Summary of TNFi agent-associated lupus
| Case | Age/sex | Biologics/DMARDs | Diagnosis | Duration of bDMARD prior to - ANA - dsDNA - Lupus | Clinical symptoms | Autoantibody profile | Clinical outcome |
|---|---|---|---|---|---|---|---|
| Drug-induced lupus on 1st TNFi with ANA/dsDNA seroconversion | |||||||
| 1 | 56 years F | Etanercept MTX | RA (seropositive) | 7 months 37 months 38 months | Drug-induced lupus (flare in arthritis, lymphopenia) | RF-positive, ACPA-positive Positive ANA—homogenous pattern and dsDNA | Switched to RTX with improvement Anti-dsDNA levels normalised |
| Drug-induced lupus on first TNFi with dsDNA seroconversion (ANA positive prior to initial TNFi) | |||||||
| 2 | 68 years F | Infliximab MTX | RA (seropositive) | 25 months 25 months 26 months | Drug-induced lupus (photosensitive rash) | RF positive, ACPA positive Positive ANA—homogenous pattern and Positive dsDNA | Switched to RTX with improvement Anti-dsDNA levels normalised |
| Drug-induced lupus on a second TNFi with ANA/dsDNA seroconversion | |||||||
| 3 | 52 years F | 1st: etanercept MTX, HCQ 2nd: adalimumab MTX, HCQ, SSZ | RA (seronegative) | Positive pre-bDMARD 37 months 38 months | Drug-induced lupus (flare in arthritis, oral ulcers) | RF negative, ACPA negative Positive ANA—homogenous pattern and dsDNA (seroconverted on 2nd TNFi) | Switched to RTX with improvement Anti-dsDNA levels normalised |
| 4 | 74 years F | ||||||
| 5 | 46 years F | ||||||
DMARDs, disease modifying antirheumatic drugs; HCQ, hydroxychloroquine; MTX, methotrexate; RA, rheumatoid arthritis; RTX, rituximab; SSZ, sulfasalazine; TNFi, tumour necrosis factor inhibitor.