Anti-Tumor Necrosis Factor-α-Induced Systemic Lupus Erythematosus in Patients with Axial Spondiloarthritis-A Single Center Experience

INTRODUCTION: Lupus induced by a tumor necrosis factor-alpha inhibitor (anti-TNF-α) can be termed "Anti-TNF-α Induced Lupus (ATIL)" and it is usually seen in patients with Crohn's disease and Rheumatoid Arthritis; however, it is rarely seen in axial Spondyloarthropathy (SpA). Here, four cases of ATIL in patients with axial SpA are presented and discussed in the light of literature data.
METHODS: The files of the patients who used anti-TNF-α drugs regularly for at least one year due to axial SpA were reviewed retrospectively.
RESULTS: Four patients with ATIL were analysed based on clinical features and biochemical investigations. When ATIL developed, the first case was using Adalimumab for 6 years, the second was using Infliximab for 5 years, the third was using Infliximab for 7 years, and the fourth was using Adalimumab for 16 months. In all four cases, antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) values were positive, while none of the cases had hypocomplementemia. ATIL aymptoms were acute mesenteric thrombosis, fever and pleuritis in the first case, arthritis in the small joints of the hand in the second case, deep vein thrombosis, fever, pleuritis and peritoneal fluid accumulation in the third case and malar rash in thr fourth one. Anti-TNF-α drug was stopped in all patients and prednisolone was added. Only the third case was switched to another anti-TNF-α agent.
DISCUSSION AND CONCLUSION: While Anti-TNF-α is an effective and common treatment option in SpA patients, one should keep in mind that these patients may develop ATIL; and these patients should be carefully monitored.