Medication-Induced Lupus Symptoms and Treatment

Drug-induced lupus (DIL) is a rare autoimmune disease caused by a reaction to certain drugs. There are an estimated 15,000 to 30,000 cases of drug-induced lupus per year. It usually begins after you've taken the drug for three to six months. The symptoms mimic systemic lupus erythematosus (SLE).

DIL can be life-threatening, but it's completely reversible once you stop taking the drug.

More than 40 drugs have been known to cause this form of lupus, but several are considered primary culprits. They're mainly drugs used to treat chronic conditions such as heart disease, thyroid disease, hypertension (high blood pressure), neuropsychiatric disorders, inflammation, and epilepsy.

The three drugs most often involved in drug-induced lupus are:

• Procainamide (brand name Pronestyl, used to treat heart arrhythmia)
• Hydralazine (brand name Apresoline, used to treat hypertension)
• Quinidine (brand name Quinaglute, used to treat heart arrhythmia)

Classes of drugs that have been implicated in DIL include:

• Anti-antiarrhythmics (e.g., procainamide, quinidine)
• Antibiotics (e.g., minocycline)
• Anticonvulsants
• Anti-inflammatories
• Antipsychotics
• Anti-thyroid drugs
• Biologics
• Chemotherapy drugs
• Cholesterol drugs
• Diuretics
• Hypertension drugs (e.g., hydralazine, diltiazem isoniazid)
• Proton pump inhibitors

Most people who take these medications will not develop the disease. DIL is a rare adverse reaction.

Doctors don't know why some people develop drug-induced lupus while taking certain medications and others don't. However, certain factors may make it more likely, including:

• Other health conditions
• Genetics
• Environmental factors
• Interactions with other medications

Men are more likely to be prescribed the drugs that cause drug-induced lupus, though they develop it at the same statistical rates as women. DIL is most common in people between 50 and 70 years old. It's more likely in while people than African-Americans, as well.

Drug-induced lupus can affect people who take the culprit drugs for months or years continuously without symptoms. That's a clue that it's DIL instead of typical side effects, because side effects usually come on soon after you start taking a new medication.

If you're experiencing drug-induced lupus, you may have symptoms that are similar to what people with SLE experience, such as:

• Muscle and joint pain
• Fatigue
• Blurred vision
• Fever
• General ill feeling (malaise)
• Joint swelling
• Loss of appetite
• Pleuritic chest pain
• Skin rash across the bridge of nose and cheeks that gets worse with sunlight (butterfly rash)
• Weight loss
• Purple spots on the skin, which is called purpura
• Red or purple lumps under the skin that are tender, called erythema-nodosum

These symptoms can appear gradually or quickly.

While SLE can impact major organs, DIL usually doesn't.

Doctors often have a hard time diagnosing DIL because the symptoms are similar not only to SLE but to numerous other autoimmune diseases and chronic pain conditions.

If you're having symptoms that are consistent with DIL, be sure to tell you doctor about all of the medications and supplements you're taking. If they believe you have DIL, you will likely need to stop taking the drug suspected as the cause. Staying on the medication will not only make your symptoms worse, but it could also even make the condition become life-threatening.

There's not a single, specific test for DIL. When considering this diagnosis, your doctor may perform a range of tests, including:

• A physical exam
• Blood tests
• Chest x-ray
• Electrocardiogram

The four types of blood tests used to diagnose DIL are:

• Antihistone antibody
• Antinuclear antibody (ANA) panel
• Antineutrophil cytoplasmic antibodies (ANCA)
• Complete blood count (CBC)

People with DIL caused by quinidine or hydralazine may have negative ANA results.

The good news is that once you stop taking the offending medication, your symptoms should resolve within several weeks to several months. In some cases, it might take up to a year for symptoms to go completely away.

To help you get through that time, your doctor may prescribe medications to treat your symptoms. These medications may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroid creams
• Antimalarial drugs

Staying on the medication is dangerous, so you and your doctor will need to discuss alternative treatments.

While DIL can be a severe and debilitating illness that's hard to diagnose, the good news is that it can be cured by going off the drug that triggered it. Work with your doctor to find the correct diagnosis, an alternative drug, and the treatments that can help you manage the symptoms of DIL until they go away. Once you're off the offending medication, the prognosis is generally excellent.