Lupus syndrome

The answer is c. (Hardman, p 868. Katzung, pp 231—232) Procainamide blocks open Na+ channels. Long-term therapy can result in drug-induced lupus syndrome, identified by circulating antinuclear antibodies. Many patients may develop a facial rash and joint pains. Pericarditis can occur, but renal involvement is rare. 

Woosley, R.L. et al., Effect of acetylator phenotype on the rate at which procainamide induces antinuclear antibodies and the lupus syndrome, New Engl. J. Med., 298, 1157, 1978. 

Debandt, M. et al., Anti-TNF-alpha-induced systemic lupus syndrome, Clin. Rheumatol., 22, 56, 2003. 

Although rare, cases of renal lupus syndrome and pemphigus blisters have also been reported as a consequence of D-penicillamine-induced immune complexes (Ntoso et al., 1986 Bigazzi, 1988), as well as with other drugs. With renal lupus syndrome, secondary glomerulonephritis may result if granular IgG antibodies are produced and deposited on the basement membranes. In patients with pemphigus blisters, autoantibodies to the intercellular substance of the skin have been recovered from the sera, and dermal biopsies have demonstrated intracellular deposits or... 

Skin rashes have been reported, as has an increase in the titer of antinuclear antibodies. Despite the latter observation, the appearance of a systemic lupus syndrome is rare. Labetalol also has been reported to interfere with chemical measurements of catecholamines and metabolites. 

Procainamide can be administered safely by intravenous and intramuscular routes and is well absorbed orally. A metabolite (/V-acetylprocainamide, NAPA) has class 3 activity. Excessive accumulation of NAPA has been implicated in torsade de pointes during procainamide therapy, especially in patients with renal failure. Some individuals rapidly acetylate procainamide and develop high levels of NAPA. The lupus syndrome appears to be less common in these patients. 

Cameron HA, Ramsay LE. The lupus syndrome induced by hydralazine a common complication with low dose therapy. Brit Med J 1984 289 410-412. 

Compared with anti-dsDNA, relatively fewer studies have been performed on anti-Ro/La antibodies. However, the unique ability to demonstrate the pathogenic role of autoantibodies causing disease provides us a chance to explore the mechanism of human autoimmune disease. The possibly most important task is to identify the cofactors making the infants of mothers with anti-Ro/La vulnerable to developing neonatal lupus syndromes. 

A14. Alexander, E., Buyon, I. P., Provost, T. T., and Guamieri, T., Anti-Ro/SS-A antibodies in the pathophysiology of congenital heart block in neonatal lupus syndrome, an experimental model. In vitro evectrophysiologic and immunocytochemical studies. Arthritis Rheum. 35, 176—189 (1992). 

B32. Buyon, J. P., Neonatal lupus syndromes. Curr. Opin. Rheum. 6, 523-529 (1994). 

B36. Buyon, J. P., Winchester, R. J., Slade, S. G., Arnett, F., Copel, J., eta .. Identification of mothers at risk for congenital heart block and other neonatal lupus syndromes in their children. Comparison of enzyme-linked immunosorbent assay and immunoblot for measurement of anti-SS-A/Ro and anti-SS-B/La antibodies. Arthritis Rheum. 36, 1263—1273 (1993). 

F8. Franco, H. L., Weston, W. L., Peebles, C., Forotol, C., and Phanuphals, P., Autoantibodies directed against sicca syndrome antigens in the neonatal lupus syndrome. /. Am. Acad. Dermatol. 4, 67-72 (1981). 

A particularly good example of a drug inducing SLE is the vasodilator hydralazine, sometimes used for the treatment of hypertension. The drug-induced lupus syndrome... 

Kluger J, Drayer DE, Reidenberg MM, Lahita R. Acetylprocainamide therapy in patients with previous procainamide-induced lupus syndrome. Ann Intern Med 1981 95 18-23. 

ACR ad hoc committee on neuropsychiatric lupus nomenclature (1999) The American College of Rheumatology nomenclature as case definitions for neuropsychiatric lupus syndrome. Arthritis Rheum 42 599-608. 

Bigot MC, Trenque T, Moulin M, Beguin J, Loyau G. Acebutolol-induced lupus syndrome. Therapie 1984 39 571-5. 

Harrison T, Sisca TS, Wood WH. Case report. Propranolol-induced lupus syndrome Postgrad Med 1976 59(1) 241. ... 

Other case reports of interest include pulmonary eosino-philia in association with montelukast (13) and the clinical exacerbation of ulcerative colitis in a patient with steroid-dependent asthma after the introduction of zafirlukast (14). Drug-induced lupus syndrome has been reported in a child with an onset 10 days after beginning treatment with zafirlukast. The child had not been taking oral glucocorticoids (15). 

Back O, Lundgren R, Wiman LG. Nitrofurantoin-induced pulmonary fibrosis and lupus syndrome. Lancet 1974 1(7863) 930. 

Berning SE, Iseman MD. Rifamycin-induced lupus syndrome. Lancet 1997 349(9064) 1521-2. 

Alarcon-Segovia D. Drug-induced lupus syndromes. Mayo Clin Proc 1969 44(9) 664-81. 

Griffiths ID, Kane SP. Sulphasalazine-induced lupus syndrome in ulcerative colitis. BMJ 1977 2(6096) 1188-9. 

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