Key distinguishing features of drug-induced versus idiopathic lupus | ||
Feature | Drug-induced | Idiopathic |
Anti-dsDNA+ | <5% (rare) | 50 to 80% |
Anti-Smith+ | <5% (rare) | 20 to 30% |
Antihistone+ | 90 to 95%* | 60 to 80% |
Discoid rash | Rare | 20% |
Malar rash | 2% | 42% |
Kidney involvement | 0 to 5% | 30 to 50% |
Drug-specific clinical patterns | ||
Drug | Clinical features | Laboratory findings |
Procainamide |
|
|
Minocycline |
|
|
TNF-alpha inhibitors |
|
|
Terbinafine |
|
|
ANA: antinuclear antibody; DLE: discoid lupus erythematosus; DNA: deoxyribonucleic acid; dsDNA: double-stranded deoxyribonucleic acid; P-ANCA: perinuclear antineutrophil cytoplasmic antibodies; SCLE: subacute cutaneous lupus erythematosus; TNF: tumor necrosis factor.
* Reported rates of antihistone antibodies with drug-induced lupus overall are 90 to 95%, but the incidence varies by agent, and lower rates have been reported for minocycline, propylthiouracil, and statins.
¶ A large proportion of patients using TNF inhibitors develop autoantibodies, but clinical signs and symptoms of a drug-induced lupus syndrome are rare.Do you want to add Medilib to your home screen?