title: The incidence and predictors of lupus-like reaction in patients with IBD treated with anti-TNF therapies.
abstract: BACKGROUND
  The incidence of lupus-like reactions (LLRs) in patients with inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (ATNF) has not been well defined. We aimed to characterize the features and predictors associated with LLR.
  
  
  METHODS
  We studied a cohort of adult patients with IBD treated with ATNF by a single specialist during 2009. Patients with LLR were characterized and compared with those without LLR for possible predictors.
  
  
  RESULTS
  Twenty of 289 patients (6.9%) had LLR (19.9 cases per 1000 patient-years). Female gender and IBD-unclassified were more prevalent in the LLR group (85% versus 54%, P = 0.009; and 15% versus 2.2%, P = 0.018, respectively), with a hazard ratio of 3.89 (95% confidence interval = 1.12-13.55; P = 0.033) and 7.38 (95% confidence interval = 1.93-28.23; P = 0.003), respectively. ATNF duration was shorter in the LLR group (median, 1 year [interquartile range, 0-3] versus 3 years [interquartile range, 1-6.5], P = 0.005). Arthropathy was universal, followed by fatigue and dermatitis (30% each). Antinuclear antibodies were universally positive, and 16 of 20 had anti-double-stranded DNA. ATNF was discontinued in all; 8 patients required corticosteroids and 1 required hydroxychloroquine followed by complete clinical resolution (mean 7.9 ± 5.9 months). Antinuclear antibodies reverted or normalized in 7 of 16 patients (44%). Fourteen patients (70%) were switched to a second ATNF, 2 with concomitant immunomodulators, and 12 as monotherapy. One patient on ATNF monotherapy developed a second LLR and was successfully switched to a third ATNF.
  
  
  CONCLUSIONS
  LLRs secondary to ATNFs are more frequent than previously reported, more common in women and IBD-unclassified. It is reversible with cessation of the culprit agent and steroids. Switching to an alternative ATNF rarely results in recurrence.
authors.affiliation: *IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel; †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Inflammatory Bowel Disease Center, University of Chicago Medical Center, Chicago, Illinois; and §Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Henit
authors.initials: H
authors.lastname: Yanai
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shuster
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
authors.forename: Liat
authors.initials: L
authors.lastname: Mlynarsky
authors.forename: Srilaxmi
authors.initials: S
authors.lastname: Tumuluri
authors.forename: Russell D
authors.initials: RD
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D062606:Tertiary Care Centers; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha