Favalli E G, Sinigaglia L, Varenna M, Arnoldi C
Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
Lupus. 2002;11(11):753-5. doi: 10.1191/0961203302lu236cr.
After introduction of infliximab for the treatment of rheumatoid arthritis (RA), there have been many reports of patients developing asymptomatic higher rate of antinuclear antibodies and anti-dsDNA antibodies than in non-infliximab-treated patients. However, only five clinical drug-induced lupus (DIL) cases have been documented following treatment with infliximab, in RA and in Crohn's diseases. We report a case of a 69-year-old female with a 5 year history of RA, whowas successfully treated with low-dose methotrexate (MTX) and infliximab (initially 3 mg/kg and from the fourth infusion 5 mg/kg) for 23 weeks. Before the sixth infusion, she was diagnosed with DIL by both clinical features (fever > 38 degrees C, recurrence of active synovitis, myalgia, erythematous rash and general malaise) and laboratory findings (antinuclear antibodies 1:160, anti-double-stranded DNA positive by ELISA assay, decreased serum complement C3 andC4, hypergammaglobulinaemia, increased erythrocyte sedimentation rate). After discontinuation of treatment and therapy with oral prednisone, lupus resolved within 8 weeks.
英夫利昔单抗用于治疗类风湿关节炎（RA）后，有许多报告称，与未接受英夫利昔单抗治疗的患者相比，使用该药的患者出现无症状抗核抗体和抗双链DNA抗体的比例更高。然而，在RA和克罗恩病患者中，使用英夫利昔单抗治疗后仅记录了5例临床药物性狼疮（DIL）病例。我们报告一例69岁女性RA患者，她接受低剂量甲氨蝶呤（MTX）和英夫利昔单抗（初始剂量3 mg/kg，从第四次输注起为5 mg/kg）成功治疗23周。在第六次输注前，根据临床特征（发热>38摄氏度、活动性滑膜炎复发、肌痛、红斑皮疹和全身不适）和实验室检查结果（抗核抗体1:160、ELISA法检测抗双链DNA阳性、血清补体C3和C4降低、高球蛋白血症、红细胞沉降率升高），她被诊断为DIL。停止治疗并口服泼尼松治疗后，狼疮在8周内消退。
