CC Sept 2015 Drug-Induced Lupus Erythematous

echoecho's version from 2015-10-15 03:08


Question Answer
Define drug-induced lupus erythematous (DILE)?it is an autoimmune disorder in which expsoure to an offending agent results in autoantibodies that attack a patient's own tissues, mimicking may of the symptoms of SLE
List the four forms of drug-induced lupus erythematous (DILE)?1) systemic, which is difficult to differentiate from SLE 2) subacute cutaneous (SCLE), which is the most common variety 3) chronic cutaneous (CCLE) which is quite rare 4) anti-TNF alpha DILE caused by exposure to anti-tissue necrosis factor agents (including infliximab {Remicade}) used widely in inflammatory bowel disease and rheumatologic conditions
What is the mechanism?unknown, but a genetic predisposition may play a role
List the most commonly implicated drugs?1) hydralazine (Apresoline) 2) procainamide 3) quinidine 4) isoniazid 5) minocycline (Minocin)
A number of other classes of drugs have been observed to cause DILE, name these?1) interferon 2) chemotherapeutic agents 3) antifungals
SCLE (subacute cutaneous lupus erythematous) is more frequently associated with cardiovascular drugs including what?1) CCB 2) ACEI
It is estimated that ____ in 10 cases of suspected SLE may actually be drug-induced lupus?1
Affected patients tend to be older (___ to ___ years old vs. 20-30 years old for SLE) and white?50-70
Are men and women equally affected?yes
What is the clinical presentation?arthralgias, LAD, fever, fatigue and weight loss
Unlike SLE, what 2 system involvment is uncommon exceptin hydralazine-induced lupus in w/c glomerulonephritis is seen?renal and central
Rare cases of renal involvment are described in which of the 4 forms of DILE?anti-TNF alpha DILE
List the cutaneous manifestations?erythema nodosum and erythematous papules on sun-exposed skin
Which dermatological manifestations of SLE are less commonly seen in DILE?mucosal ulcers, alopecia, discoid plaques and photosensitivity
Lab studies include _____ antibodies (positive in > 95% of patients) and positive anti-single-stranded ____ antibodies?antihistone ; DNA
What are levels of C3/C4 complement in DILE?normal
How can you differentiate DILE from SLE using double-stranded DNA and complement levels?ds DNA is commonly positive and complement levels are low in SLE
If skin lesions are biopsied, the histology is generally indistinguishable from that seen in SLE, true or false?true
Anti-TNF alpha DILE is more likely to have a _____ (lower vs higher) complement level and _____ (positive vs. negative) anti-double-stranded DNA than in classic DILE?lower; positive
*** In most forms of DILE, s/s generally resolve ____ weeks after stopping the offending agent?several
In anti-TNF alpha DILE, the symptoms are generally mild and may not require drug discontinuation, true or false?true
Switching to another anti-TNF drug is a consideration since crossover is unlikely and _______ is less likely to induce the reaction?adalimumab (Enbrel)
If s/s are severe, a short course of what drugs may be used?oral corticosteroids or NSAIDS
Residual antibodies may remain for months or longer. It is recommended that these levels be followed until they are what?normal
*** Summary: the most commonly implicated drugs for DILE are?1) hydralazine (Apresoline) 2) procainamide 3) quinidine 4) isoniazid 5) minocycline (Minocin)
*** Summary: affected pts tend to be older ___ to ____ y.o.. vs. 20-30 years for SLE and white?50-70
*** Summary: s/s generally resolve ______weeks after stopping the offending agent?several