Occurence of autoimmune diseases following the biological treatment


Authors: K. Pavelka;  K. Jarošová
Authors‘ workplace: Revmatologický ústav a Klinika revmatologie 1. LF UK Praha
Published in: Čes. Revmatol., 19, 2011, No. 1, p. 4-10.
Category: Reviews

Overview

Biological therapy of chronic inflammatory, rheumatic, gastroenterological and dermatological diseases has revolutionized the treatment of these conditions. The number of patients treated with biologicals as well as the range of indications for this therapy is still growing. Although this treatment is relatively safe, adverse events may occur including development of autoimmune disorders. These autoimmune diseases may be divided into autoimmune systemic diseases and organ specific autoimmune diseases. Systemic lupus erythematosus (SLE) and vasculitides are among the most frequently induced systemic autoimmune diseases, whereas demyelinating diseases of the central nervous system (CNS) and peripheral neuropathy, interstitial lung disease and autoimmune hepatitis represent the organ specific group. Autoimmune diseases are most frequently induced by anti-TNF agents. Drug induced lupus usually manifests with consitutional symptoms, skin and joint involvement, haematological abnormalities and serositis. Nephritis and CNS involvement are less common. Anti-TNF induced SLE patients are ANA positive in 100% and anti dsDNA positive in 90%, whereas in classical drug induced SLE and idiopathic SLE, anti dsDNA positivity occurs less frequently. Antinuclear antibodies (ANA) are typical for classical drug induced SLE (occurs in 95%), less frequent in TNF induced SLE (57%) and least frequent in idiopathic SLE (25–40%). The treatment of drug induced SLE consists of discontinuation of TNF therapy in mild cases and mandatory use of corticosteroids and immunosuppressive therapy in more severe cases. The prognosis is good; the portion of patients with persistent disease is approximately 13%. In this review article, the author included two case reports describing patients with drug induced lupus from the Institute of Rheumatology in Prague including their treatment. Patients with skin vasculitis dominated the group of vasculitis patients with 88%, whereas renal involvement and peripheral neuropathy were rare. Conclusion: It is necessary to consider the possibility of drug induced autoimmune disease following a biological therapy when forming a differential diagnosis, and to take adequate therapeutic actions. In most cases, discontinuation of anti-TNF therapy is sufficient, whereas in more severe cases, introduction of immunosuppressive treatment is mandatory.

Key words:
autoimmune disease, anti-TNF therapy, drug induced systemic lupus erythematosus


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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