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    Drug-induced lupus erythematosus

    Lupus - drug induced

    Drug-induced lupus erythematosus is an autoimmune disorder that is brought on by a reaction to a medicine.

    Causes

    Drug-induced lupus erythematosus is similar to systemic lupus erythematosus (SLE). It is an autoimmune disorder. This meansyour body attacks healthy tissue by mistake. It is caused by an overreactionto a medicine.

    The most common medicines known to cause drug-induced lupus are:

    • Isoniazid
    • Hydralazine
    • Procainamide

    Other less common drugs may also cause the condition. These may include:

    • Anti-seizure medications
    • Capoten
    • Chlorpromazine
    • Etanercept
    • Infliximab
    • Methyldopa
    • Minocycline
    • Penicillamine
    • Quinidine
    • Sulfasalazine

    Symptoms tend to occur after taking the drug for at least 3 to 6 months.

    Symptoms

    • Blurred vision
    • Fever
    • General ill feeling (malaise)
    • Joint pain
    • Joint swelling
    • Loss of appetite
    • Pleuritic chest pain
    • Skin rash
      • Gets worse with sunlight
      • "Butterfly" rash across bridge of nose and cheeks
    • Weight loss

    Exams and Tests

    The health care providerwill do a physical exam and listen to your chest with a stethoscope. The doctor may hear a sound called a heart friction rub or pleural friction rub.

    A skin exam shows a rash.

    Joints may be swollen and tender.

    Tests that may be done include:

    • Antihistone antibody
    • Antinuclear antibody (ANA) panel
    • Complete blood count (CBC)

    A chest x-ray may show signs of pleuritis or pericarditis (inflammation around the lining of the lung or heart). An ECG may show that the heart is affected.

    Treatment

    Most of the time, symptoms go away within several days to weeks after stopping the medication that caused the condition.

    Treatment may include:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat arthritis and pleurisy
    • Corticosteroid creams to treat skin rashes
    • Antimalarial drugs (hydroxychloroquine) to treat skin and arthritis symptoms

    If the condition is affecting your heart, kidney, or nervous system, your doctor may prescribe high doses of corticosteroids (prednisone, methylprednisolone) and immune system suppressants (azathioprine or cyclophosphamide). This is rare.

    Guard against too much sun exposure when the disease is active by wearing clothing and sunglasses and using sunscreen.

    Outlook (Prognosis)

    Most of the time, drug-induced lupus erythematosus is as severe as SLE. The symptoms often go away within a few days to weeks after stopping the medicine you were taking.

    Avoid taking the drug that caused the reaction in future. Symptoms are likely to return if you do so. Get regular eye exams to detect any complications early.

    • Infection
    • Thrombocytopenia purpura -- bleeding near the skin surface, resulting from a low number of platelets in the blood
    • Hemolytic anemia
    • Myocarditis
    • Pericarditis
    • Nephritis

    When to Contact a Medical Professional

    Call your health care provider if:

    • You develop new symptoms on any of the medicines listed above
    • Your symptoms do notget betterafter you stop taking the medicine that caused the condition

    Prevention

    Watch for signs of a reaction if you are taking any of the drugs that can cause this problem.

    References

    Wright B, Bharadwaj S, Abelson A. Systemic Lupus Erythematosus. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 13.

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      A Closer Look

      Self Care

        Tests for Drug-induced lupus erythematosus

        Review Date: 4/20/2013

        Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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