|
Investigation of clinical and laboratory symptoms of drug-induced lupus in patients over 20 years old with inflammatory rheumatic diseases using anti-TNFα, referring to BooAli Hospital in Tehran during the years 2020-2023
|
Parivash Fadaei Zadeh Bidari1    , Shahla Abolghasemi2 , Shima Mosalanejad1 , Mehdi Afkar3 |
1- Internal Medicine Resident, Department of Internal Diseases, TeMS.C., Islamic Azad University, Tehran, Iran
2- Assistant Professor, Department of Rheumatology, TeMS.C., Islamic Azad University, Tehran, Iran , Abolghasemishahla129@gmail.com
3- Specialist in Social Medicine, Department of Social Medicine, TeMS.C., Islamic Azad University, Tehran, Iran |
|
|
Abstract: (287 Views) |
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies against nuclear antigens. Drug-induced lupus erythematosus (DILE) is a type of SLE that occurs as a result of the prolonged use of certain medications, including anti-tumor necrosis factor alpha (anti-TNFα) agents. This study aimed to investigate the clinical and laboratory manifestations of drug-induced lupus in individuals over 20 years of age with inflammatory rheumatologic diseases treated with anti-TNFα at BooAli Hospital in Tehran.
Materials and methods: This cross-sectional, descriptive-analytical study was conducted on 46 patients (13 men and 33 women) with a mean age of 55 years. Patients had rheumatoid arthritis, psoriasis, or spondyloarthropathy and had been suffering from their disease for at least one year. Clinical and laboratory assessments were performed before and six months after the initiation of treatment with etanercept or adalimumab.
Results: After six months of treatment with anti-TNFα, no clinical manifestations related to DILE were observed. The frequency of patients with positive ANA significantly increased from 17.39% to 32.60%. Other laboratory parameters did not show significant changes. A significant decrease in RF and Anti-CCP levels was observed, indicating suppression of the inflammatory process.
Conclusion: Treatment with anti-TNFα in patients with inflammatory rheumatic diseases leads to an increase in positive ANA, but this increase does not lead to the clinical manifestations of DILE. The decrease in RF and Anti-CCP levels indicates the effectiveness of the treatment in controlling disease activity.
|
|
| Keywords: Systemic lupus erythematosus (SLE), Drug-induced lupus (DILE), Etanercept, Adalimumab, Inflammatory rheumatic diseases |
|
|
Full-Text [PDF 843 kb]
(62 Downloads)
|
Semi-pilot: Survey/Cross Sectional/Descriptive |
Subject:
Romatology
Received: 2024/09/24 | Accepted: 2024/11/25 | Published: 2025/05/31
|
|
|
|
|
|
|
| References |
|
1. Tsokos GC, ed. Systemic lupus erythematosus: basic, applied and clinical aspects. San Diego (CA): Academic Press; 2017. 2. Rubin RL. Chapter 56 - drug-induced lupus. In: Tsokos GC, ed. Systemic lupus erythematosus. 2nd ed. London: Academic Press; 2020. p.535-47. [ DOI:10.1016/B978-0-12-814551-7.00056-8] 3. Borchers AT, Keen CL, Gershwin ME. Drug-induced lupus: an update. Ann N Y Acad Sci 2007;1108:196-207. [ DOI:10.1196/annals.1422.019] 4. Yung RL, Richardson BC. Chapter 22 - Drug-induced lupus mechanisms. In: Lahita RG, ed. Systemic lupus erythematosus. 5th ed. San Diego (CA): Academic Press; 2011. p.385-403. [ DOI:10.1016/B978-0-12-374994-9.10022-1] 5. Williams EL, Gadola S, Edwards CJ. Anti-TNF-induced lupus. Rheumatology (Oxford) 2009;48:716-20. [ DOI:10.1093/rheumatology/kep080] 6. De Bandt M, Sibilia J, Le Loët X, Prouzeau S, Fautrel B, Marcelli C, et al. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther 2005;7:R545-51. [ DOI:10.1186/ar1715] 7. Costa MF, Said NR, Zimmermann B. Drug-induced lupus due to anti-tumor necrosis factor α agents. Semin Arthritis Rheum 2008;37:381-7. [ DOI:10.1016/j.semarthrit.2007.08.003] 8. de Rycke L, Baeten D, Kruithof E, Van den Bosch F, Veys EM, de Keyser F. Infliximab, but not etanercept, induces IgM anti-double-stranded DNA autoantibodies as main antinuclear reactivity: biologic and clinical implications in autoimmune arthritis. Arthritis Rheum 2005;52:2192-201. [ DOI:10.1002/art.21190] 9. Ramos-Casals M, Brito-Zerón P, Soto MJ, Cuadrado MJ, Khamashta MA. Autoimmune diseases induced by TNF-targeted therapies. Best Pract Res Clin Rheumatol 2008;22:847-61. [ DOI:10.1016/j.berh.2008.09.008] 10. Eriksson C, Engstrand S, Sundqvist KG, Rantapää-Dahlqvist S. Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNFalpha. Ann Rheum Dis 2005;64:403-7. [ DOI:10.1136/ard.2004.024182] 11. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81. [ DOI:10.1002/art.27584] 12. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665-73. [ DOI:10.1002/art.21972] 13. Solomon DH, Kavanaugh AJ, Schur PH; American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Evidence-based guidelines for the use of immunologic tests: Antinuclear antibody testing. Arthritis Rheum 2002;47:434-44. [ DOI:10.1002/art.10561] 14. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;128:1810-52. [ DOI:10.1161/CIR.0b013e31829e8807] 15. Egner W. The use of laboratory tests in the diagnosis of SLE. J Clin Pathol 2000;53:424-32. [ DOI:10.1136/jcp.53.6.424] 16. Rubin RL. Chapter 56 - drug-induced lupus. In: Tsokos GC, ed. Systemic lupus erythematosus. 2nd ed. London: Academic Press; 2020. p.535-47. [ DOI:10.1016/B978-0-12-814551-7.00056-8] 17. Shmerling RH, Delbanco TL. The rheumatoid factor: an analysis of clinical utility. Am J Med 1991;91:528-34. [ DOI:10.1016/0002-9343(91)90190-9] 18. Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 20075;146:797-808. [ DOI:10.7326/0003-4819-146-11-200706050-00008] 19. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21:2286-91. 20. Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. J Psoriasis Psoriatic Arthritis 2019;4:31-58. [ DOI:10.1177/2475530318812244] 21. Eriksson C, Engstrand S, Sundqvist KG, Rantapää-Dahlqvist S. Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNF alpha. Ann Rheum Dis 2005;64:403-7. [ DOI:10.1136/ard.2004.024182] 22. Voll RE, Herrmann M, Roth EA, Stach C, Kalden JR, Girkontaite I. Immunosuppressive effects of apoptotic cells. Nature 1997;390:350-1. [ DOI:10.1038/37022] 23. Charles PJ, Smeenk RJT, De Jong J, Feldmann M, Maini RN. Assessment of antibodies to double-stranded DNA induced in rheumatoid arthritis patients following treatment with infliximab, a monoclonal antibody to tumor necrosis factor alpha: findings in open-label and randomized placebo-controlled trials. Arthritis Rheum 2000;43:2383-90.
https://doi.org/10.1002/1529-0131(200011)43:11<2383::AID-ANR2>3.0.CO;2-D [ DOI:10.1002/1529-0131(200011)43:113.0.CO;2-D] 24. Ramos-Casals M, Perez-Alvarez R, Diaz-Lagares C, Cuadrado MJ, Khamashta MA. Autoimmune diseases induced by biological agents: a double-edged sword? Autoimmun Rev 2010;9:188-93. [ DOI:10.1016/j.autrev.2009.10.003] 25. Mease PJ, Goffe BS, Metz J, VanderStoep A, Finck B, Burge DJ. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 2000;356:385-90. [ DOI:10.1016/S0140-6736(00)02530-7] 26. Keystone EC, Kavanaugh AF, Sharp JT, Tannenbaum H, Hua Y, Teoh LS, et al. Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis Rheum 2004;50:1400-11. [ DOI:10.1002/art.20217] 27. Lachmann PJ. Chapter 4 - The amplification loop of the complement pathways. In: Alt FW, ed. Advances in immunology. Vol. 104. Amsterdam: Academic Press; 2009. p.115-49. [ DOI:10.1016/S0065-2776(08)04004-2] 28. Feldmann M, Maini RN. Anti-TNFalpha therapy of rheumatoid arthritis: what have we learned? Annu Rev Immunol 2001;19:163-96. [ DOI:10.1146/annurev.immunol.19.1.163] |
|
| Send email to the article author |
|
|
|
| Add your comments about this article |
|
|
|
|
Fadaei Zadeh Bidari P, Abolghasemi S, Mosalanejad S, Afkar M. Investigation of clinical and laboratory symptoms of drug-induced lupus in patients over 20 years old with inflammatory rheumatic diseases using anti-TNFα, referring to BooAli Hospital in Tehran during the years 2020-2023. MEDICAL SCIENCES 2025; 35 (2) :223-233 URL: http://tmuj.iautmu.ac.ir/article-1-2309-en.html
|
