[Development of systemic lupus erythematosus with focal proliferative lupus nephritis during anti-TNF-alpha therapy for psoriatic arthritis].
BACKGROUND
Treatment with tumor necrosis factor-(TNF-)alpha-blocking agents is used in a variety of autoimmune diseases. In anti-TNF-alpha therapy for rheumatoid arthritis, occasionally, the development of autoantibodies as well as lupus-like syndromes have been observed, rarely, glomerulonephritides are also induced. The authors first report the development of lupus erythematosus with renal involvement in a patient with psoriatic arthritis during therapy with the soluble TNF-alpha receptor etanercept.


METHODS
A 70-year-old patient with long-standing psoriatic arthritis developed pleuritis, pericarditis, as well as marked arthralgias during therapy with etanercept. Laboratory investigation showed markedly increased parameters of inflammation, antinuclear antibodies (ANA), a proteinuria of 3.2 g/day, mild impairment of renal function, as well as a nephritic urinary sediment. A subsequently performed renal biopsy was diagnostic for focal proliferative lupus nephritis. After withdrawal of etanercept and initiation of a cyclophosphamide pulse therapy in combination with oral steroids, parameters of inflammation and renal function rapidly normalized; pleuritis and pericarditis were not detectable anymore.


CONCLUSIONS
Anti-TNF-alpha therapy in patients with psoriatic arthritis or other autoimmune diseases may lead to induction of systemic lupus with renal involvement.
Haake
Hendrik
H
Abteilung für Kardiologie, Nephrologie und Intensivmedizin, Medizinische Klinik II, Krankenhaus St. Franziskus, Kliniken Maria Hilf, Mönchengladbach.
Köneke
Jens
J
Amann
Kerstin
K
vom Dahl
Jürgen
J
Janssen
Ulf
U
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000175:diagnosis; D008181:Lupus Nephritis / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000305:Adrenal Cortex Hormones; D000974:Antibodies, Antinuclear; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D003520:Cyclophosphamide; D000068800:Etanercept