Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina 45110, Greece.
Curr Rheumatol Rev. 2022;18(1):72-82. doi: 10.2174/1573397117666211102094330.
Nowadays, tumor necrosis factor-alpha (TNFα) inhibitors have revolutionised the treatment of inflammatory arthritides by demonstrating efficacy with an acceptable toxicity profile. However, autoimmune phenomena and clinical entities have been reported ranging from an isolated presence of autoantibodies to full-blown autoimmune diseases, including drug-induced lupus (DIL). Case Presentation: A 62-year-old woman with rheumatoid arthritis (RA) refractory to methotrexate and prednisone was treated with adalimumab (ADA). 4 months later, she presented acute cutaneous eruptions after sun exposure, positive ANA (1/640 fine speckled pattern), Ro (SSA) and anti- Smith (Sm) antibodies with no other clinical or laboratory abnormalities. The diagnosis of DIL was made, ADA was discontinued, and she was treated successfully with prednisone plus local calcineurin inhibitors. Conclusion: Thus, we review the literature for cases of DIL development in patients treated with TNFα inhibitors. Rheumatologists should be aware of the possible adverse events and the requirement of careful clinical evaluation and monitoring.
如今，肿瘤坏死因子-α（TNFα）抑制剂通过展示具有可接受毒性特征的疗效，彻底改变了炎症性关节炎的治疗方法。然而，已经报道了自身免疫现象和临床实体，从单独存在自身抗体到全面的自身免疫性疾病，包括药物诱导的狼疮（DIL）。
一位 62 岁的女性患有类风湿关节炎（RA），对甲氨蝶呤和泼尼松耐药，接受阿达木单抗（ADA）治疗。4 个月后，她在暴露于阳光下后出现急性皮肤疹，抗核抗体（ANA）阳性（1/640 细斑点型），Ro（SSA）和抗 Smith（Sm）抗体阳性，无其他临床或实验室异常。诊断为 DIL，停用 ADA，并成功地用泼尼松加局部钙调磷酸酶抑制剂治疗。
因此，我们复习了文献中 TNFα抑制剂治疗患者发生 DIL 的病例。风湿病学家应该意识到可能出现的不良反应，需要进行仔细的临床评估和监测。
