TNF-induced Lupus. A Case-Based Review

Nowadays, tumor necrosis factor-alpha (TNF alpha) inhibitors have revolutionised the treat-ment of inflammatory arthritides by demonstrating efficacy with an acceptable toxicity profile. However, autoimmune phenomena and clinical entities have been reported ranging from an isolat -ed presence of autoantibodies to full-blown autoimmune diseases, including drug-induced lupus (DIL). Case Presentation: A 62-year-old woman with rheumatoid arthritis (RA) refractory to methotrex-ate and prednisone was treated with adalimumab (ADA). 4 months later, she presented acute cuta-neous eruptions after sun exposure, positive ANA (1/640 fine speckled pattern), Ro (SSA) and an-ti-Smith (Sm) antibodies with no other clinical or laboratory abnormalities. The diagnosis of DIL was made, ADA was discontinued, and she was treated successfully with prednisone plus local calcineurin inhibitors. Conclusion: Thus, we review the literature for cases of DIL development in patients treated with TNF alpha inhibitors. Rheumatologists should be aware of the possible adverse events and the require-ment of careful clinical evaluation and monitoring.