The Medical School, Baylor College of Medicine, Houston, TX, USA.
Int J Dermatol. 2011 May;50(5):619-25. doi: 10.1111/j.1365-4632.2011.04871.x.
In patients with various autoimmune and rheumatic diseases, a drug-induced lupus-like syndrome (DILS) has been reported with the use of adalimumab, cerrolizumab pegol, etanercept, and infliximab.
To review clinical characteristics of patients who develop tumor necrosis factor (TNF) alpha antagonist-induced lupus-like syndrome (TAILS) and review implications for further TNF alpha antagonist therapy.
We describe a 62-year-old woman with rheumatoid arthritis who developed a pruritic photo-distributed rash two months after the initiation of etanercept therapy. Her skin biopsy showed lupus erythematosus, and she had positive serum ANA, anti-Sjogren's syndrome A (SSA)/Ro, and anti-Sjogren's syndrome B (SSB)/La antibodies. Her symptoms resolved after discontinuation of the drug, topical and systemic corticosteroids, and hydroxychloroquine sulfate. Subsequently, her rheumatoid arthritis was treated with golimumab for six months without recurrence of skin lesions. Published reports of individuals who have developed TAILS and those who have continued treatment with alternative TNF alpha antagonists are reviewed.
TAILS is most commonly associated with the use of etanercept and infliximab. It occurs most often in women in the fifth decade of life. Onset of symptoms ranges from less than one month to more than four years. Syndrome-associated cutaneous lesions and induction of autoantibodies are common. There is no definitively established mechanism of pathogenesis. Treatment can include discontinuation of the drug, corticosteroids, immunosuppressives, and hydroxychloroquine sulfate. To date, 10 patients with TAILS have continued therapy with an alternative TNF alpha antagonist without recurrence of lupus symptoms.
Development of a DILS after one TNF alpha antagonist does not preclude continued treatment with an alternative TNF alpha antagonist.
在患有各种自身免疫和风湿性疾病的患者中，已有报道阿达木单抗、西仑吉肽、依那西普和英夫利昔单抗会引起药物诱导的狼疮样综合征（DILS）。
综述发生肿瘤坏死因子（TNF）α拮抗剂诱导的狼疮样综合征（TAILS）患者的临床特征，并探讨对进一步 TNFα拮抗剂治疗的影响。
我们描述了一位 62 岁女性类风湿关节炎患者，在开始使用依那西普治疗两个月后出现瘙痒性、光分布皮疹。她的皮肤活检显示红斑狼疮，血清抗核抗体、抗 Sjögren 综合征 A（SSA）/Ro 和抗 Sjögren 综合征 B（SSB）/La 抗体均为阳性。停药、局部和全身皮质类固醇以及硫酸羟氯喹治疗后，她的症状得到缓解。随后，她的类风湿关节炎用戈利木单抗治疗六个月，未再出现皮肤病变。我们还回顾了已发表的 TAILS 患者和继续使用替代 TNFα拮抗剂治疗的患者的报告。
TAILS 最常与依那西普和英夫利昔单抗相关。它通常发生在 50 岁出头的女性中。症状发作时间从不到一个月到四年多不等。与综合征相关的皮肤病变和自身抗体的诱导很常见。目前尚未确定发病机制的明确机制。治疗可以包括停药、皮质类固醇、免疫抑制剂和硫酸羟氯喹。迄今为止，10 名 TAILS 患者继续使用替代 TNFα拮抗剂治疗，狼疮症状未再复发。
一种 TNFα 拮抗剂引起 DILS 并不排除继续使用另一种 TNFα 拮抗剂。
