drug-induced lupus syndrome

薬剤性ループス様症候群

WordNet

1. reason or establish by induction
2. cause to arise; "induce a crisis" (同)bring_on
3. produce electric current by electrostatic or magnetic processes (同)induct
4. cause to do; cause to act in a specified manner; "The ads induced me to buy a VCR"; "My children finally got me to buy a computer"; "My wife made me buy a new sofa" (同)stimulate, cause, have, get, make
5. cause to occur rapidly; "the infection precipitated a high fever and allergic reactions" (同)stimulate, rush, hasten
6. use recreational drugs (同)do drugs
7. administer a drug to; "They drugged the kidnapped tourist" (同)dose
8. a substance that is used as a medicine or narcotic
9. a pattern of symptoms indicative of some disease
10. a complex of concurrent things; "every word has a syndrome of meanings"
11. brought about or caused; not spontaneous; "a case of steroid-induced weakness"
12. any of several forms of ulcerative skin disease

PrepTutorEJDIC

1. 〈人〉‘に'『勧めて』(…)『させる』 / …‘を'『引き起こす』,もたらす(cause) / 〈電気〉‘を'誘導する / …‘を'帰納する
2. 『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる
3. (疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
4. 狼瘡(ろうそう)(皮膚結核の一種)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/31 07:26:50」(JST)

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Drug-induced lupus erythematosus
Classification and external resources
Hydralazine, a medication associated with drug-induced lupus erythematosus
ICD-10	M32.0
ICD-9	710.0
OMIM	152700
DiseasesDB	12782
MedlinePlus	000435
eMedicine	med/2228 emerg/564
MeSH	C17.300.480

Drug-induced lupus erythematosus (DIL or DILE) is an autoimmune disorder (similar to systemic lupus erythematosus [SLE]) caused by chronic use of certain drugs. These drugs cause an autoimmune response (the body attacks its own cells) producing symptoms similar to those of SLE. There are 38 known medications to cause DIL but there are three that report the highest number of cases: hydralazine, procainamide, and isoniazid. While the criteria for diagnosing DIL has not been thoroughly established, symptoms of DIL typically present as myalgia and arthralgia. Generally, the symptoms recede after discontinuing use of the drugs.

Causes

The processes that lead to drug-induced lupus erythematosus are not entirely understood. The exact processes that occur are not known even after 50 years since its discovery, but many studies present theories on the mechanisms of DIL.

A predisposing factor to developing DIL is N-acetylation speed, or the rate at which the body can metabolize the drug. This is greatly decreased in patients with a genetic deficiency of the enzyme N-acetyltransferase. A study showed that 29 of 30 patients with DIL were slow acetylators. In addition, these patients had more hydralazine metabolites in their urine than fast acetylators. These metabolites (byproducts of the interactions between the drug and constituents in the body) of hydralazine are said to have been created when white blood cells have been activated, meaning they are stimulated to produce a respiratory burst. Respiratory burst in white blood cells induces an increased production of free radicals and oxidants such as hydrogen peroxide. These oxidants have been found to react with hydralazine to produce a reactive species that is able to bond to protein. Monocytes, one type of leukocyte, detect the antigen and relay the recognition to T helper cells, creating antinuclear antibodies leading to an immune response. Further studies on the interactions between oxidants and hydralazine are necessary to understand the processes involved in DIL.

Of the drugs that cause DIL, hydralazine has been found to cause a higher incidence. Hydralazine is a medication used to treat high blood pressure. Approximately 5% of the patients who have taken hydralazine over long periods of time and in high doses have shown DIL-like symptoms. Many of the other drugs have a low to very low risk to develop DIL. The following table shows the risk of development of DIL of some of these drugs on a very to high scale.

• High risk:
  • Procainamide (antiarrhythmic)
  • Hydralazine (antihypertensive)

• Moderate to low risk:
  • Infliximab anti (TNF-α)
  • Etanercept anti (TNF-α)
  • Isoniazid (antibiotic)
  • Minocycline (antibiotic)
  • Pyrazinamide (antibiotic)
  • Quinidine (antiarrhythmic)
  • D-Penicillamine (anti-inflammatory)
  • Carbamazepine (anticonvulsant)
  • Oxcarbazepine (anticonvulsant)
  • Phenytoin (anticonvulsant)
  • Propafenone (antiarrhythmic)

Signs and symptoms

Signs and symptoms of drug-induced lupus erythematosus include the following:

• Joint pain (Arthralgia) and muscle pain (myalgia)
• Fatigue
• Inflammation of the sac around the heart (pericarditis) and the sac around the lungs (pleuritis)
• Anti-histone antibodies in 95% of cases

These signs and symptoms are not side effects of the drugs taken which occur during short term use. DIL occurs over long-term and chronic use of the medications listed above. While these symptoms are similar to those of systemic lupus erythematosus, they are generally not as severe unless they are ignored which leads to more harsh symptoms, and in some reported cases, death.

Treatment

It is important to recognize early that these drugs are causing DIL like symptoms and discontinue use of the drug. Symptoms of drug-induced lupus erythematosus generally disappear days to weeks after medication use is discontinued. Non-steroidal anti-inflammatory drugs (NSAIDs) will quicken the healing process. Corticosteroids may be used if more severe symptoms of DIL are present.

See also

• Anti-histone antibody
• Lupus erythematosus
• Hydralazine
• Discoid lupus erythematosus
• List of cutaneous conditions

References

External links

• S.L.E. Lupus Foundation
• Lupus Foundation of America, Inc.
• Lupus Research Institute
• eMedicine

UpToDate Contents

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• 1. 薬物誘発性ループス drug induced lupus
• 2. 皮膚エリテマトーデスの概要 overview of cutaneous lupus erythematosus
• 3. 薬疹 drug eruptions
• 4. 全身性エリテマトーデスにおける腎疾患の診断および分類 diagnosis and classification of renal disease in systemic lupus erythematosus
• 5. 抗リン脂質抗体症候群の診断 diagnosis of antiphospholipid syndrome

English Journal

• Lupus in a patient with cystinosis: is it drug induced?

• Eroglu FK1, Besbas N2, Ozaltin F2, Topaloglu R2, Ozen S2.
• Lupus.Lupus.2015 Jul 28. pii: 0961203315598017. [Epub ahead of print]
• A 9-year-old girl with a diagnosis of cystinosis since 2 years of age, on cysteamine therapy, presented with complaints of serositis and arthritis, and laboratory tests revealed high antinuclear antibody titers with hypocomplementemia. Kidney biopsy was not consistent with lupus nephritis. With pred
• PMID 26223294

• Drug-Induced Glomerular Disease: Immune-Mediated Injury.

• Hogan JJ1, Markowitz GS2, Radhakrishnan J3.
• Clinical journal of the American Society of Nephrology : CJASN.Clin J Am Soc Nephrol.2015 Jul 7;10(7):1300-10. doi: 10.2215/CJN.01910215. Epub 2015 Jun 19.
• Drug-induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupus-like syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Over the years, multiple other agents have been linked to immune-mediated glomerular disease, often with associate
• PMID 26092827

• Systemic lupus erythematosus in Crohn's disease: drug-induced or idiopathic?

• Michalopoulos G1, Vrakas S1, Makris K1, Tzathas C1.
• Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology.Ann Gastroenterol.2015 Jul-Sep;28(3):408-409.
• Coexistence of Crohn's disease (CD) and idiopathic systemic lupus erythematosus (SLE) is very rare. On the other hand, drug-induced lupus erythematosus (DILE) due to anti-tumor necrosis factor (TNF) agents is a relatively more common entity. DILE due to anti-TNF agents and idiopathic SLE share commo
• PMID 26126856

Japanese Journal

• Beneficial Therapeutic Effect of Plasma Exchange Followed by Prednisolone for Drug-Induced Hypersensitivity Syndrome Caused by Allopurinol

• Iijima Shigeruko,Ebihara Itaru,Yamada Hiromichi
• 日本アフェレシス学会雑誌 31(3), 237-241, 2012-10-31
• … The efficacy of plasma exchange for the treatment of severe drug eruption, such as toxic epidermal necrolysis or Stevens-Johnson syndrome, has been well established in many recent reports; … however, that for drug-induced hypersensitivity syndrome (DIHS) has not yet to be clarified. …
• NAID 110009543814

• Etanercept-Induced Lupus Accompanied by Hemophagocytic Syndrome

• Araki Daisuke,Fujii Hiroshi,Matsumura Masami,Yamagishi Masakazu,Yachie Akihiro,Kawano Mitsuhiro
• Internal Medicine 50(17), 1843-1848, 2011
• … Hemophagocytic syndrome (HPS) is a severe, potentially life-threatening disorder characterized by an excessive activation of macrophages, such as may occur in the setting of lupus. … Simultaneously, lupus-like features including pleuritis, hypocomplementemia, and positive autoantibodies were observed. … She was diagnosed with HPS related to etanercept-induced lupus, and underwent immunosuppressive therapy with successful recovery. …
• NAID 130002063083

• Clinical features of liver dysfunction in collagen diseases

• TAKAHASHI Atsushi,ABE Kazumichi,YOKOKAWA Junko,IWADATE Haruyo,KOBAYASHI Hiroko,WATANABE Hiroshi,IRISAWA Atsushi,OHIRA Hiromasa
• Hepatology research : the official journal of the Japan Society of Hepatology 40(11), 1092-1097, 2010-11-01
• … systemic lupus erythematosus [SLE], n = 164; … Sjögren's syndrome [SjS], n = 44; … vasculitis syndrome, n = 25; … Patients with AOSD (81.3%), PM/DM (51.9%) and vasculitis syndrome (48.0%) frequently displayed liver dysfunction. … drug-induced liver injury (26.1%), fatty liver (7.6%), viral hepatitis (1.3%), autoimmune hepatitis (4.2%), primary biliary cirrhosis (15.9%) and the collagen disease itself (15.5%). …
• NAID 10027821599

Related Links

• Drug-induced lupus erythematosus: MedlinePlus Medical ...

Drug-induced lupus erythematosus is similar to systemic lupus erythematosus (SLE). It is an autoimmune disorder. This means your body attacks healthy tissue by mistake. It is caused by an overreaction to a medicine.

• Drug-Induced Lupus Erythematosus: Background ...

Drug-induced lupus erythematosus (DILE) is a variant of lupus erythematosus that resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction. DILE can ...

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★リンクテーブル★

リンク元	「薬剤性ループス」
関連記事	「induce」「induced」「lupus」「drug」「syndrome」

「薬剤性ループス」

　　[★]

同

薬剤性ループス様症候群 drug-induced lupus syndrome、薬剤誘発性ループス drug-induced lupus、薬剤関連ループス, 全身性エリテマトーデス型薬疹 drug-induced systemic lupus erythematosus、LE様薬疹

• 薬剤(ex.ヒダントイン、プロカインアミド)の長期服用により出現する全身性エリテマトーデス様の病態。(SLE症状、抗核抗体(抗ヒストン抗体))
• 投薬により臨床症状、抗核抗体が消失。

「induce」

　　[★]

• v.

• 誘発する、誘導する、誘起する、導入する、引き起こす

関

cause、challenge、derivation、elicit、elicitation、evocation、evoke、guidance、induction、inductive、introduce、introduction、precipitate、provocation、provoke、spark

　 　 　 　 　 　

「induced」

　　[★]

• v.

• (induceの過去分詞)誘導される、引き起こされる

hypercalcaemia induced pancreatitis 高カルシウム血症による膵炎

　

「lupus」

　　[★] ループス、狼瘡

　 　

「drug」

　　[★]

同

drugs

　 　 　 　

「syndrome」

　　[★]

• n.

• 症候群