Induction of Systemic Lupus Erythematosus with Tumor Necrosis Factor Blockers

Abstract

To the Editor: Tumor necrosis factor-α (TNF-α) inhibitors are considered safe and effective for treatment of rheumatoid arthritis (RA) and psoriatic arthritis (PsA)1. Although induction of antinuclear antibodies (ANA) and lupus-like syndromes have been described in patients treated with TNF blockers1, their use was recently advocated in treatment of systemic lupus erythematosus (SLE)2. Most reported lupus-like cases were characterized by malaise, fatigue, and increased arthritis, without major organ system involvement3. We describe 6 women who developed active SLE satisfying American College of Rheumatology diagnostic criteria (Table 1) with life-threatening manifestations after receiving TNF blockade for treatment of RA or PsA (Table 2). View this table: Table 1. ACR criteria for SLE in 6 patients exposed to TNF inhibitors. View this table: Table 2. Time course of onset of clinical symptoms, serological markers, and ACR diagnostic criteria in 6 patients, all Caucasian women, with TNF inhibitor-induced SLE. The first patient was admitted for dyspnea and chest pain after 3-month treatment of RA with etanercept. She had decreased breath … Address correspondence to Prof. Perl. E-mail: perla{at}upstate.edu