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Hydralazine-induced Lupus

Sonal Singh, MD
Volume: 99 Issue: 1 January, 2006

Abstract:

Nearly 50 years after the first published case report of hydralazine-induced lupus was described,1 scientists are still grappling with the mysteries of drug-induced autoimmunity.2


A drug-induced lupus-like syndrome may present with arthralgias, myalgias, fever, and serositis but is distinguished from systemic lupus erythematosus by several characteristics. Sex ratios are nearly equal in drug-induced lupus and nephritis and central nervous system features are absent, although lupus nephritis has been known to occur with hydralazine.3 Antihistone antibodies are present in more than 90% of cases and anti–double-stranded-DNA antibodies are typically absent. More importantly, when the drug is discontinued, the patient has resolution of clinical manifestations and abnormal laboratory values revert to normal although antinuclear antibodies may persist for months.

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References:

1. Reinhardt DJ, Waldron JM. Lupus erythematosus-like syndrome complicating hydralazine (apresoline) therapy. J Am Med Assoc 1954;155:1491–1492.
 
2. Uetrecht J. Current trends in drug-induced autoimmunity. Autoimmun Rev 2005; 4:309–314. Epub 2005 Feb 15.
 
3. Ihle BU, Whitworth JA, Dowling JP, et al. Hydralazine and lupus nephritis. Clin Nephrol 1984; 22: 230–238.
 
4. Deng C, Lu Q, et al. Hydralazine may induce autoimmunity by inhibiting extra cellular signal-regulated kinase pathway signaling. Arthritis Rheum 2003; 48:746–756.
 
5. Adhami E. A predictive equation for drug-induced lupus. Med Hypotheses 2003.; 61:473–476.
 
6. Yung R, Richardson B. Drug-induced rheumatic syndromes. Bulletin on the Rheumatic Diseases2002; 51:1–5.
 
7. Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 2004;351:2049–2057.
 
8. Food and Drug Administration. US FDA approves BiDil heart failure drug for African-American patients, Jun 23 2005 http://www.fda.gov/bbs/topics/NEWS/2005/NEW01190.html. Accessed September 5 2005.
 
9. Finks SW, Finks AL, Self TH. Hydralazine-induced lupus: Maintaining vigilance with increased use in patients with heart failure. South Med J 2006; 99:18–22.
 
10. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004;351:543–551.

CME:

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