Drug-induced lupus after treatment with infliximab in rheumatoid arthritis.
We report a case of a 45-year-old man with an 8-month history of rheumatoid arthritis, who was treated with hydroxychloroquine 400 mg per day and 15 mg intramuscular methotrexate per week without reaching a good control of the disease. The patient was successfully treated with 3 mg/kg infliximab for 20 weeks. Before the last infusion, drug-induced lupus (DIL) was diagnosed based on the clinical features of fever > 37.5 degrees C, recurrence of active synovitis, myalgia, erythematosus rash, pericardial and pleural effusion, and of some laboratory findings (antinuclear antibodies 1:160 and anti double-strand DNA positive by DNA recombinant plasmid assay dsDNA). After infliximab discontinuation and the beginning of therapy with methylprednisolone, lupus symptoms resolved within 6 weeks. A new rheumatoid arthritis flare, occurring after 8 weeks, was controlled by methotrexate plus leflunomide. We also review the development of antinuclear and antidouble-strand DNA antibodies and drug-induced lupus in patients treated with anti-TNFalpha agents (infliximab, etanercept, and adalimumab).
Benucci
Maurizio
M
Section of Rheumatology, Nuovo Ospedale di S. Giovanni di Dio ASL 10, Via di Torregalli 3, 50143 Florence, Italy. maubenucci@tiscali.it
Li Gobbi
Francesca
F
Fossi
Fiammetta
F
Manfredi
Mariangela
M
Del Rosso
Angela
A
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D000069285:Infliximab; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D000069285:Infliximab