Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0409974 (lupus)
 22,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Drug-induced lupus is a syndrome which share symptoms and laboratory characteristics with idiopathic systemic lupus erythematosus (SLE). The terms drug-induced lupus (DIL) and drug-induced lupus erythematosus (DILE) are preferred, but other ones are also used-drug-related lupus, lupus-like syndrome and lupus erythematosus medicamentosus. The first case of DILE was reported in 1945 and associated with sulfadiazine. In 1953, it was reported that DILE was related to the use of hydralazine. More than 80 drugs have been associated with DILE. The average age of patients with DILE is nearly twice that of patients with idiopathic SLE. Approximately half the patients with drug-induced SLE are women, compared with 90% of patients with idiopathic SLE. Similarly to idiopathic lupus, DILE can be divided into systemic, sub-acute cutaneous and chronic cutaneous lupus. The syndrome is characterised by arthralgia, myalgia, pleurisy, rash and fever in association with antinuclear antibodies in the serum. The clinical and laboratory manifestations of drug-induced SLE are similar to those of idiopathic SLE, but central nervous system and renal involvement are rare in DILE. Recognition of DILE is important because it usually reverts within a few weeks after stopping the drug. This review discusses the general issues in DILE, such as pathogenic mechanisms, clinical forms and diagnostic criteria, and provides more detailed information for some of the most recent implicated drugs: minocycline, statins, anti-TNF-alpha agents.
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PMID:Drug-induced lupus erythematosus. 1836 39

The 3-Hydroxy-3-methyl-glutaryl coenzyme A (HGM-CoA) reductase inhibitors, or statins, are competitive inhibitors of the rate-limiting enzyme in cholesterol synthesis. Generally, statins have an excellent safety profile. Elevations of liver transaminases and creatine phosphokinase with myalgia have been associated with the use of HGM-Co A reductase inhibitors, case reports of rhabdomyolysis are rare, most occurring with concomitant use with other drugs such as cyclosporin, fusidic acid and gemfibrozil. We describe here the clinical case of a patient who developed interstitial lung disease as probably a result of the use of statins which particularly increased with long-term atorvastatin treatment. The present review details some case-reports of interstitial lung disease reported under statins in the literature. Few systemic adverse effects such as lupus-like-syndromes and polymyositis have been reported. Recent experimentations have demonstrated that cholesterol is not the only intracellular target of statins but that they also have a potential role in atherosclerosis and in organ transplantation as immunosuppressor agents.
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PMID:[A case of interstitial lung disease with atorvastatin (Tahor) and a review of the literature about these effects observed under statins]. 1679 55

We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies.
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PMID:[Minocycline-induced lupus erythematodes]. 1697 Jan 39

Muscle toxicity is one adverse reaction reported with the use of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins). This toxicity may include asymptomatic elevations of muscle enzymes, weakness, myalgia, and myositis. High doses of statins, or the combination of statins with other anti-cholesterol medications, increase the risk of toxicity. In addition, case reports of systemic and autoimmune reactions such as lupus, nephritis, vasculitis, and myositis, suspected to be associated with statins, have been reported. Our 76-year-old patient demonstrates a case of serologically and biopsy-proven inflammatory polymyositis, combined with a statin toxic myopathy. His symptoms and enzyme abnormalities resolved with both the removal of the statin medication and the institution of immunosuppressive therapy. Investigation of muscle enzyme elevation and weakness that do not resolve with statin removal is warranted. Certain muscle biopsy findings, including mononuclear cell infiltrate, distinguish the etiology as inflammatory/possibly autoimmune and do not suggest statin myopathy.
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PMID:A case of atorvastatin combined toxic myopathy and inflammatory myositis. 1703 67

Chronic pain is very common in all European countries, with musculoskeletal problems predominating. About 1% of the adult population develops a syndrome of chronic muscle pain, fibromyalgia (FMS), characterized by multiple tender points, back or neck pain, and a number of associated problems from other organs, including a high frequency of fatigue. Evidence points to central sensitization as an important neurophysiological aberration in the development of FMS. Importantly, these neurological changes may result from inadequately treated chronic focal pain problems such as osteoarthritis or myofascial pain. It is important for health professionals to be aware of this syndrome and to diagnose the patients to avoid a steady increase in diagnostic tests. On the other hand, patients with chronic widespread pain have an increased risk of developing malignancies, and new or changed symptoms should be diagnosed even in FMS. In rheumatology practice it is especially important to be aware of the existence of FMS in association with immune inflammatory diseases, most commonly lupus and rheumatoid arthritis. Differential diagnoses are other causes of chronic pain, e.g. thyroid disease. The costs of this syndrome are substantial due to loss of working capability and direct expenses of medication and health-system usage. Fibromyalgia patients need recognition of their pain syndrome if they are to comply with treatment. Lack of empathy and understanding by healthcare professionals often leads to patient frustration and inappropriate illness behavior, often associated with some exaggeration of symptoms in an effort to gain some legitimacy for their problem. FMS is multifaceted, and treatment consists of both medical interventions, with emphasis on agents acting on the central nervous system, and physical exercises.
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PMID:Chronic widespread pain in the spectrum of rheumatological diseases. 1760 90

We encountered an adult patient with acute parvovirus B19 infection who presented with transient lupus-like symptoms (i.e., polyarthritis, fever, myalgia, pancytopenia, hypocomplementemia, and nephritis). Our case is characterized by the demonstration of acute nephritis as a complication of this infection, making it difficult to distinguish between a viral infection and the first episode of systemic lupus erythematosus.
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PMID:Emerging lupus-like manifestations in acute parvovirus B19 infection. 1762 80

Although the prescription of statin medication has increased worldwide and especially in Europe, its musculoskeletal side effects and their management strategy has not been highlighted in orthopaedic literature. We present three cases of statin-induced musculoskeletal symptoms which presented to an orthopaedic department. There were two patients with statin induced muscle pain (one in the thigh and one around the hip), and one with both myositis (with raised creatine kinase) and lupus-like symptoms. All of the symptoms resolved with stopping the statin. Muscle pain (often with normal creatine kinase) is the commonest side effect of statins. It is usually bilateral, but two of our cases presented with unilateral symptoms which made it more difficult to exclude a primary orthopaedic pathology. The widespread use of statins is likely to lead to an increase in the number of patients presenting to orthopaedic surgeons with muscle pain. It is important to consider muscle pain induced by statins in the differential diagnosis of acute or chronic pain in the limbs.
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PMID:Statin-induced muscular symptoms: a report of 3 cases. 1881 Oct 49

The aim of this study is to characterize the clinical manifestations of postmenopausal systemic lupus erythematosus (SLE) patients. Of the 699 SLE inpatients, 20 postmenopausal and 70 menstruous SLE patients were evaluated and compared for the clinical manifestations. The mean age of onset was 55.05 years (range from 42 to 66) with a peak of 50-60 in postmenopausal lupus patients. The average time from SLE onset to diagnosis was 2.18 years. Arthritis was the most frequent initial manifestation in the postmenopausal group. Other common clinical manifestations and laboratory abnormalities include lassitude, fever, alopecia, malar rash, cardiac impairment and weight loss, and elevated ESR, decreased C3, ANA >or= 1:80, hypergammaglobulinemia and anti-RNP antibody positive. Compared with menstruous lupus patients, postmenopausal patients were more likely to have weight loss (P < 0.01), myalgia and myasthenia (P < 0.01), and less likely to have malar rash (P < 0.05), renal involvement (P < 0.01), leukocytopenia (P < 0.05) and positive ANA (P < 0.01). Thus, less disease severity and favorable prognosis were associated with postmenopausal SLE patients. Misdiagnosis and missed diagnosis were easy to make with their non-specific symptoms with fewer features suggestive of diagnosis.
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PMID:Less disease severity and favorable prognosis are associated with postmenopausal systemic lupus erythematosus patients. 1881 29

We present a 43-year-old woman with relapsing-remitting multiple sclerosis (MS) who developed lupus syndrome after 32 months of IFN-beta-1a therapy. She presented with malaise, myalgia, arthralgia and fever. Laboratory tests showed high erythrocyte sedimentation rate, anaemia and lymphopenia. Antibodies to double stranded DNA (dsDNA) of IgG, IgM and IgA classes were detected on Critidia luciliae. Additionally, high levels of anti-nucleosomal antibodies, low levels of anti-histone and anti-Ro/SSA antibodies were also found. Diagnosis of drug-induced SLE was established. Treatment with IFN-beta was discontinued and oral prednisone was started. Twelve weeks after cessation of IFN-beta therapy, the patient's symptoms completely resolved and autoantibodies disappeared. To the best of our knowledge, this is the first report of a patient with MS in whom treatment with IFN-beta induced lupus syndrome and antibodies to dsDNA and nucleosome.
Lupus 2009 Jan
PMID:Anti-double stranded DNA and lupus syndrome induced by interferon-beta therapy in a patient with multiple sclerosis. 1907 73

We report an unusual case of acute suppurative thyroiditis associated with juvenile systemic lupus erythematosus (JSLE) onset. A 10 year-old girl presented with a painful voluminous swelling in the anterior cervical region with fever and dysphagia. She also had dysphonia, myalgia, swelling of the small joints of the hands, weight loss, and erythematous malar rash. Thyroid ultrasonography disclosed an ill-defined solid cystic area containing abundant echoes in suspension suggestive of an abscess in both lobes compatible with suppurative bacterial thyroiditis. Fine-needle aspiration biopsy showed a secretion with positive culture for Staphylococcus aureus. Endoscopic evaluation did not demonstrate pyriform sinus fistula. The child had no previous thyroid disease. Hormonal evaluation showed thyrotrophin (TSH) 13 microIU/ml and free thyroxine (FT4) 0.4 ng/dl. After laboratory confirmation of JSLE, high dose 'pulse' therapy was performed with methylprednisolone (30 mg/kg/day for 3 days), followed by prednisone (2 mg/kg/day). The acute thyroiditis was treated with oxacillin, metronidazole and amikacin which ameliorated the symptoms of infection followed by normalization of thyroid function with levothyroxine. In spite of the known association between autoimmune diseases and thyroid disorders, the coexistence of suppurative thyroiditis and JSLE is rare, generally occurring during the course of lupus and not at diagnosis.
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PMID:Acute suppurative thyroiditis as the initial presentation of juvenile systemic lupus erythematosus. 1955 14


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