Drug induced lupus

Question 1

When does drug induced lupus typically present in relation to initiation of drug?

Answer 1

> 1 year after drug initiation

Question 2

How long after discontinuation of inciting drug does drug induced lupus resolve?

Answer 2

4-6 weeks

Question 3

What are the two important antibodies for drug induced lupus?

Answer 3

+ anti histone

negative anti ds DNA

Question 4

What are the common symptoms of drug induced lupus? What findings are typically absent?

Answer 4

-Arthritis/arthralgia (90%)

• myalgia (50%)
• serositis (pericarditis, pleurisy)
• fever and weight loss

renal, CNS and skin findings are typically absent

Question 5

What are the high risk drugs a/w drug induced lupus?

Answer 5

• procainamide, hydralazine

Question 6

What are the medium and low risk drugs a/w drug induced lupus?

Answer 6

• methyldopa
• quinidine
• isoniazid

D-penicillamine

- minocyline

- TNF-alpha inhibitors

Question 7

Which drugs a/w drug induced lupus dont have the typical presentation of drug induced lupus?

Answer 7

• minocycline: often negative anti-histone and positive ANCA against elastase or MPO
• TNF-alpha inhibitors- anti ds-DNA frequently positive, which are usually negative (>anti-histone) and increased skin involvement (DILE usually lacks skin involvment)