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Drug Insight: autoimmune effects of medications—what's new?

Nature Clinical Practice Rheumatology volume 4, pages 136–144 (2008)Cite this article

Abstract

Autoantibodies and lupus-like syndromes can develop following the use of certain medications; however, although many patients develop autoantibodies, only a minority develop clinical features. Although these autoantibodies primarily consist of antinuclear and antihistone antibodies, additional types of antibody, such as antineutrophil cytoplasmic antibodies and anti-double-stranded DNA antibodies, have been reported in association with minocycline and tumor necrosis factor inhibitor therapy. Clinical features of drug-related lupus usually consist of constitutional symptoms, arthralgias, arthritis, myalgias and serositis, although cutaneous manifestations have been reported in association with the use of tumor necrosis factor inhibitors. Typically, clinical features resolve with discontinuation of the medication, although antibodies can persist for months or years. Arthralgias and inflammatory arthritis have also been reported in association with the use of aromatase inhibitors and other biologic agents such as interleukins and interferons.

Key Points

  • Autoantibodies are associated with the use of certain medications

  • Although many patients develop autoantibodies, only a minority develop autoimmune-like diseases

  • The development of autoantibodies alone is not sufficient reason to discontinue the medication

  • Patients treated with medications such as tumor necrosis factor inhibitors and minocycline who develop an apparent 'flare' of the disease should be evaluated for the possibility of drug-related lupus

  • Rechallenge with minocycline might be useful in order to confirm a diagnosis of minocycline-related lupus

  • Clinical trial data indicate that patients who receive aromatase inhibitors can develop arthralgias and arthritis, although no data regarding the development of autoantibodies have been reported

  • Patients with pre-existing thyroid autoantibodies are more likely to develop autoimmune thyroid disease when treated with interferon-α than patients with no pre-existing condition

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. A-B Mongey is Professor of Internal Medicine and Director of the Rheumatology Fellowship Program in the Division of Immunology at the University of Cincinnati, and is also the Medical Director of the Medical Subspeciality and Arthritis Clinics at The University Hospital, Cincinnati, OH.,

    Anne-Barbara Mongey

  2. EV Hess is Professor of Internal Medicine in the Division of Immunology at the University of Cincinnati, OH, USA.,

    Evelyn V Hess

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  1. Anne-Barbara Mongey
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Correspondence to Anne-Barbara Mongey.

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Mongey, AB., Hess, E. Drug Insight: autoimmune effects of medications—what's new?. Nat Rev Rheumatol 4, 136–144 (2008). https://doi.org/10.1038/ncprheum0708

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