Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature

被引:46
作者
Shovman, Ora [1 ,2 ]
Tamar, Shalev [3 ]
Amital, Howard [1 ,2 ,4 ]
Watad, Abdulla [1 ,2 ,4 ]
Shoenfeld, Yehuda [1 ,4 ,5 ]
机构
[1] Chaim Sheba Med Ctr, Zabludowicz Ctr Autoimmune Dis, IL-52621 Tel Hashomer, Israel
[2] Sheba Med Ctr, Dept Med B, Tel Hashomer, Israel
[3] E Wolfson Med Ctr, Dept Gastroenterol, Holon, Israel
[4] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
[5] Tel Aviv Univ, Laura Schwarz Kipp Chair Res Autoimmune Dis, Sackler Fac Med, Tel Aviv, Israel
关键词
Anti-TNF-induced lupus (ATIL); Autoantibodies; Hepatitis; Lupus; TNF-alpha blockers; DRUG-INDUCED LUPUS; GLOBAL CLINICAL-TRIALS; AUTOIMMUNE HEPATITIS; CROHNS-DISEASE; RHEUMATOID-ARTHRITIS; INFLIXIMAB TREATMENT; TARGETED THERAPIES; NO RELAPSE; PATIENT; ERYTHEMATOSUS;
D O I
10.1007/s10067-017-3884-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The induction of autoantibodies is common following therapy with anti-TNF-alpha agents. However, anti-TNF-alpha-induced lupus (ATIL) is rare. We assessed the clinical characteristics of three patients with inflammatory bowel disease (IBD) who were treated with infliximab and developed distinct subsets of ATIL. Also, we searched for similar cases in the published literature. We describe three patients with ATIL. The first patient had a classical drug-induced lupus (DIL) presented by thrombocytopenia that resolved after infliximab discontinuation. The second case experienced symmetric polyarthritis of 14 joints in rheumatoid arthritis (RA)-like distribution accompanied by lymphopenia. The third one had a severe serositis including ascites and pleural and pericardial effusions along with pancytopenia. In this patient, ATIL coexisted with anti-TNF-alpha-induced hepatitis. The second and third patients met the American College of Rheumatology classification criteria for SLE. Nevertheless, all three cases exhibited ANA and anti-dsDNA positivity, and only the second patient had anticardiolipin (aCL IgG) and anti-histone antibodies. The coexistence of both lupus-like syndrome and hepatitis following anti-TNF-alpha therapy in the same patient is very rare, and to the best of our knowledge, only four such case reports are mentioned in literature. Patients with mild ATIL may tolerate another anti-TNF-alpha agent without recurrence of the disease. Rheumatologists should be aware of the distinct clinical presentations of ATIL and its coexistence with other rare anti-TNF-alpha complications such as hepatitis.
引用
收藏
页码:563 / 568
页数:6
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