Drug-induced lupus

Definition

• Form of lupus that is caused by a drug reaction

Causative Medications

• High risk:
  • Hydralazine (antihypertensive)
  • Procainamide (antiarrhythmic)
• Moderate to low risk:
  • Infliximab (anti-TNF-α)
  • Etanercept (anti-TNF-α)
  • Isoniazid (antibiotic)
  • Minocycline (antibiotic)
  • Pyrazinamide (antibiotic)
  • Quinidine (antiarrhythmic)
  • D-penicillamine (anti-inflammatory)
  • Carbamazepine (anticonvulsant)
  • Oxcarbazepine (anticonvulsant)
  • Phenytoin (anticonvulsant)
  • Propafenone (antiarrhythmic)
  • Chlorpromazine (antipsychotic)
  • Minoxidil (antihypertensive vasodilator)

Investigations

• Serology positive for anti-histone antibodies

Management

• Stop the offending medication
• Treat the symptoms similarly to how you would in lupus, until they resolve
  • Arthralgia/arthritis/serositis: NSAIDs
  • Cutaneous eruptions: topical steroids
  • If prolonged symptoms: hydroxychloroquine
  • Rarely steroids