Medication-Induced Lupus Symptoms and Treatment

Drug-induced lupus (DIL) is a rare autoimmune condition caused by a reaction to certain drugs. There are an estimated 15,000 to 30,000 cases of drug-induced lupus in the United States per year. It usually begins after you've taken the offending drug for three to six months.

The symptoms of DIL mimic those of systemic lupus erythematosus (SLE). There are many, including muscle and joint pain, weight loss, and fever.

Drug-induced lupus can be life-threatening, but it's completely reversible once you stop taking the drug that's to blame.

Drugs That Cause Drug-Induced Lupus

More than 40 drugs have been known to cause this form of lupus, but several are considered primary culprits.

They're mainly drugs used to treat chronic conditions such as heart disease, thyroid disease, hypertension (high blood pressure), neuropsychiatric disorders, inflammation, and epilepsy.

The three drugs most often involved in drug-induced lupus are:

• Pronestyl (procainamide), used to treat heart arrhythmia
• Apresoline (hydralazine), used to treat hypertension
• Quinaglute (quinidine), used to treat heart arrhythmia

Classes of drugs that have been implicated in DIL include:

• Anti-antiarrhythmics (e.g., procainamide, quinidine)
• Antibiotics (e.g., minocycline)
• Anticonvulsants
• Anti-inflammatories
• Antipsychotics
• Anti-thyroid drugs
• Biologics
• Chemotherapy drugs
• Cholesterol drugs
• Diuretics
• Hypertension drugs (e.g., hydralazine, diltiazem isoniazid)
• Penicillamine
• Proton pump inhibitors

Most people who take these medications will not develop the disease. DIL is a rare adverse reaction.

Risk Factors

Healthcare providers don't know why some people develop drug-induced lupus while taking certain medications and others don't. However, certain factors may make it more likely, including:

• Other health conditions
• Genetics
• Environmental factors
• Interactions with other medications

Men are more likely to be prescribed the drugs that cause drug-induced lupus, though they develop it at the same statistical rates as women.

DIL is most common in people between 50 and 70 years old. It's more likely to develop in White people than African-Americans, as well.

Drug-Induced Lupus Symptoms

If you're experiencing drug-induced lupus, you may have symptoms that are similar to what people with SLE experience, such as:

• Muscle and joint pain
• Fatigue
• Blurred vision
• Fever
• General ill feeling (malaise)
• Joint swelling
• Loss of appetite
• Pleuritic chest pain
• Skin rash across the bridge of nose and cheeks that gets worse with sunlight (butterfly rash)
• Weight loss
• Purple spots on the skin (purpura)
• Red or purple lumps under the skin that are tender (erythema-nodosum)

These symptoms can appear gradually or quickly.

While SLE can impact major organs, DIL usually doesn't.

A clue that you are experiencing DIL and not typical drug side effects is that the symptoms arise after months or years of continuously taking the medication without issue. Regular side effects, on the other hand, usually come on soon after you start taking a new medication.

Diagnosis

Healthcare providers often have a hard time diagnosing DIL because the symptoms are similar not only to SLE but to numerous other autoimmune diseases and chronic pain conditions.

If you're having symptoms that are consistent with DIL, be sure to tell you healthcare provider about all of the medications and supplements you're taking.

If they believe you have DIL, you will likely need to stop taking the drug suspected as the cause. Staying on the medication will not only make your symptoms worse, but it could also even make the condition become life-threatening.

There's no single, specific test for DIL. When considering this diagnosis, your healthcare provider may perform a range of tests, including:

• A physical exam
• Blood tests
• Chest X-ray
• Electrocardiogram

The four types of blood tests used to diagnose DIL are:

• Antihistone antibody
• Antinuclear antibody (ANA) panel
• Antineutrophil cytoplasmic antibodies (ANCA)
• Complete blood count (CBC)

People with DIL caused by quinidine or hydralazine may have negative ANA results.

Treatment

You were put on the medication in the first place for good reason. Since staying on it is dangerous, you and your healthcare provider will need to discuss alternative treatments for whatever condition the drug was intended to treat.

The good news is that once you stop taking the offending medication, your symptoms should resolve within several weeks to several months. In some cases, however, it might take up to a year for symptoms to go completely away.

To help you manage during this time, your healthcare provider may prescribe medication to treat your symptoms. Some options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroid creams
• Antimalarial drugs
  

A Word From Verywell

While DIL can be a severe and debilitating illness that's hard to diagnose, the good news is that it can be cured by going off the drug that triggered it.

Work with your healthcare provider to find the correct diagnosis, an alternative drug, and the treatments that can help you manage the symptoms of DIL until they go away. Once you're off the offending medication, the prognosis is generally excellent.