Approaches in the drug-induced lupus erythematosus

Abstract

Introduction. Drug-induced lupus erythematosus (DILE) is an autoimmune syndrome similar to systemic lupus erythematosus (SLE), caused by the long-term administration of certain drugs. The management of the disease is an important issue, because the pathogenesis and clinic manifestations of the disease have remained unclear. Aim of the study. Analysis of literature and new results regarding disease pathogenesis, clinical and laboratory manifestations, treatment and comorbidities in drug-induced lupus erythematosus. Material and methods. Selection and analysis of new literature in clinical practice, diagnostic and therapeutic approaches of drug-induced lupus erythematosus. Results. Over 80 drugs have high potential to induce DILE. The most common are; procainamide, hydralazine and quinidine. Drugs’ metabolism by the means of myeloperoxidase, their deacetylation of acetyl groups and the apoptosis with antinucleosomal antigen release are the basic links in the DILE pathogenesis. Diagnosis is made by determination of antinuclear and/or antihistronic antibodies. Most commonly used drugs for DILE control are: mycophenolate mofetil, cyclophosphamide, methylprednisolone, rituximab, belimumab, and blisibimod, indicated according to treatment schemes. Conclusions. The use of drugs must be individualized on the base of their efficacy and harmlessness. Recommended drugs in DILE treatment are prescribed according to their efficacy, accessibility, and evidence-based medicine and represent: glucocorticoids, immunosuppressants and B-cell blockade.