DOCSLIB.ORG

Minocycline and Lupuslike Syndrome in Acne Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Minocycline and Lupuslike Syndrome in Acne Patients ORIGINAL INVESTIGATION Minocycline and Lupuslike Syndrome in Acne Patients Miriam C. J. M. Sturkenboom, PhD, PharmD, MSc; Christoph R. Meier, PhD, MSc; Hershel Jick, MD; Bruno H. C. Stricker, PhD, MB Background: Recently several case reports described the Results: We identified 29 cases and selected 152 controls. association between minocycline and lupuslike syn- Current single use of minocycline was associated with an drome. Minocycline, one of the tetracyclines, is widely 8.5-fold (95% confidence interval [CI], 2.1-35) increased used to treat acne. We aimed to examine the association risk of developing lupuslike syndrome compared with non- of exposure to minocycline and other tetracyclines with users and past users of tetracyclines combined. The risk of the development of lupuslike syndrome. past exposure to any of the tetracyclines was closely simi- lar to nonuse (relative risk, 1.3; 95% CI, 0.5-3.3). Current Methods: We conducted a nested case-control study in use of doxycycline, oxytetracycline, or tetracycline com- a cohort of 27 688 acne patients aged 15 to 29 years, us- bined was associated with a 1.7-fold (95% CI, 0.4-8.1) in- ing data automatically recorded on general practitioners’ crease of risk. The risk increased with longer use. office computers in the United Kingdom. Controls were matched to cases on age, sex, and practice. The main out- Conclusion: Current use of minocycline increased the come was lupuslike syndrome defined as the occurrence risk of developing lupuslike syndrome 8.5-fold in the co- of polyarthritis or polyarthralgia of unknown origin, with hort of young acne patients. The effect was stronger in negative rheumatoid factor or latex agglutination test, posi- longer-term users. However, the absolute risk of devel- tive or unmeasured antinuclear factor, elevated or unmea- oping lupuslike syndrome seems to be relatively low. sured erythrocyte sedimentation rate, and absence of or unmeasured antinative DNA antibody levels. Arch Intern Med. 1999;159:493-497 INOCYCLINE IS a semi- In 1959, 3 patients were described synthetic tetracycline who developed a systemic lupus antibiotic that is used erythematosus–like clinical syndrome to treat infections while being treated with tetracycline.6 caused by several types However, this association was likely Mof gram-positive and gram-negative bac- based on a misperception, and no other terias, Rickettsia, Chlamydia, and Myco- cases of tetracycline-induced lupus have plasma species. It became available in been published since then.7 Minocycline, 1972 and has been widely used since however, was related to lupus in num- then. Its long half-life, allowing for erous case reports, the first of which once- or twice-daily dosing, and the appeared in 1992.8 Through the begin- suggestion that minocyline rarely causes ning of 1998, 64 minocycline users who resistance makes it popular with both developed lupuslike syndrome have been patients and physicians.1-4 Tetracyclines described in the literature.7-19 The mean are used orally in the treatment of mod- age of patients was 21 years and 85% erate to severe inflammatory acne vul- were female. In most patients, the onset From the garis and other infections sensitive to of arthralgia or arthritis accompanied by Pharmacoepidemiology Unit, the actions of tetracylines. Because of its myalgia or malaise developed after pro- Erasmus University Medical favorable dosing characteristics and the longed periods of exposure to minocy- School, Rotterdam, the low rate of resistance, minocycline is cline (mean duration, 24 months; range, Netherlands (Dr Sturkenboom now the most widely prescribed antibi- 1.5-72 months). All were asymptomatic and Stricker); and Boston 1 Collaborative Drug otic for acne. An estimated 800 000 before treatment. Typical were the pres- Surveillance Program, Boston prescriptions were written in 1993 in ence of antinuclear antibodies and 1 University Medical Center, the United Kingdom, and 65% of oral elevated erythrocyte sedimentation rate Lexington, Mass (Drs Meier minocycline use in the United States but negative levels of antihistone anti- and Jick). was for treatment of acne.5 bodies and antinative DNA antibodies. ARCH INTERN MED/ VOL 159, MAR 8, 1999 493 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 METHODS CASES AND CONTROLS From the cohort of acne patients, we identified (blinded We conducted a case-control study with data from the Gen- to any tetracycline exposure) all patients who had a first- eral Practice Research Database (GPRD). More than 4 mil- time diagnosis of systemic lupus erythematosus or poly- lion people in the United Kingdom are enrolled with se- arthralgia/polyarthritis. We then asked general practition- lected general practitioners who use office computers ers to send us patient records of these potential cases and provided by Value Added Medical Products (currently assessed all available information. These hospital records owned by Reuters Information Services, Toronto, Ontario) and referral letters as well as laboratory reports were re- and who have agreed to provide data for research pur- viewed independently by 2 of us (C.R.M. and M.C.J.M.S.), poses to the GPRD, which is currently owned by the United again while blinded to exposure. Cases were included if they Kingdom Department of Health. General practitioners have had negative rheumatoid factor or latex agglutination test, been trained to record medical information in a standard positive or unmeasured antinuclear antibody levels, el- manner and to supply it anonymously. The information re- evated or unmeasured erythrocyte sedimentation rate, and corded includes demographics, medical diagnoses, and all absence of or unmeasured anti-DNA antibody levels. drug prescriptions, since the physicians generate prescrip- To each case, we matched 8 controls from among all tions directly with the computer. It contains the name of noncases in the base population of patients with acne on the preparation, route of administration, dose, and num- practice, age (same year), and sex. The same exclusion cri- ber of tablets for each prescription. Hospital discharge and teria and index date were applied to controls as to cases. referral letters are available for review to validate the di- Exposure to minocycline, tetracycline, oxytetracycline, agnoses recorded in the computer record. A modification and doxycycline, as well as to other drugs that have been im- of the Oxford Medical Information System (OXMIS) is used plicated as causing drug-induced lupus, was assessed from to enter medical diagnoses. For the purpose of this study, the computer record.20 Drug use was classified as either “cur- OXMIS codes have been mapped onto International Clas- rent use” (legend duration of prescription includes the index sification of Diseases, Ninth Revision, Clinical Modification date or stops at a maximum of 14 days before) and “past use” (ICD) codes. The recorded information on drug exposure (theoretical stop date .2 weeks prior to index date). The to- and on diagnoses in the GPRD is of high quality and is sat- tal cumulative exposure was assessed using defined daily doses isfactory for drug safety studies.21,22 and categorized “#100 defined daily doses” and “.100 de- For this study, 319 practices contributed informa- fined daily doses.”23 If study subjects used more than 1 tet- tion recorded on computer from January 1, 1991, through racycline within the study period, we classified them as “mul- February 1996. From this population we identified all per- tiple users,” but their defined daily doses were summed. sons with acne (ICD codes 706.0 and 706.1), aged 15 to 29 years, without a history of lupus, arthralgia, rheuma- ANALYSIS toid arthritis, or chronic active hepatitis. Persons were ex- cluded if they had any preexisting cancer of the blood or Based on the number of cases occurring during current use immune system (leukemia, lymphoma) or acquired im- of one of the tetracyclines and the number of prescriptions munodeficiency syndrome prior to the index date, if they for the different tetracyclines, we assessed crude incidence used anticonvulsants (associated with lupuslike syn- rates and 95% confidence intervals (CIs) for exposure to the drome), or if the first diagnosis of acne occurred after the various study drugs, stratified by sex. For the case-control diagnosis of lupuslike syndrome (subsequently, the date analysis, we obtained relative risk (RR) estimates (odds ra- of first-time diagnosis of the lupuslike syndrome will be tios) through conditional logistic regression analysis with referred to as the index date). the software program SAS (SAS Institute Inc, Cary, NC). All patients recovered rapidly after drug removal, and an- approximately 60% of the use occurred in males and tibody levels became normal. In several cases, rechal- about 70% of the prescriptions of the various tetracy- lenge was positive, indicating a causal relationship.7-19 clines were written for persons in the age range of 15 to There is no consensus on the diagnostic criteria for 19 years. drug-induced lupus, but it should be expected in pa- We identified by computer 78 potential cases with tients who do not have a history of idiopathic lupus, who a diagnosis of systemic lupus erythematosus or multiple develop antinuclear antibodies, and who have at least 1 joint pain. After manual review of the computerized pa- clinical feature of lupus after an appropriate duration of tient profiles, we retained 44 patients for whom
Load more

Recommended publications
  • Autoimmune Associations of Alopecia Areata in Pediatric Population - a Study in Tertiary Care Centre
    IP Indian Journal of Clinical and Experimental Dermatology 2020;6(1):41–44 Content available at: iponlinejournal.com IP Indian Journal of Clinical and Experimental Dermatology Journal homepage: www.innovativepublication.com Original Research Article Autoimmune associations of alopecia areata in pediatric population - A study in tertiary care centre Sagar Nawani1, Teki Satyasri1,*, G. Narasimharao Netha1, G Rammohan1, Bhumesh Kumar1 1Dept. of Dermatology, Venereology & Leprosy, Gandhi Medical College, Secunderabad, Telangana, India ARTICLEINFO ABSTRACT Article history: Alopecia areata (AA) is second most common disease leading to non scarring alopecia . It occurs in Received 21-01-2020 many patterns and can occur on any hair bearing site of the body. Many factors like family history, Accepted 24-02-2020 autoimmune conditions and environment play a major role in its etio-pathogenesis. Histopathology shows Available online 29-04-2020 bulbar lymphocytes surrounding either terminal hair or vellus hair resembling ”swarm of bees” appearance depending on chronicity of alopecia areata. Alopecia areata in children is frequently seen. Pediatric AA has been associated with atopy, thyroid abnormalities and a positive family history. We have done a study to Keywords: find out if there is any association between alopecia areata and other auto immune diseases in children. This Alopecia areata study is an observational study conducted in 100 children with AA to determine any associated autoimmune Auto immunity conditions in them. SALT score helps to assess severity of alopecia areata. Severity of alopecia areata was Pediatric population assessed by SALT score-1. S1- less than 25% of hairloss, 2. S2- 25-49% of hairloss, 3. 3.S3- 50-74% of hairloss.
    [Show full text]
  • Coexistence of Vulgar Psoriasis and Systemic Lupus Erythematosus - Case Report
    doi: http://dx.doi.org/10.11606/issn.1679-9836.v98i1p77-80 Rev Med (São Paulo). 2019 Jan-Feb;98(1):77-80. Coexistence of vulgar psoriasis and systemic lupus erythematosus - case report Coexistência de psoríase vulgar e lúpus eritematoso sistêmico: relato de caso Kaique Picoli Dadalto1, Lívia Grassi Guimarães2, Kayo Cezar Pessini Marchióri3 Dadalto KP, Guimarães LG, Marchióri KCP. Coexistence of vulgar psoriasis and systemic lupus erythematosus - case report / Coexistência de psoríase vulgar e lúpus eritematoso sistêmico: relato de caso. Rev Med (São Paulo). 2019 Jan-Feb;98(1):77-80. ABSTRACT: Psoriasis and Systemic lupus erythematosus (SLE) RESUMO: Psoríase e Lúpus eritematoso sistêmico (LES) são are autoimmune diseases caused by multifactorial etiology, with doenças autoimunes de etiologia multifatorial, com envolvimento involvement of genetic and non-genetic factors. The purpose de fatores genéticos e não genéticos. O objetivo deste relato of this case report is to clearly and succinctly present a rare de caso é expor de maneira clara e sucinta uma associação association of autoimmune pathologies, which, according to some rara de patologias autoimunes, que, de acordo com algumas similar clinical features (arthralgia and cutaneous lesions), may características clínicas semelhantes (artralgia e lesões cutâneas), interfere or delay the diagnosis of its coexistence. In addition, it podem dificultar ou postergar o diagnóstico de sua coexistência. is of paramount importance to the medical community to know about the treatment of this condition, since there is a possibility Além disso, é de suma importância à comunidade médica o of exacerbation or worsening of one or both diseases. The conhecimento a respeito do tratamento desta condição, já que combination of these diseases is very rare, so, the diagnosis existe a possibilidade de exacerbação ou piora de uma, ou de is difficult and the treatment even more delicate, due to the ambas as doenças.
    [Show full text]
  • Table of Contents (PDF)
    CJASNClinical Journal of the American Society of Nephrology October 2018 c Vol. 13 c No. 10 Editorials 1451 Metabolic Acidosis and Cardiovascular Disease Risk in CKD Matthew K. Abramowitz See related article on page 1463. 1453 Beware Intradialytic Hypotension: How Low Is Too Low? Jula K. Inrig See related article on page 1517. 1455 PD Solutions and Peritoneal Health Yeoungjee Cho and David W. Johnson See related article on page 1526. 1458 Proton Pump Inhibitors in Kidney Disease Benjamin Lazarus and Morgan E. Grams See related article on page 1534. 1460 Inching toward a Greater Understanding of Genetic Hypercalciuria: The Role of Claudins Ronak Jagdeep Shah and John C. Lieske See related article on page 1542. Original Articles Chronic Kidney Disease 1463 Effect of Treatment of Metabolic Acidosis on Vascular Endothelial Function in Patients with CKD: A Pilot Randomized Cross-Over Study Jessica Kendrick, Pratik Shah, Emily Andrews, Zhiying You, Kristen Nowak, Andreas Pasch, and Michel Chonchol See related editorial on page 1451. 1471 Kidney Function Decline in Patients with CKD and Untreated Hepatitis C Infection Sara Yee Tartof, Jin-Wen Hsu, Rong Wei, Kevin B. Rubenstein, Haihong Hu, Jean Marie Arduino, Michael Horberg, Stephen F. Derose, Lei Qian, and Carla V. Rodriguez Clinical Nephrology 1479 Perfluorinated Chemicals as Emerging Environmental Threats to Kidney Health: A Scoping Review John W. Stanifer, Heather M. Stapleton, Tomokazu Souma, Ashley Wittmer, Xinlu Zhao, and L. Ebony Boulware Cystic Kidney Disease 1493 Vascular Dysfunction, Oxidative Stress, and Inflammation in Autosomal Dominant Polycystic Kidney Disease Kristen L. Nowak, Wei Wang, Heather Farmer-Bailey, Berenice Gitomer, Mikaela Malaczewski, Jelena Klawitter, Anna Jovanovich, and Michel Chonchol Glomerular and Tubulointerstitial Diseases 1502 Peripheral Blood B Cell Depletion after Rituximab and Complete Response in Lupus Nephritis Liliana Michelle Gomez Mendez, Matthew D.
    [Show full text]
  • ORIGINAL ARTICLE a Clinical and Histopathological Study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka
    ORIGINAL ARTICLE A Clinical and Histopathological study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka. Khaled A1, Banu SG 2, Kamal M 3, Manzoor J 4, Nasir TA 5 Introduction studies from other countries. Skin diseases manifested by lichenoid eruption, With this background, this present study was is common in our country. Patients usually undertaken to know the clinical and attend the skin disease clinic in advanced stage histopathological pattern of lichenoid eruption, of disease because of improper treatment due to age and sex distribution of the diseases and to difficulties in differentiation of myriads of well assess the clinical diagnostic accuracy by established diseases which present as lichenoid histopathology. eruption. When we call a clinical eruption lichenoid, we Materials and Method usually mean it resembles lichen planus1, the A total of 134 cases were included in this study prototype of this group of disease. The term and these cases were collected from lichenoid used clinically to describe a flat Bangabandhu Sheikh Mujib Medical University topped, shiny papular eruption resembling 2 (Jan 2003 to Feb 2005) and Apollo Hospitals lichen planus. Histopathologically these Dhaka (Oct 2006 to May 2008), both of these are diseases show lichenoid tissue reaction. The large tertiary care hospitals in Dhaka. Biopsy lichenoid tissue reaction is characterized by specimen from patients of all age group having epidermal basal cell damage that is intimately lichenoid eruption was included in this study. associated with massive infiltration of T cells in 3 Detailed clinical history including age, sex, upper dermis. distribution of lesions, presence of itching, The spectrum of clinical diseases related to exacerbating factors, drug history, family history lichenoid tissue reaction is wider and usually and any systemic manifestation were noted.
    [Show full text]
  • The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible?
    CASE REPORT The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible? Hendra Gunawan, Awalia, Joewono Soeroso Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo Hospital, Surabaya, Indonesia Corresponding Author: Prof. Joewono Soeroso, MD., M.Sc, PhD. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo Hospital. Jl. Mayjen. Prof. Dr. Moestopo 4-6, Surabaya 60132, Indonesia. email: [email protected]; [email protected]. ABSTRAK Lupus eritematosus sistemik (LES) adalah penyakit autoimun kronik eksaserbatif dengan manifestasi klinis yang beragam. Psoriasis vulgaris adalah penyakit kulit yang menyerang 1-3% dari populasi. Patofisiologi mengenai tumpang tindihnya penyakit tersebut belum sepenuhnya diketahui. Hal ini menyebabkan adanya tantangan tersendiri dalam tatalaksana kedua penyakit tersebut. Dua orang laki-laki dengan LES dan psoriasis vulgaris dilaporkan dengan manifestasi klinis eritroderma berulang dengan fotosensitif. Perbaikan klinis dicapai setelah terapi kombinasi metilprednisolon dengan metotrexat. Adanya LES yang tumpang tindih psoriasis vulgaris merupakan suatu fenomena klinis yang langka. Hubungan kedua penyakit tersebut dapat berupa saling mendahului atau tumpang tindih pada suatu waktu yang sama dan memiliki hubungan dengan adanya anti- Ro/SSA. Adanya tumpang tindih dari dua penyakit tersebut memberikan paradigma baru dalam patofisiologi, diagnosis, dan tatalaksana di masa mendatang. Kata kunci: lupus eritematosus sistemik, psoriasis vulgaris, psoriatic artritis, overlap syndrome. ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other.
    [Show full text]
  • African Americans and Lupus
    African Americans QUICK GUIDE and Lupus 1 Facts about lupus n People of all races and ethnic groups can develop lupus. n Women develop lupus much more often than men: nine of every 10 It is not people with lupus are women. Children can develop lupus, too. known why n Lupus is three times more common in African American women than lupus is more in Caucasian women. common n As many as 1 in 250 African American women will develop lupus. in African Americans. n Lupus is more common, occurs at a younger age, and is more severe in African Americans. Some scientists n It is not known why lupus is more common in African Americans. Some scientists think that it is related to genes, but we know that think that it hormones and environmental factors play a role in who develops is related to lupus. There is a lot of research being done in this area, so contact the genes, but LFA for the most up-to-date research information, or to volunteer for we know that some of these important research studies. hormones and environmental What is lupus? factors play 2 n Lupus is a chronic autoimmune disease that can damage any part of a role in who the body (skin, joints and/or organs inside the body). Chronic means develops that the signs and symptoms tend to persist longer than six weeks lupus. and often for many years. With good medical care, most people with lupus can lead a full life. n With lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and germs (“foreign invaders,” like the flu).
    [Show full text]
  • A Case of Discoid Lupus Erythematosus Masquerading As Acne
    Letters to the Editor 175 A Case of Discoid Lupus Erythematosus Masquerading as Acne Anastasios Stavrakoglou, Jenny Hughes and Ian Coutts Department of Dermatology, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK. E-mail: [email protected] Accepted July 4, 2007. Sir, On examination he had a widespread acneiform eruption, We describe here a case of discoid lupus erythemato- which was distributed on his face, pre-sternal area and back, particularly down the length of his spine. He had multiple sus (DLE) masquerading as acne vulgaris. Cutaneous brown-red follicular papules and open comedones, especially manifestations of lupus erythematosus (LE) are usually on his back, and hypopigmented atrophic scars. There were no characteristic enough to permit straightforward diagnosis. pustules or nodulocystic lesions (Fig. 1). However, occasionally they may be variable and mimic Treatment was started with erythromycin 500 mg bid and other dermatological conditions. adapalene cream once daily to treat a presumed diagnosis of acne vulgaris. He was seen 3 months later with a deterioration Acneiform presentation is one of the most rarely re- of his clinical appearance and increased pruritus. This was ported and one of the most confusing, as it resembles a attributed by the patient to increased sun exposure. The photo- very common inflammatory skin disease and therefore aggravation, the intense pruritus and the absence of pustules can be easily missed clinically. Only 5 cases have been and nodulocystic lesions broadened our differential diagnosis reported in the literature (1–4). The patient described and therefore diagnostic biopsies were obtained. A biopsy from the back where the rash was most suggestive clinically here presented with a widespread pruritic acneiform of acne vulgaris, showed hyperkeratosis with orthokeratosis, rash, which was initially diagnosed and treated as epidermal atrophy and extensive vacuolar degeneration of the acne vulgaris with no response.
    [Show full text]
  • Risk of Systemic Lupus Erythematosus in Patients with Idiopathic
    Correspondence response Ann Rheum Dis: first published as 10.1136/annrheumdis-2020-218177 on 22 July 2020. Downloaded from 4Department of Allergy, Immunology & Rheumatology, Chung Shan Medical Response to: ‘Risk of systemic lupus University Hospital, Taichung, Taiwan erythematosus in patients with idiopathic 5Graduate Institute of Integrated Medicine, China Medical University, Taichung, thrombocytopenic Taiwan Correspondence to Dr James Cheng- Chung Wei, Institute of Medicine, Chung purpura: population- based cohort study’ by Shan Medical University, Taichung 40201, Taiwan; jccwei@ gmail. com Goulielmos and Zervou Handling editor Josef S Smolen Contributors JCCW: manuscript writing. J- YH: data analysis. FXZ: critical appraisal We thank Goulielmos et al1 for their interests on our article enti- and approve the manuscript. tled ‘Risk of systemic lupus erythematosus (SLE) in patients with Funding Funding The present study was supported by the Programme of Scientific idiopathic thrombocytopenic purpura (ITP): a population-based and Technology Project (Guilin Science Research and Technology Development; grant no. 2016012706–2). cohort study’.2 Goulielmos et al raised possible mechanism and explanation Competing interests None declared. about the link of ITP and SLE. We appreciated their review and Patient and public involvement Patients and/or the public were not involved in comments on sensitised platelets, shared genetic background and the design, or conduct, or reporting, or dissemination plans of this research. similar molecular signatures of these two diseases. We also agree Patient consent for publication Not required. that these genetic and molecular background, especially inter- Provenance and peer review Commissioned; internally peer reviewed. feron signatures in ITP might lead to development autoimmune © Author(s) (or their employer(s)) 2020.
    [Show full text]
  • Unique Urticarial Presentation of Minocycline-Induced Lupus
    Volume 23 Number 8 | August 2017 Dermatology Online Journal || Case Report DOJ 23 (8): Unique urticarial presentation of minocycline-induced lupus erythematosus Ashley K Clark1, Vivian Y Shi2 MD, Raja K Sivamani3,4 MD MS CAT Affiliations: 1School of Medicine, University of California, Davis, Sacramento, CA USA, 2Department of Medicine, Division of Dermatology, University of Arizona, Tucson, USA, 3Department of Dermatology, University of California, Davis, Sacramento, CA USA, 4Department of Biological Sciences, California State Univeristy, Sacramento, CA USA Corresponding Author: Raja Sivamani, MD MS CAT, Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, Tel: 916-703-5145, Fax: 916-734-7183, Email: [email protected] Abstract with minocycline-induced lupus (MIL) typically present with fever and polyarthralgia, ANA positivity, We present a 17-year-old boy who developed a and elevated erythrocyte sedimentation rate, but generalized urticarial eruption, malar rash, fever, and negative levels of antihistone antibodies (AHAs) arthralgia within one week of initiating minocycline and anti-native DNA antibodies [4, 5]. Our report therapy for acne. His workup showed positive anti- highlights an unusual urticarial presentation of MIL nuclear and anti-histone antibodies. His symptoms with rapid resolution after oral prednisone. To the best quickly resolved after discontinuing minocycline and of our knowledge there is only one case of DIL with starting oral prednisone. We believe the constellation an urticarial presentation. The purpose of this report of his symptoms, laboratory findings, and temporal is to increase recognition of a unique presentation of association of minocycline initiation was suggestive DIL following minocycline treatment.
    [Show full text]
  • Association of Atopic Dermatitis with Rheumatoid Arthritis and Systemic Lupus Erythematosus in US Adults
    Association of atopic dermatitis with rheumatoid arthritis and systemic lupus erythematosus in US adults Alexander Hou, BS1, Jonathan I. Silverberg, MD, PhD, MPH2 1Department of Dermatology, Feinberg School of Medicine, Northwestern University. 2Department of Dermatology, George Washington University School of Medicine, Washington D.C., USA https://orcid.org/0000-0003-3686-7805 Twitter: @JonathanMD Background: There have been conflicting studies about the association of atopic dermatitis (AD) and autoimmune disorders, e.g. rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Little is known about which subsets of AD patients have increased likelihood to develop autoimmune disorders. Objective: We sought to determine whether AD with or without atopic comorbidities is associated with RA and SLE, and which subsets of adults have increased likelihood of RA and SLE. Methods: Data were analyzed from the 2012 National Health Interview Survey, a representative United States population-based cross-sectional survey study (n=34,242 adults age ≥18 years). Results: In bivariate and multivariate weighted logistic regression models, RA was associated with AD overall (adjusted odds ratio [95% confidence interval]: 1.65 [1.27-2.16]), and AD with comorbid asthma (2.27 [1.46-3.52]), hay fever (1.76 [1.03-3.02]), food allergy (2.05 [1.23- 3.42]), or respiratory allergy (1.75 [1.14-2.68]). RA was associated with AD without atopic comorbidities in bivariate models, but not in multivariate models adjusting for sociodemographic characteristics (1.44 [0.95-2.19]). Similarly, SLE was associated with AD overall (2.62 [1.40- 4.90]), and AD with comorbid asthma (2.75 [1.13-6.70]), food allergy (6.58 [2.71-16.0]), or respiratory allergy (5.34 [2.21-12.9]), but not AD alone (1.44 [0.59-3.50]) or AD with comorbid hay fever (1.37 [0.33-5.75]).
    [Show full text]
  • Understanding Lupus English-NRCL-Digital.Pdf
    Understanding Lupus If you’ve been diagnosed with lupus, you probably have a lot of questions about the disease and how it may affect your life. Lupus affects different people in different ways. For some, lupus can be mild — for others, it can be life-threatening. Right now, there’s no cure for lupus. The good news is that with the support of your doctors and loved ones, you can learn to manage it. Learning as much as you can about lupus is an important first step. | What is lupus? Lupus is a chronic (long-term) disease that can cause inflammation The immune system is the (swelling) and pain in any part of your body. It’s an autoimmune part of the body that fights disease, meaning that your immune system attacks healthy tissue off bacteria and viruses to (tissue is what our organs are made of). Lupus most commonly affects help you stay healthy. the skin, joints, and internal organs — like your kidneys or lungs. | Who is at risk for developing lupus? In the United States, at least 1.5 million people have lupus — and about 16,000 new cases of lupus are reported each year. People of all ages, genders, and racial or ethnic groups can develop lupus. But certain people are at higher risk than others, including: • Women ages 15 to 44 • Certain racial or ethnic groups — including people who are African American, Asian American, Hispanic/Latino, Native American, or Pacific Islander • People who have a family member with lupus or another autoimmune disease | What are the symptoms of lupus? Because lupus can affect so many different parts of the body, it can cause a lot of different symptoms.
    [Show full text]
  • Proliferative Lupus Nephritis and Leukocytoclastic Vasculitis During Treatment with Etanercept ADAM MOR, CLIFTON O
    Case Report Proliferative Lupus Nephritis and Leukocytoclastic Vasculitis During Treatment with Etanercept ADAM MOR, CLIFTON O. BINGHAM III, LAURA BARISONI, EILEEN LYDON, and H. MICHAEL BELMONT ABSTRACT. Tumor necrosis factor-α (TNF-α) is a proinflammatory cytokine. Agents that neutralize TNF-α are effective in the treatment of disorders such as rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), spondyloarthropathies, and inflammatory bowel disease. TNF-α antagonist therapy has been associated with the development of antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies, as well as the infrequent development of systemic lupus erythematosus (SLE)- like disease. We describe the first case of biopsy-confirmed proliferative lupus nephritis and leuko- cytoclastic vasculitis in a patient treated with etanercept for JRA. (J Rheumatol 2005; 32:740–3) Key Indexing Terms: TUMOR NECROSIS FACTOR SYSTEMIC LUPUS ERYTHEMATOSUS NEPHRITIS VASCULITIS ETANERCEPT Tumor necrosis factor-α (TNF-α) is a proinflammatory CASE REPORT cytokine involved in the pathogenesis of several inflamma- A 22-year-old woman presented with a purpuric rash and lower extremity tory and autoimmune diseases1. Agents that neutralize TNF edema. At 14 years of age she was diagnosed with polyarticular JRA after are effective in the treatment of disorders such as rheuma- presenting with symmetric arthritis of hands, shoulders, ankles, and knees. C-reactive protein (CRP) and erythrocyte sedimentation rate were elevated, toid arthritis, juvenile rheumatoid arthritis (JRA), spondy- while both ANA and rheumatoid factor (RF) were negative. During her dis- loarthropathies, and inflammatory bowel disease. One TNF ease course she did not experience any extraarticular manifestations. She antagonist is etanercept, a soluble type II TNF receptor was treated with multiple disease modifying antirheumatic drugs [e.g, (p75) fused to the Fc portion of human immunoglobulin (Ig) plaquenil, sulfasalazine, and methotrexate (MTX)] without achieving com- G1.
    [Show full text]