Lupus-Like Syndrome Attributable to Anti-Tumor Necrosis Factor a Therapy in 14 Patients During an 8-Year Period at Mayo Clinic

Wetter, David A.; Davis, Mark D. P.
November 2009
Mayo Clinic Proceedings;Nov2009, Vol. 84 Issue 11, p979
Academic Journal
OBJECTIVE: To examine clinical characteristics, laboratory features, and outcomes of patients with lupus-like syndrome attributable to anti-tumor necrosis factor α (TNF-α) therapy. PATIENTS AND METHODS: We performed α retrospective review of patients with lupus-like syndrome attributable to anti-TNF-α therapy at Mayo Clinic's site In Rochester, MN, between July 1, 2000, and June 30, 2008. RESULTS: Of 14 patients (mean age at disease onset, 46.2 years), 12 (86%) were female. Ten patients (71%) had Crohn disease, and 4 (29%) had rheumatoid arthritis. Thirteen patients (93%) originally were treated with Infliximab, and 1 (7%) was treated with adalimumab. A lupus-Ike syndrome occurred after a mean treatment duration of 16.2 months. Features of lupus included presence of antinuclear antibodies (14 patients [100%]), arthritis (13 patients [93%]), anti-double-stranded-DNA antibodies (10 patients [71%]), cutaneous findings (malar rash, discoid rash, or photosensitivity, 4 patients [29%]), serositis (4 patients [29%]), hematologic abnormalities (4 patients [29%1), oral ulcers (4 patients [29%]), and lupus anticoagulant (1 patient [7%)). No patient had renal or neurologic abnormalities. All patients Improved after stopping anti-TNF-α therapy (mean time to improvement, 2.9 months). Four (80%) of 5 patients tolerated an alternative TNF-α Inhibitor (adalimumab, 3 patients; etanercept, 1 patient) without recurrence of lupus-like syndrome. CONCLUSION: Compared with previous studies, cutaneous findings were less frequent and arthritis was more frequent in our cohort of patients. Some patients were able to tolerate an alternative TNF-α inhibitor without recurrence of lupus-like syndrome.


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