Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.
Clin Rheumatol. 2018 Feb;37(2):563-568. doi: 10.1007/s10067-017-3884-2. Epub 2017 Oct 23.
The induction of autoantibodies is common following therapy with anti-TNF-α agents. However, anti-TNF-α-induced lupus (ATIL) is rare. We assessed the clinical characteristics of three patients with inflammatory bowel disease (IBD) who were treated with infliximab and developed distinct subsets of ATIL. Also, we searched for similar cases in the published literature. We describe three patients with ATIL. The first patient had a classical drug-induced lupus (DIL) presented by thrombocytopenia that resolved after infliximab discontinuation. The second case experienced symmetric polyarthritis of 14 joints in rheumatoid arthritis (RA)-like distribution accompanied by lymphopenia. The third one had a severe serositis including ascites and pleural and pericardial effusions along with pancytopenia. In this patient, ATIL coexisted with anti-TNF-α-induced hepatitis. The second and third patients met the American College of Rheumatology classification criteria for SLE. Nevertheless, all three cases exhibited ANA and anti-dsDNA positivity, and only the second patient had anticardiolipin (aCL IgG) and anti-histone antibodies. The coexistence of both lupus-like syndrome and hepatitis following anti-TNF-α therapy in the same patient is very rare, and to the best of our knowledge, only four such case reports are mentioned in literature. Patients with mild ATIL may tolerate another anti-TNF-α agent without recurrence of the disease. Rheumatologists should be aware of the distinct clinical presentations of ATIL and its coexistence with other rare anti-TNF-alpha complications such as hepatitis.
抗 TNF-α 药物治疗后常可诱导自身抗体产生。然而，抗 TNF-α 诱导的狼疮（ATIL）较为罕见。我们评估了三例接受英夫利昔单抗治疗的炎症性肠病（IBD）患者的临床特征，他们均发生了不同类型的 ATIL。此外，我们还在已发表的文献中搜索了类似病例。我们描述了三例 ATIL 患者。第一例患者表现为经典的药物诱导性狼疮（DIL），伴有血小板减少，停药后缓解。第二例患者出现类似类风湿关节炎（RA）的 14 个关节对称性多关节炎，伴有淋巴细胞减少。第三例患者有严重的浆膜炎，包括腹水、胸腔和心包积液，同时伴有全血细胞减少。在该患者中，ATIL 与抗 TNF-α 诱导的肝炎并存。第二例和第三例患者符合美国风湿病学会（ACR）系统性红斑狼疮（SLE）分类标准。然而，所有三例患者均表现为 ANA 和抗 dsDNA 阳性，仅第二例患者有抗心磷脂（aCL IgG）和抗组蛋白抗体。抗 TNF-α 治疗后同一患者同时出现狼疮样综合征和肝炎非常罕见，据我们所知，文献中仅报道了四例此类病例。轻度 ATIL 患者可能耐受另一种抗 TNF-α 药物而不复发疾病。风湿病学家应注意到 ATIL 的独特临床表现及其与其他罕见抗 TNF-α 并发症（如肝炎）的共存。
