*This is a syndrome of positive ANA associated with symptoms such as fever, malaise, arthritis or intense arthralgias/myalgias, serositis, and/or rash.
*The syndrome appears during therapy with certain medications and biologic agents, is predominant in Caucasians, has less female predilection than SLE, rarely involves kidneys or brain, is rarely associated with anti-dsDNA, is commonly associated with antibodies to histones, and usually resolves over several weeks after discontinuation of the offending medication.
*The list of substances that can induce lupus-like disease is long. Among the most frequent are the :
- Antiarrhythmics procainamide, disopyramide, and propafenone;
- The antihypertensive hydralazine; several angiotensin-converting enzyme inhibitors and beta blockers;
- The antithyroid propylthiouracil;
- The antipsychotics chlorpromazine and lithium;
- The anticonvulsants carbamazepine and phenytoin;
- The antibiotics isoniazid, minocycline, and macrodantin;
- The antirheumatic sulfasalazine;
- The diuretic hydrochlorothiazide;
- The antihyperlipidemics lovastatin and simvastatin; and
- Interferons and TNF inhibitors.
*ANA usually appears before symptoms; however, many of the medications mentioned above induce ANA in patients who never develop symptoms of drug-induced lupus.
*It is appropriate to test for ANA at the first hint of relevant symptoms and to use test results to help decide whether to withdraw the suspect agent.
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