Generally, whilst much is understood about the modus operandi of Lupus, the jury is still out on the causation. Research has identified the processes systemically within the body but not why one person is affected and another free of it. So, it is fair to conclude, that the precise cause of Lupus is yet to be accurately identified with one notable exception, Drug Induced Lupus the mnemonic for which is DIL or DILE, Drug Induced Lupus Erythematosus. DILE was first officially recognised way back in 1945, the offending therapy was Sulfadiazine.
What is drug induced lupus?
No great mystery, DIL is lupus caused by the use of certain medications, commonly over a long period of time. These substances alter the body’s immune response, actuating a form of lupus due to lengthy over exposure. Drug induced lupus does not affect everyone; in a controlled sample of users, matched in age and exhibiting identical health concerns, some will develop drug induced lupus whilst others remain unaffected.
Is drug induced Lupus the same as SLE – Systemic Lupus Erythematosus?
The symptoms of SLE are very similar to medically induced lupus which is an alternative moniker for DIL. Flu-like symptoms, unusual or left field blood test results and joint pain are typically shared reactions in both scenarios.
Certainty can be established by the withdrawal or cessation of the offending remedies following which the condition should disappear totally.
Are there known Lupus medications which can cause drug induced lupus?
There is a rogues’ gallery of key offenders which have form in instigating drug induced lupus. They demonstrate the complex balancing act of the physician who must weigh one risk against another, particularly if the drug of choice is the only or best option for the patient. These compound medications are used to treat significant diseases and so their recommendation is not undertaken lightly. There are actually 46 known remedies which have the potential to activate DIL including chemotherapy drugs and significant pain medications but in reality, the risks are negligible for all but three of them. The trio of principle protagonists are:-
- Isoniazid which is used in the treatment of Tuberculosis or TB
- A medication prescribed for cardiac arrhythmias called Procainamide branded as Pronesty
- Hydralazine which is controlling medicine for elevated blood pressure or hypertension marketed under the label, Apresoline
These Lupus medications as they are referred to may not initiate any symptoms for years, if ever. All medicines carry risks especially if they are taken continuously for a long period of time.
A doctor will always prescribe the best medication for his patient whilst advising of and monitoring carefully for any side effects. Sometimes, DIL can take years before it manifests itself but an approach that is too cautionary would have denied that particular individual, the best medication recommended for their particular condition, perhaps wholly unnecessarily.
In more recent times, DILE has been connected to state of the art new medications including TNF (tumour necrosis factor) blockers and interferons. Described as TAIL – TNF alpha antagonist-induced lupus syndrome – an impressive list is being compiled including estrogen based oral contraceptive pills and what are termed, other biologic agents.
Is there any other method used to determine whether drugs are causing Lupus symptoms?
There is a blood test for systemic lupus which identifies and highlights antinuclear antibodies or ANA. The majority of those with drug induced lupus are often ANA negative. The medical profession does not use this test on a precautionary and regular basis rather like screening. Instead, they wait for patients to report adverse reactions and then, depending on their nature or severity, run bloods at that point.
What action is taken after a DIL diagnosis?
The medication is stopped with immediate effect, no tapering withdrawal period. Despite this urgent action, symptoms can take weeks to recede and die down. Such is the peculiarity and uniqueness of the human immune system that symptoms can develop years into a long-term drug regime, hence the difficulties associated with detecting the cause.
An alternative remedy needs to be selected with care to manage the primary condition. There is no scientific data to support the claim that DIL will in turn metamorphosed into the full lupus condition.
Is there a particular type of person more vulnerable to drug induced lupus?
There are some indicators that men are more prone to succumb than women but this has been attributed to the fact that they are prescribed these medications more frequently statistically. Evidence suggests that men aged over 50 are more likely to contract DIL but this may just be a response to an immune system altering with age.
Drug induced lupus is distinct from merely adverse side effects although this is not to trivialise the latter. Most takers comprehend contraindications, that dire list in the pill packet, but not so many anticipate they could acquire a whole new disease. The Dean of Pharmacy at the University of California maintains this is an artificial distinction, purely “a matter of semantics”. Any compromise or complications to regular bodily functions is a disease.
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