Title:TNF-induced Lupus. A Case-Based Review
Volume: 18
Issue: 1
Author(s): Anastasia Skalkou, Eleftherios Pelechas, Paraskevi V. Voulgari and Alexandros A. Drosos*
Affiliation:
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina 45110,
Greece
Keywords:
TNF inhibitor, adalimumab, TNF-induced lupus, adverse events, RA, SSA.
Abstract: Nowadays, tumor necrosis factor-alpha (TNFα) inhibitors have revolutionised the treatment
of inflammatory arthritides by demonstrating efficacy with an acceptable toxicity profile.
However, autoimmune phenomena and clinical entities have been reported ranging from an isolated
presence of autoantibodies to full-blown autoimmune diseases, including drug-induced lupus
(DIL).
Case Presentation: A 62-year-old woman with rheumatoid arthritis (RA) refractory to methotrexate
and prednisone was treated with adalimumab (ADA). 4 months later, she presented acute cutaneous
eruptions after sun exposure, positive ANA (1/640 fine speckled pattern), Ro (SSA) and anti-
Smith (Sm) antibodies with no other clinical or laboratory abnormalities. The diagnosis of DIL
was made, ADA was discontinued, and she was treated successfully with prednisone plus local
calcineurin inhibitors.
Conclusion: Thus, we review the literature for cases of DIL development in patients treated with
TNFα inhibitors. Rheumatologists should be aware of the possible adverse events and the requirement
of careful clinical evaluation and monitoring.
