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This publication is made possible by an educational grant from Amgen
Inc.
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Volume 51, Number 4
Drug-Induced
Rheumatic Syndromes
Raymond
Yung, MD
Department
of Internal Medicine
University
of Michigan
Ann
Arbor, MI
Bruce
Richardson, MD, PhD
Department
of Internal Medicine
Ann
Arbor Veterans Affairs Medical Center
Ann
Arbor, MI
Summary
Points
-
A
variety of drugs can be associated with rheumatic syndromes.
-
Drugs
like minocycline, interferon, and anti-TNF agents can induce ANAs and anti-DNAs
and, less commonly, clinical lupus syndromes.
-
A
number of drugs, including G-CSF and GM-CSF, vaccinations, and leukotriene
inhibitors are associated with ANCA-positive vasculitis.
Introduction
The
intriguing possibility of iatrogenic autoimmunity was first raised in 1945 with
a report of possible sulfadiazine-induced lupus (1).
This was followed by a number of anecdotal reports implicating
sulfonamides and penicillin as the inciting agents for lupus or lupus-like
illnesses. While the link between antibiotics and lupus was subsequently found
to be relatively weak, these early reports highlighted the potential role of
drugs in the induction of clinical rheumatic syndromes.
The
drug-induced rheumatic diseases can be broadly divided into three main
categories: drug-induced lupus (DIL), drug-induced myopathy/myositis (DIM), and
drug-induced vasculitis (DIV). Recent
reports in two of these areas are emphasized in this review. (Read
“Inflammatory Myopathies,” Vol. 51, No. 3, for more information about DIM.)
However, it is important to
note that a majority of the publications regarding drug-induced rheumatic
syndromes are case reports or case series and have not been examined by careful
epidemiological studies. Thus, the
term “drug-induced” may be misleading and may be more appropriately referred
to as “possibly associated.”
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