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Journal of Chinese Integrative Medicine ›› 2008, Vol. 6 ›› Issue (5): 458-462.doi: 10.3736/jcim20080505

• Review • Previous Articles     Next Articles

Pay close attention to drug-induced lupus

Min-jie Zhou, Zhao-hui Ni()   

  1. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2008-03-14 Online:2008-05-20 Published:2008-05-15
  • Contact: NI Zhao-hui

Drug-induced lupus (DIL) is a lupus-like illness that has been recognized as a side effect of over 80 drugs since its first description in association with sulfadiazine in 1945. The epidemiology and clinical course of idiopathic systemic lupus erythematosus and DIL differ markedly, and prognosis is generally favorable in the latter although occasional life-threatening cases have been reported in the literature. Constant pharmacovigilance is crucial for prompt diagnosis and cessation of offending therapy, hence achieving the best outcome. This review discusses the clinical presentation, diagnosis and treatment of DIL so as to call for vigilance of medical workers.

Key words: drugs, lupus, nephrosis

CLC Number: 

  • R593.242


明确相关 可能相关 可疑相关 个案报道
肼苯哒嗪 柳氮磺胺吡啶 抗生素 因福利美
普鲁卡因酰胺 抗惊厥药 非甾体类抗炎药 依那西普
异烟肼 抗甲状腺药 降压药 白细胞介素2
甲基多巴 他汀类药 锂剂 扎鲁司特
奎尼丁 特比萘芬 干扰素 氯巴占
米诺环素 D-青霉胺 氯金化钠 妥卡尼
氯丙嗪 氟尿嘧啶 赖诺普利
氢氯噻嗪 丁氨苯丙酮


起病年龄 老年(50岁左右) 育龄期(20~40岁)
女∶男 1∶1 9∶1
人种 非黑色人种 所有人种
病程 停药后自愈 慢性,易复发
乙酰化表现型 慢乙酰化者易发生 快、慢乙酰化者发生概率均等
起病速度 急骤 逐渐
症状严重度 通常中度 中度到重度
全身受累 50% 83%
皮肤受累 紫癜和结节性红斑 颧部盘状红斑、光敏感和口腔溃疡
关节痛和关节炎 95% 90%
浆膜炎和心包炎 50% 50%
肝肿大 25% 25%
肾脏受累 5% 53%
中枢神经系统受累 0% 32%
血液异常 罕见 常见
ANA 95%(均质型) 95%(均质型或斑点型)
LE细胞 90% 90%
抗核糖核蛋白抗体 20% 40%~50%
抗Sm抗体 罕见 20%~30%
抗dsDNA抗体 <5% 50%~70%
抗组蛋白抗体 >95% >50%
补体 正常 降低
免疫复合物 正常 增高
[1] Hoffman BJ.Sensitivity of sulfadiazine resembling acute disseminated lupus erythematosus[J].Arch Dermatol Syph, 1945, 51: 190-192
[2] Puttini P, Atzeni F, Capsoni F , et al. Drug-induced lupus erythematosus[J]. Autoimmunity, 2005,38(7):507-518
doi: 10.1080/08916930500285857
[3] Kale SA . Drug-induced systemic lupus erythematosus. Differentiating it from the real thing[J]. Postgrad Med, 1985,77(3):231-235
pmid: 2866863
[4] Atzeni F, Marrazza MG, Sarzi-Puttini P , et al. Drug-induced lupus erythematosus[J]. Reumatismo, 2003,55(3):147-154
[5] Mansilla-Tinoco R, Harland SJ, Ryan PJ , et al. Hydralazine, antinuclear antibodies, and the lupus syndrome[J]. Br Med J (Clin Res Ed), 1982,284(6320):936-939
doi: 10.1136/bmj.284.6320.936 pmid: 6802356
[6] Batchelor JR, Welsh KI, Tinoco RM , et al. Hydralazine-induced systemic lupus erythematosus: influence of HLA-DR and sex on susceptibility[J]. Lancet, 1980,1(8178):1107-1109
doi: 10.1016/S0140-6736(80)91554-8 pmid: 6103441
[7] Gunnarsson I, Nordmark B, Hassan Bakri A , et al. Development of lupus-related side-effects in patients with early RA during sulphasalazine treatment——the role of IL-10 and HLA[J]. Rheumatology (Oxford), 2000,39(8):886-893
doi: 10.1093/rheumatology/39.8.886
[8] Speirs C, Fielder AH, Chapel H , et al. Complement system protein C4 and susceptibility to hydralazine-induced systemic lupus erythematosus[J]. Lancet, 1989,1(88644):922-924
[9] Totoritis MC, Tan EM , McNally EM, et al.Association of antibody to histone complex H2A-H2B with symptomatic procainamide-induced lupus[J]. N Engl J Med, 1988,318(22):1431-1436
doi: 10.1056/NEJM198806023182204
[10] Peterson LL . Hydralazine-induced systemic lupus erythematosus presenting as pyoderma gangrenosum-like ulcers[J]. J Am Acad Dermatol, 1984,10(2 Pt 2):379-384
doi: 10.1016/S0190-9622(84)80011-0
[11] Elkayam O, Yaron M, Caspi D . Minocycline-induced autoimmune syndromes: an overvie[J]. Semin Arthritis Rheum, 1999,28(6):392-397
doi: 10.1016/S0049-0172(99)80004-3
[12] Sturkenboom MC, Meier CR, Jick H , et al. Minocycline and lupuslike syndrome in acne patients[J]. Arch Intern Med, 1999,159(5):493-497
doi: 10.1001/archinte.159.5.493
[13] Gough A, Chapman S, Wagstaff K , et al. Minocycline induced autoimmune hepatitis and systemic lupus erythematosus-like syndrome[J]. BMJ, 1996,312(7024):169-172
doi: 10.1136/bmj.312.7024.169 pmid: 2349841
[14] Khattak FH, Morris IM, Mattingly PC . Sulphasalazine-induced systemic lupus erythematosus in a patient with rheumatoid arthritis[J]. Br J Rheumatol, 1996,35(1):104
doi: 10.1093/rheumatology/35.1.104 pmid: 8624617
[15] Gordon MM, Porter DR, Capell HA . Does sulphasalazine cause drug induced systemic lupus erythematosus? No effect evident in a prospective randomised trial of 200 rheumatoid patients treated with sulphasalazine or auranofin over five years[J]. Ann Rheum Dis, 1999,58(5):288-290
doi: 10.1136/ard.58.5.288
[16] Walshe JM . Penicillamine and the SLE syndrome[J]. J Rheumatol Suppl, 1981,( 7):155-160
pmid: 6939878
[17] Spiera RF, Berman RS, Werner AJ , et al. Ticlopidine-induced lupus: a report of 4 cases[J]. Arch Intern Med, 2002,162(19):2240-2243
doi: 10.1001/archinte.162.19.2240
[18] Fenniche S, Dhaoui A, Ammar FB , et al. Acebutolol-induced subacute cutaneous lupus erythematosus[J]. Skin Pharmacol Physiol, 2005,18(5):230-233
doi: 10.1159/000086668
[19] Carter JD, Valeriano-Marcet J, Kanik KS , et al. Antinuclear antibody-negative, drug-induced lupus caused by lisinopril[J]. South Med J, 2001,94(11):1122-1123
doi: 10.1097/00007611-200111000-00017 pmid: 11780682
[20] Graziadei IW, Obermoser GE, Sepp NT , et al. Drug-induced lupus-like syndrome associated with severe autoimmune hepatitis[J]. Lupus, 2003,12(5):409-412
doi: 10.1191/0961203303lu313cr
[21] Borchers AT, Keen CL, Gershwin ME . Drug-induced lupus[J]. Ann N Y Acad Sci, 2007,1108(5):166-182
doi: 10.1196/annals.1422.019
[22] Uetrecht J . Current trends in drug-induced autoimmunity[J]. Autoimmun Rev, 2005,4(5):309-314
doi: 10.1016/j.autrev.2005.01.002 pmid: 15990079
[23] Griem P, Wulferink M, Sachs B , et al. Allergic and autoimmune reactions to xenobiotics: how do they arise?[J]. Immunol Today, 1998,19(3):133-141
doi: 10.1016/S0167-5699(98)80012-1 pmid: 9540273
[24] Pirmohamed M, Williams DP, Naisbitt DJ , et al. Induction of metabolism-dependent and -independent neutrophil apoptosis by clozapine[J]. Mol Pharmacol, 2000,58(1):133-141
[25] Hess DA, Sisson ME, Suria H , et al. Cytotoxicity of sulfonamide reactive metabolites: apoptosis and selective toxicity of CD8(+) cells by the hydroxylamine of sulfamethoxazole[J]. FASEB J, 1999,13(13):1688-1698
doi: 10.1096/fasebj.13.13.1688
[26] Yung RL, Quddus J, Chrisp CE , et al. Mechanism of drug-induced lupus. I. Cloned Th2 cells modified with DNA methylation inhibitors in vitro cause autoimmunity in vivo[J]. J Immunol, 1995,154(6):3025-3035
[27] Kretz-Rommel A, Duncan SR, Rubin RL . Autoimmunity caused by disrution of central T cell tolerance. A murine model of drug-induced lupus[J]. J Clin Invest, 1997,99(8):1888-1896
doi: 10.1172/JCI119356
[28] Kretz-Rommel A, Rubin RL . Disruption of positive selection of thymocytes causes autoimmunity[J]. Nat Med, 2000,6(3):298-305
doi: 10.1038/73152 pmid: 10700232
[29] van Rijthoven AW, van Roon JA . Drug-induced systemic lupus erythematosus: reports to The Netherlands Pharmacovigilance Centre Lareb[J]. Ned Tijdschr Geneeskd. 2007, 2007,151(14):839
[30] Ye RG. Integrated traditional Chinese and Western nephrology.[J]. Beijing: People's Medical Publishing House, 2003,151(14):261
叶任高 . 中西医结合肾脏病学[J].北京: 人民卫生出版社, 2003,151(14):261
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