Rheumatology Department, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain.
Z Rheumatol. 2021 Jun;80(5):481-486. doi: 10.1007/s00393-021-00983-8. Epub 2021 Mar 11.
Anti-tumor necrosis factor‑α (TNF-α)-induced lupus (ATIL) represents a diagnostic and treatment challenge. Most cases are caused by infliximab and in some cases by etanercept and adalimumab. Symptoms can range from cutaneous manifestations to more rare and serious conditions. Diagnosis requires a temporal relationship between symptoms and positive autoantibody determination. Arthritis and cutaneous symptoms are the most common manifestations accompanied by positive antinuclear antibody (ANA) and anti-double strand DNA (dsDNA) determinations. The etiology of ATILS remains to be definitively established. Several mechanisms have been proposed for anti-TNF-α-induced lupus, including apoptosis, immunosuppression and humoral autoimmunity. Treatment includes discontinuation of anti-TNF‑α agents and in some cases corticosteroids and immunosuppressors. Questions to be answered: (1) Are soluble TNF receptor fusion proteins such as etanercept and anti-TNF chimeric antibodies equally likely to cause ATIL? (2) Can patients with ATIL switch from one anti-TNF‑α antagonist to another? (3) Can the concurrent use of a conventional synthetic disease-modifying antirheumatic drug (csDMARD) like methotrexate or hydroxychloroquine reduce the probability of ATIL?
抗肿瘤坏死因子-α（TNF-α）诱导的狼疮（ATIL）是一个诊断和治疗的挑战。大多数病例是由英夫利昔单抗引起的，在某些情况下，依那西普和阿达木单抗也会引起。症状范围从皮肤表现到更罕见和严重的情况。诊断需要症状与阳性自身抗体测定之间存在时间关系。关节炎和皮肤症状是最常见的表现，伴有抗核抗体（ANA）和抗双链 DNA（dsDNA）测定阳性。ATILS 的病因仍有待明确。已经提出了几种机制来解释抗 TNF-α 诱导的狼疮，包括细胞凋亡、免疫抑制和体液自身免疫。治疗包括停止使用抗 TNF-α 药物，在某些情况下还包括皮质类固醇和免疫抑制剂。需要回答的问题是：（1）依那西普和抗 TNF 嵌合抗体等可溶性 TNF 受体融合蛋白是否同样可能引起 ATIL？（2）ATIL 患者能否从一种抗 TNF-α拮抗剂转换为另一种？（3）同时使用甲氨蝶呤或羟氯喹等传统合成疾病修饰抗风湿药物（csDMARD）是否会降低 ATIL 的可能性？
