Drug-induced lupus resolves after anti-TNF switch

Australian rheumatologists have reported the third known case of infliximab-related lupus which resolved after drug cessation and did not recur on switching to another TNF inhibitor. Writing in Clinical Rheumatology the doctors from the department of rheumatology, Austin Health, Victoria, said their case study illustrated that doctors should not rule out switching to an alternative anti-TNF in these circumstances. They presented the case of a 22 year old woman who after 13 months of receiving infiximab for ankylosing spondylitis (AS) developed SLE. She immediately stopped infliximab therapy and began 400mg of hydroxychloroquine daily. Within a month her arthralgia and rash resolved and there was a prompt decline in titre of dsDNA antibody and serum complement increased. However, two months after stopping infiximab her AS symptoms returned and did not respond to high-dose NSAIDs and prednisolone. Etanercept 50mg a week was ‘cautiously’ introduced. The doctors said they favoured etanercept because of its short half life and different mode of action. The patient’s inflammatory back pain and spine mobility improved and at 14 months there was no clinical or serologic evidence of a lupus recurrence. “TNFi therapy has considerably improved the quality of life for many patients with poorly controlled chronic inflammatory disorders. The induction of serologic systemic autoimmunity is common while clinical lupus is uncommon,” the study authors said. “Our case suggests that development of TNF-i related lupus does not preclude switching to alternative anti-TNF therapy”. Clinical Rheumatology 2010; published online before print....