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Lupus erythematosus with leflunomide: induction or reactivation?
  1. D Gensburger1,
  2. M Kawashima1,
  3. H Marotte1,
  4. J Kanitakis2,
  5. P Miossec1
  1. 1Departments of Immunology and Rheumatology and Hospices Civils de Lyon-bioMérieux Research Unit on Rheumatoid Arthritis, Hôpital Edouard Hérriot, Lyon, France
  2. 2Department of Dermatology, Hôpital Edouard Hérriot, Lyon, France
  1. Correspondence to:
    Professor P Miossec
    Clinical Immunology Unit, Departments of Immunology and Rheumatology, Hôpital Edouard Hérriot, 69437 Lyon Cedex 03, France; miossecuniv-lyon1.fr

Abstract

Background: Leflunomide is a new oral disease modifying antirheumatic drug with a good safety profile.

Case report: The first case of lupus erythematosus in a 58 year old white woman after administration of leflunomide for primary Sjögren’s syndrome is reported. The relationship between induced lupus and leflunomide was confirmed by the resolution of the skin rash when the drug was stopped and its recurrence when it was reintroduced following a dose-response effect.

Discussion: Peripheral blood cells from this patient, from 15 patients with rheumatoid arthritis, and from healthy controls were used in a bioassay, which suggested that leflunomide affected the Th1/Th2 balance. Such a side effect might be related, in part, to the anti-tumour necrosis factor α activity of leflunomide.

  • ELISA, enzyme linked immunosorbent assay
  • ENA, extractable nuclear antigen
  • IFNγ, interferon γ
  • IL, interleukin
  • PBMC, peripheral blood mononuclear cells
  • RA, rheumatoid arthritis
  • TNFα, tumour necrosis factor α
  • leflunomide
  • lupus
  • side effects
  • Th1/Th2 balance

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