Tumor necrosis factor alpha (TNF-[alpha]) antagonist-induced lupus-like syndrome (TAILs) (1) is characterized by rashes, arthralgias, fever, and/or serositis along with positive lupus serologies temporally associated with initiation of TNF-[alpha] antagonist medications.
Labs at diagnosis of antagonist-induced lupus-like syndromes Serological marker Result Anti-nuclear antibody 1:640 (previously 1:160 @ [RA.sup.+] diagnosis) Anti-SSA antibody Positive Anti-dsDNA antibody 14 IU/mL Anti-Smith antibody Negative Anti-Histone antibody 1.9 U Anti-Chromatin antibody Positive C3 (80-178 mg/dL) 85 mg/dL C4 (12-42 mg/dL) 13 mg/dL Anti-SSA antibody: Anti-Sjogren's-syndrome-related antigen A; Anti-dsDNA: Anti-doublestranded deoxyribonucleic acid; RA: Rheumatoid arthritis; C3: Complement component 3; C4: Complement component 4
When the symptoms of pericarditis, chest pain, arthritis, arthralgia, rash, and fever are seen, a drug-induced, systemic, lupus-like syndrome should be considered.
Approximately 50 drugs that may cause lupus-like syndrome have been reported since 1970.
Sulphasalazine-induced lupus-like syndrome with cardiac tamponade in a patient with ulcerative colitis.
"The likelihood of developing a lupus-like syndrome
is elevated 8.5-fold with minocycline, so many clinicians are moving away from using minocycline for acne and rosacea and switching to doxycycline, which doesn't have this effect.
New York Bureau Lupus-Like Features in Patients Treated With Anti-TNF Drugs Antinuclear antibodies and anti-double-stranded DNA antibodies 94% Cutaneous manifestations 89% Musculoskeletal features 39% General manifestations 29% Note: Based on 92 patients who developed lupus-like syndrome
while on anti-TNF drugs.
One patient died of a lupus-like syndrome
, (24) and the other (who had multifocal Kikuchi's disease) died of sudden heart failure 72 hours after a cervical lymph node biopsy was performed under local anesthesia.
The patient developed a lupus-like syndrome
associated with use of procainamide.
Vascular complications of lupus nephritis and lupus-like syndromes
. Wien Klin Wochenschr.