Drug Induced Lupus (DIL)

 • Epidemiology: -10% of all lupus cases, drug-dependent, 4:1 to 1:1 F:M

 • Clinical Manifestations: Constitutional symptoms, Arthritis, myalgia, serositis, Kidney & NPSLE rare, Malar rash is rare in DIL, SCLE-DIL (terbinafine, thiazidic, PPI, ACE, calcium-b)

 • Laboratory Manifestations: 

    - CRP - Usually normal (except with serositis)

    - Cytopenia - Less common (drug-dependent)

 • Immunologic Workup: 

    - ANA > 95% (IgG anti-chromatin)

    - Anti-ENA - Rare (SSA+ for cutaneous DIL), anti-Sm rare

    - Anti-dsDNA - Rarely positive (common with anti-TNF)

    - Anti-histone - Positive in >90%

    - Low complement - Rare

    - pANCA anti-MPO - Seen with PTU (50%) and minocycline (65-100%)

 • Prognosis: Usually mild forms with constitutional symptoms

 • Treatment: Discontinuation of causal drug +++, Hydroxychloroquine, csDMARDs and/or bDMARDs (rare), Topics for cutaneous-DIL

 • Evolution: Disappearance of manifestations (weeks to months) and of autoantibodies (months to years)



Dr. Laurent ARNAUD @Lupusreference



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