Lupus erythematosus syndrome

Sieber C, Grimm E, FoUath F. CaptoprU and systemic lupus erythematosus syndrome. BMJ 1990 301(6753) 669. 

A drug-induced systemic lupus erythematosus (SEE) with proliferative glomerulonephritis has also been described in patients treated with D-penicillamine [111, 157]. Systemic lupus erythematosus syndrome is induced in approximately 2% of patients treated with D-penicillamine [112,158]. Unlike other forms of drug-induced systemic lupus erythematosus, anti-double-strand DNA anhbodies and/or hypocomplementemia are seen in D-penicillamine-induced systemic lupus erythematosus syndrome [111, 156]. Nephropathy is rare in D-penicillamine-induced systemic lupus erythematosus syndrome [111]. Walshe [112] reported that 8 patients developed the serological change of systemic lupus erythematosus of 120 patients with Wilson s disease treated with D-penicillamine, but none of them showed nephropathy. 

Chalmers [111] reported 6 rheumatoid arthritis patients with D-penicillamine-induced systemic lupus erythematosus syndrome. All patients had previous... 

In addition to penicillamine nephropathy, other side effects of the drug may be related to the widespread deposition of immune complexes (Figure 3). Dense, granular immunoglobuhn deposits have been identified at the epidermodermal junction in 4 rheumatoid arthritis patients who developed toxic reactions, such as severe rashes, thrombocytopenia, aplastic anemia, and proteinuria. Three of 4 penicillamine-induced systemic lupus erythematosus syndrome patients had similar findings on skin biopsy [161]. 

Chalmers [111] reported 6 rheumatoid arthritis patients with D-penidllamine-induced systemic lupus erythematosus syndrome. All patients had previous mucocutaneous reactions to chry so therapy. Manifestations included pleurisy in 5 of 6 patients, rashes in 3, and nephritis in 2. LE cells were present in 5 patients. 

Impaired sexual function Lupus erythematosus syndrome Orthostatic hypotension Throbbing headache... 

Raftery AV, Demman AM (1973) Systemic lupus erythematosus syndrome induced by practolol. Br Med J 11 452... 

The duration of most usual allergic reactions, such as urticarial and maculo-papular rashes, is limited to a few days, the exanthema seldom stays for more than 1-2 weeks. But lupus erythematosus syndrome, pancytopenia, interstitial nephritis and allergic pneumopathy (chronic interstitial) may be diseases lasting for months or years, leaving permanent damage even when treatment is possible. 

Pugh S, Pel ton B, Raftery EB, Denman AM (1976) Abnormal lymphocyte function is secondary to drug induced autoimmunity. Ann Rheum Dis 35 344-348 Raftery EB, Denman AM (1973) Systemic lupus erythematosus syndrome induced by prac-tolol. Br Med J 2 452-455... 

Sunder, S. K. and Shah, A. (1975) Constrictive pericarditis in procainamide induced lupus erythematosus syndrome. Amer. J. Cardiol, 36, 960. 

Berkowitz, H. S. (1976) Disseminated lupus erythematosus syndrome associated with hydra-... 

Hydantoln anticonvulsants may cause the appearance of positive L.E. cells and methemoglobinemia. Chloropromazlne has been Implicated In causing a syndrome like systemic lupus erythematosus with accompanying positive tests for L.E. cells and antinuclear antibodies (6). 

Systemic lupus erythematosus, Sjogren s syndrome, multiple myeloma, obstructive uropathy, cirrhosis, and sickle cell disease... 

Carcinoid syndrome, anemias, systemic lupus erythematosus... 

Glomerular diseases (e.g., anti-glomerular basement membrane disease, focal segmental glomerularsclerosis, IgA nephropathy, hemolytic uremic syndrome, systemic lupus erythematosus, Alport s syndrome, amyloidosis, membranous nephropathy, and Goodpasture s syndrome)... 

Patients with genetically low levels of iY- acetyl transferase are more prone to develop a lupus erythematosus-like syndrome with which of the following drugs ... 

A recent report by the National Institutes of Health estimated that at 14 to 22 million people in the United States are affected by an autoimmune disease.1 As a group, these diseases represent a leading cause of death among women under age 65, with systemic lupus erythematosus, multiple sclerosis, and type 1 diabetes being the major sources of this impact on mortality.2 The autoimmune thyroid diseases, type 1 diabetes and rheumatoid arthritis are the most common of the autoimmune diseases (Table 25.1).3-5 Most autoimmune diseases disproportionately affect women. In the thyroid diseases, primary biliary cirrhosis, scleroderma, systemic lupus erythematosus, and Sjogren s syndrome, more than 85% of patients are female, but it is not known why the female predominance is so high in these specific diseases. 

This leaves hydralazine as the only drug of this kind available to date on the U.S. market for chronic use. The total picture of the mechanism of action of hydralazine is still not clearly defined but there is general agreement that direct relaxation of the vasculature leading to reduced peripheral resistance is the principal component of its mechanism of action. This drug has stood the test of time despite such side effects as headache, tachycardia and a syndrome which resembles acute systemic lupus erythematosus, often called "hydralazine syndrome" (1). 

Lp(a), Systemic Lupus Erythematosus, and Anti-phospholipid Syndromes. 103... 

Edematous states To induce diuresis or remission of proteinuria in the nephrotic syndrome (without uremia) of the idiopathic type or that caused by lupus erythematosus. 

The prolonged administration often leads to the development of a positive antinuclear antibody (ANA) test, with or without symptoms of a lupus erythematosus-like syndrome. If a positive ANA titer develops, assess the benefit/risk ratio related to continued procainamide therapy. 

Significant adverse reactions include a lupus erythematosus-like syndrome of arthralgia, pleural or abdominal pain, and sometimes arthritis, pleural effusion, pericarditis, fever, chills, myalgia, and possibly related hematologic or skin lesions (after prolonged administration) neutropenia thrombocytopenia agranulocytosis (after repeated use deaths have occurred) anorexia nausea vomiting abdominal pain bitter taste diarrhea. 

Lupus erythematosus Certain patients will develop a positive antinuclear antibody (ANA) test and some may show a lupus erythematosus-like syndrome similar to other drug-induced lupus, but it is not associated with hypocomplementemia and may be present without nephropathy. A positive ANA test does not mandate drug discontinuance however, a lupus erythematosus-like syndrome may develop later. Sensitivity reactions Once instituted for Wilson s disease or cystinuria, continue treatment with penicillamine on a daily basis. Interruptions for even a few days have been followed by sensitivity reactions after reinstitution of therapy. 

The autoimmune rheumatic diseases consists of Rheumatoid Arthritis (RA), Spondylarthritis (SpA), Systemic Lupus Erythematosus (SLE), Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Acute Temporal Arteritis, Giant Cell Arteritis, Behcet s Disease, Sjorgren s Syndrome, Felty s Syndrome and Mixed Connective Tissue Disease (MCTD). Spondylarthritis (SpA) can be subdivided in Reactive Arthritis (ReA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Arthritis associated with the inflammatory bowel diseases are Crohn s disease and Ulcerative Colitis (IBD), Undifferentiated SpA (UspA) and Sacro-ilitis, Juvenile SpA and Acute Anterior Uveitis (AAU). 

Pathophysiologically normochromic and normo-cytic anaemia, as occurs in many clinical syndromes exemplified by renal failure, a number of cancers, rheumatoid arthritis and systemic lupus erythematosus, is typical. Initially erythrocytes are of normal size and degree of haemoglobinization. However, persistent impairment of iron supply, especially from mitochondria to globin in the cytoplasm, leads to them becoming hypochromic and microcytic. 

Long-term drug use leads to increased antinuclear antibody titers in more than 80% of patients more than 30% of patients receiving long-term procainamide therapy develop a clinical lupus erythematosus-like syndrome. The symptoms may disappear within a few days of cessation of procainamide therapy, although the tests for antinuclear factor and lupus erythematosus cells may remain positive for several months. 

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