TNF antagonist induced lupus: a critically appraised topic

Abstract

TNF antagonist induced lupus is diagnosed upon a temporal relationship of TNF antagonist therapy and the development of four of the 11 American college of rheumatology (ACR) diagnostic criteria for lupus.

We critically appraise the literature on TNF antagonist induced lupus, focusing on the diagnostic criteria, dermatological manifestations, management and outcome.

Eighty cases of TNF antagonist induced lupus that met the ACR criteria were included and analysed. Infliximab was the most commonly reported agent (58.8%, n=47). Cutaneous manifestations were the most common presentation (67.5%, n=54,), specifically malar rash (26.3%, n=21) and photosensitivity (23.4%, n=19). Lupus symptoms resolved in all cases (n=80), withdrawal of the TNF antagonist was sufficient in 18.8% of cases (n=15), additional immunosuppression was required in the remaining cases. Four patients were treated with a second, different TNF antagonist, with no recurrence of symptoms. TNF antagonist induced lupus appears to have a good prognosis and treatment should be tailored to each individual case. As cutaneous features are the most common manifestation it is important that dermatologists are aware of the ACR diagnostic criteria of lupus to ensure accurate diagnoses of TNF antagonist induced lupus.

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