Drug induced lupus is a form of lupus
that is caused by the use of certain prescribed
medications. Drug induced lupus causes similar symptoms
as systemic lupus erythematosus (SLE) but the symptoms
stop soon after discontinuation of the medication.
Drug induced lupus has similar symptoms to SLE. These
symptoms are muscle and joint pain and swelling,
serositis (inflammation of the lungs or heart), fatigue,
fever, certain abnormal lab tests. If symptoms stop
after discontinuation of the suspected drug, than drug
induced lupus can be diagnosed. Symptoms may come on
gradually in some people and may come suddenly in
others.
White people are more likely to develop drug induced
lupus than African Americans. People who have SLE are at
no greater risk of developing drug induced lupus than
the general population. The people with the greatest
risk of developing drug induced lupus are men over the
age of 50 due to the fact that this group is more likely
to be taking the drugs that are known to cause the
disorder. This is because men over 50 are more likely to
have high blood pressure and cardiac arrhythmias than
other groups.
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In order to develop drug induced
lupus, the patient usually has to take the lupus causing
drug continuously for several months or years. Even when
patients use the drugs with the most risk (procainamide
and hydralazine) drug induced lupus only occurs in 5-20%
of patients. As for the other drugs, the risks are only
fewer that one percent that the patient taking them will
develop drug induced lupus.
Drug induced lupus is caused by the use of a medications
to treat hypertension hyralazine (Apresoline), and some
anti-seizure medications such as phenytoin (Dilantin or
carbamazepine (Tegretol). Quinidine (Quinaglute), used
to treat cardiac arrhythmias and isoniazid (INH) are two
others that may cause drug induced lupus. Over 38
different medications can cause drug induced lupus,
however procainamide (Pronestyl), quinidine (Quinaglute)
and hydralazine(Apresoline) most often cause the
disorder. As for the other 35 drugs, the incidence of
drug induced lupus is extremely low.
Scientists are beginning to understand the cause of drug
induced lupus after 50 years of studies. However, many
disagree about the processes that lead to drug induced
lupus. The theory that has the most circumstantial
evidence is that drug induced lupus is caused by
metabolic changes in the drug that occur in the body and
affect the immune system. Another idea is that drug
metabolites attach themselves to proteins which cause
drug-specific lymphocytes to become activated, thereby
stimulating nearby lymphocytes or damaging surrounding
tissue. One study showed that drug induced lupus may
begin in the human thymus. The fact that drug induced
lupus has similar symptoms to SLE is evidence that the
two have closely related immune problems.
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The only hereditary factor in the
development of drug induced lupus that is known is a
hereditary tendency to not be able to metabolize
procainamide and hydralazine effectively. These people
are known as "slow acetylators." About one half the
population are "slow acetylators."
Treatment for drug induced lupus includes
discontinuation of the lupus causing drug which
generally improves symptoms within a few days.
Improvement can be even quicker if the patient is given
non-steroidal anti-inflammatory drugs (NSAIDs). When a
patient has severe symptoms such as inflammation around
the heart, kidney disease and severe inflammation of
several joints, corticosteroids may be used.
Drug induced lupus is curable in that symptoms generally
disappears after the offending drug is discontinued.
However, abnormal antibodies may take years to go away.
It is unwise to take a drug that previously caused drug
induced lupus, due to the fact that it is likely to
cause drug induced lupus again.
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