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204 INFLIXIMAB-INDUCED LUPUS SYNDROMES - A CASE SERIES AND REVIEW OF THE LITERATURE JJ Williams1, L Martin2, SG Barr2, M Fritzler2, R Panaccione1 BACKGROUND: Infliximab therapy has been a significant advance in the management of immune-mediated diseases including Crohn's disease and ulcerative colitis. A number of published data illustrate varying degrees of autoantibody conversion following treatment with infliximab ranging from 16% to 45%. Several cases of lupus like syndrome have been described.
1Divisions of Gastroenterology, 2Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta
AIM: To identify and review the cases of infliximab induced lupus in the Calgary Health Region and describe the course of these patients.
METHODS: Cases of suspected infliximab induced systemic lupus erythematosus (SLE) were identified from the Rheumatoid Arthritis and Inflammatory Bowel Disease Databases. Affected patients charts were reviewed and their clinical course was compared to that of typical patients with drug-induced lupus.
RESULTS: A total of eight cases were identified. Three cases were identified in patients following infliximab treatment for rheumatoid arthritis and five cases in patients with inflammatory bowel disease. All patients had positive ANA and positive anti-DsDNA. Symptoms included photosensitivity dermatitis (1), pleuropericarditis (2), a chylous/chyliform pleural effusion (1), alopecia (1), lupus cerebritis (2), and inflammatory polyarthritis (5). All cases resolved with discontinuation of infliximab and appropriate treatment for lupus.
CONCLUSION: This represents the largest case series of SLE following treatment with infliximab. Many patients in our series developed systemic manifestations other than polyarthritis. Most cases resembled idiopathic SLE rather than drug-induced lupus. Clinicians who treat patients should be aware of this rare but potentially serious side effect.