What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced SLE
• Medication-Induced SLE
• Medication-Induced Systemic Lupus Erythematosus

What is Drug-Induced Systemic Lupus Erythematosus? (Definition/Background Information)

• Systemic lupus erythematosus (SLE) is an autoimmune disorder that may affect any area of the body such as the skin, joints, blood cells, kidneys, brain, heart, and lungs
• Drug-Induced Systemic Lupus Erythematosus (DISLE) develops secondary to the use of certain medication as an adverse reaction of the body. About 1 in 10 cases of SLE are induced by medications
• This condition may occur several months after the start of medication usage. The offending medication that triggers the lupus-like symptoms in the body includes certain anti-arrhythmic medications, hypertensives, and antibiotics used for tuberculosis treatment
• Drug-Induced Systemic Lupus Erythematosus may be characterized by the presence of mild symptoms that include joint pain in most of the affected individuals and muscle pain in some. Skin symptoms are usually rare, but red rashes and sensitivity to sun exposure may be present
• Stopping or discontinuing the use of the causative medications may decrease the progression of Drug-Induced Systemic Lupus Erythematosus and/or may result in the resolution of the condition. The prognosis is good in a majority of cases with early adequate treatment; however, Drug-Induced SLE is generally difficult to diagnose

Who gets Drug-Induced Systemic Lupus Erythematosus? (Age and Sex Distribution)

• Drug-Induced Systemic Lupus Erythematosus may affect individuals of any age group since the condition is caused by the use of medications. But, the condition is more commonly seen in older adults
• Both males and females are affected
• No racial or ethnic group predilection is observed, and the condition is observed worldwide

What are the Risk Factors for Drug-Induced Systemic Lupus Erythematosus? (Predisposing Factors)

The key risk factor for Drug-Induced Systemic Lupus Erythematosus is the use of certain medications that cause the condition as a side effect. The drugs observed to induce this abnormal condition are grouped as high-risk, moderate-risk, and low-risk.

• High-risk medications include:
  • Hydralazine that is used in treating hypertension
  • Procainamide, which is used in the treatment of cardiac arrhythmia, is among the most common medicine causing Drug-Induced SLE
• Moderate-risk medication includes quinidine, an antiarrhythmic agent
• Low-risk medications include:
  • Antibiotics, such as isoniazid (for tuberculosis treatment) and minocycline (for wide-spectrum infections)
  • Tumor necrosis factor antagonists
  • Anti-inflammatory medication such as mesalazine
  • Hypertensive medication such as methyldopa and diltiazem
  • Antipsychotic medication such as chlorpromazine

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Systemic Lupus Erythematosus? (Etiology)

• Drug-Induced Systemic Lupus Erythematosus develops from the use of certain medications/drugs that are used for various health conditions
• It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body
• Sometimes, the appearance of signs and symptoms due to the drug may not be observed immediately after starting the medication. The condition may arise after a period of time

In general, the symptoms of Drug-Induced SLE may appear after a few months of starting use of the particular medication or even after a couple of years (gradual onset).

What are the Signs and Symptoms of Drug-Induced Systemic Lupus Erythematosus?

The signs and symptoms of Drug-Induced Systemic Lupus Erythematosus may vary from one individual to another. It may be mild in some individuals or severe in others and is related to the type and usage of the drug. Generally, skin symptoms are not very commonly observed in Drug-Induced SLE.

The signs and symptoms are usually mild and may include:

• Low-grade fever, tiredness, and fatigue
• Weight loss
• Arthritis; joint pain and inflammation, seen in a vast majority of cases
• Muscle pain is observed in about half the cases
• Continuing the medication tends to worsen the symptoms gradually
• Involvement of various organs of the body are highly-uncommon
• Skin findings, although uncommon, can be of the variety seen in other cases of Systemic Lupus Erythematosus
• Sensitivity to sunlight

The onset of Drug-Induced SLE is usually slow. In some cases, the symptoms may be observed only after several months to even years following drug administration.

How is Drug-Induced Systemic Lupus Erythematosus Diagnosed?

There is no specific set of criteria provided by the American College of Rheumatology (ACR) for Drug-Induced Systemic Lupus Erythematosus, unlike for lupus. The condition may be diagnosed by the following tests and exams:

• Complete physical examination with a comprehensive evaluation of one’s medical history (which includes the use of any drug/medication). The condition is known to get better after the stoppage of the offending medication
• Assessment of the signs and symptoms
• Blood tests that include:
  • Routine blood testing (sedimentation rate/C-reactive protein)
  • Antinuclear antibody (ANA) levels blood test to look for antibodies in blood
  • Serological blood test for anti-double-stranded DNA (ds-DNA)
  • Extractable nuclear antigen antibodies panel blood test to detect anti-Ro antibodies and anti-La antibodies
  • Blood chemistry panels
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis
• Direct immunofluorescence studies on tissue biopsies

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Systemic Lupus Erythematosus?

Significant complications due to Drug-Induced Systemic Lupus Erythematosus are generally not noted; however, in some cases, the following may be observed:

• Involvement of the heart causing cardiac tamponade
• Involvement of other organs, such as the brain, kidneys, or liver, due to delayed diagnosis and treatment
• Complications with pregnancy

How is Drug-Induced Systemic Lupus Erythematosus Treated?

The following measures may be considered in treating Drug-Induced Systemic Lupus Erythematosus:

• Discontinuing the medication responsible for the side effect may result in a cure or in the improvement of the condition
• Avoiding the triggers causing the condition
• Topical medication and ointments, if skin symptoms are present
• Photodynamic therapy or phototherapy
• In case of severe symptoms, systemic therapy using antimalarial drugs may be necessary
• Systemic steroid therapy

Note: If any prescribed treatment medications or methods cause new stinging or burning symptoms, then it is important to discontinue the medication/method and immediately inform the healthcare provider.

How can Drug-Induced Systemic Lupus Erythematosus be Prevented?

Currently, there is no effective preventive method available for Drug-Induced Systemic Lupus Erythematosus. However, the following measures may be considered to help lower one’s risk for the condition:

• Drugs that cause the condition may be discontinued, or alternative medication prescribed
• Inform your physician if you are allergic to any medication
• Avoiding factors that aggravate the condition through the following measures:
  • Limiting sun exposure
  • Avoidance of smoking
  • Undertaking early treatment of viral infections
  • Addressing issues causing hormonal imbalance in the body

What is the Prognosis of Drug-Induced Systemic Lupus Erythematosus? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Systemic Lupus Erythematosus is usually good in many cases upon discontinuation of the medication and adequate treatment of the skin condition when needed
• However, the prognosis may also depend upon the type of medication involved, the period of exposure to the offending medication, and the severity of the symptoms

Additional and Relevant Useful Information for Drug-Induced Systemic Lupus Erythematosus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/systemic-lupus-erythematosus/