Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature

Abstract

The induction of autoantibodies is common following therapy with anti-TNF-α agents. However, anti-TNF-α-induced lupus (ATIL) is rare. We assessed the clinical characteristics of three patients with inflammatory bowel disease (IBD) who were treated with infliximab and developed distinct subsets of ATIL. Also, we searched for similar cases in the published literature. We describe three patients with ATIL. The first patient had a classical drug-induced lupus (DIL) presented by thrombocytopenia that resolved after infliximab discontinuation. The second case experienced symmetric polyarthritis of 14 joints in rheumatoid arthritis (RA)-like distribution accompanied by lymphopenia. The third one had a severe serositis including ascites and pleural and pericardial effusions along with pancytopenia. In this patient, ATIL coexisted with anti-TNF-α-induced hepatitis. The second and third patients met the American College of Rheumatology classification criteria for SLE. Nevertheless, all three cases exhibited ANA and anti-dsDNA positivity, and only the second patient had anticardiolipin (aCL IgG) and anti-histone antibodies. The coexistence of both lupus-like syndrome and hepatitis following anti-TNF-α therapy in the same patient is very rare, and to the best of our knowledge, only four such case reports are mentioned in literature. Patients with mild ATIL may tolerate another anti-TNF-α agent without recurrence of the disease. Rheumatologists should be aware of the distinct clinical presentations of ATIL and its coexistence with other rare anti-TNF-alpha complications such as hepatitis.

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

“…However, in patients with advanced heart damage (NYHA class III‐IV HF), anti‐TNFα therapy may actually interfere with the beneficial preconditioning effects of TNFα . Induction and paradoxical reactions of autoantibodies have also been described following anti‐TNFα therapy, leading to anti‐TNFα‐induced lupus and the development of sarcoidosis‐like lesions . Partial resolution was elicited after the discontinuation of anti‐TNF treatment in some cases .…”

The Emerging Jamboree of Transformative Therapies for Autoimmune Diseases

“…This problem turned out to be a major concern for the development of the first TNF-α blockers (281), and it is still today a significant cause of morbidity for many immunotherapies (9,10,282,283). Moreover, in the context of obtaining an adequate immunological balance, TNF-α blockers intended for the treatment of RA have elicited SLE (284)(285)(286). Over the years, the scientific community has learned that immunotherapy products do not represent universal solutions for all patient populations and that their indiscriminate use could be detrimental for some of them.…”

The Role of TNF in the Pathogenesis of Inflammatory Bowel Disease

“…Most patients develop fatigue or fever, musculoskeletal or skin symptoms, or serositis, a rarely major organ disease. The symptoms resolve after discontinuation of TNF therapy [52,53].…”