Typical Symptoms and Manifestations

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Most symptoms of drug-induced lupus are similar for all drugs that cause a lupuslike syndrome; however, the spectrum is somewhat different with each. The only two drugs for which a sufficient number of cases of a lupus-like syndrome have been accumulated to provide a clear picture are procainamide and hydralazine. The symptoms and laboratory characteristics associated with these two drugs are contrasted with those of idiopathic lupus in Table 9.1. As mentioned previously, although there is overlap with idiopathic lupus, the drug-induced syndrome is usually mild, and the most serious manifestations of idiopathic lupus, especially involvement of the central nervous system and the kidneys, are uncommon in most types of drug-induced lupus. Several reviews summarize the clinical syndrome, including the following:

Adams and Hess 1991, Lee and Chase 1975, Price and Venables 1995, Yung and Richardson 1994.

The syndrome of drug-induced lupus usually begins a month or more after drug therapy is initiated. In fact, unlike most idiosyncratic drug reactions, the symptoms of lupus usually begin more than a year after initiating use of the responsible drug. The most common symptoms are arthralgias, myalgias, pleurisy, pulmonary infiltrates, fever, and malaise. The arthralgias usually involve small joints and are symmetrical but can involve single joints. In some cases, frank arthritis can occur, but it rarely leads to destruction of the joints. Rashes are not uncommon, but they are usually maculopapular "drug rashes," and the classic malar rash associated with idiopathic lupus is rare in drug-induced lupus.

Table 9.1. Characteristics of idiopathic lupus and drug-induced lupusa

Idiopathic lupus

Drug-induced lupus

Procainamide

Hydralazine

(Dubois and

(Blomgren

(Perry 1973)

Wallace 1987)

et al. 1972)

Patient profile

Age (years)

29

63

48

Sex (female)

89

41

64

Race (white)

72

95

95

Symptoms

Arthralgias

92

95

93

Arthritis

35

18

70

Fever

84

45

52

Myalgias

48

48

NR

Pleurisy

45

52

25

Rash

72

5

34

Adenopathy

59

9

12

Pericarditis

31

14

NR

Splenomegaly

9

5

20

Renal involvement

46

0

5

Central nervous system

involvement

26

2

0

Arthralgias

92

95

93

Laboratory findings

Antinuclear antibodies

100

100

98

Antihistone antibodies

(Yung and Richardson

1994)

70

>95

>95

Anti-double strand DNA

(Yung and Richardson

1994)

44

<1

<1

Lupus cells

76

77

62

VDRL

11

0

5

Anemia

57

9

17

Leukopenia

43

2

24

a Data are given as percentages, except where otherwise indicated. NR, not reported.

a Data are given as percentages, except where otherwise indicated. NR, not reported.

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