: Usual therapeutic management of SLE
• Evolution: Chronic disease
Dr. Laurent ARNAUD @Lupusreference
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