Bruno Oliveira, MD, Rheumatology, 10:28PM Jan 17, 2010
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Some patients with inflammatory autoimmune diseases exposed to anti-TNF blockade experience drug-induced Lupus which is more severe than other forms of drug-induced Lupus, according to new report in the Journal of Rheumatology. The authors of the paper describe 6 cases of drug-induced Lupus following anti-TNF therapy. Patients developed severe cutaneous, renal, and central nervous system involvement and anti-dsDNA antibodies. Moreover, additional therapy for Lupus was necessary beyond discontinuation of the anti-TNF drug. It is difficult to establish if the patients cited in this report had overlap RA/SLE. ANAs were not available prior to the start of anti-TNF drugs. That raises the question if we should be ordering ANAs prior to starting anti-TNF drugs. But then, what to do with positive results? Are we going to withhold all anti-TNF for these patients. All in all, the number of patients exposed to TNF blockers who developed drug-induced Lupus is small. Considering the rate of false positive ANA tests, a lot of people would wind up not receiving valuable therapeutic agents. Therefore, knowing the ANA status of patients prior to anti-TNF initiation would probably not influence treating Physicians (ignorance is bliss!). FREE FULL TEXT: Induction of Systemic Lupus
Erythematosus with Tumor Necrosis Factor
Blockers. |