Rheumatology International

, Volume 34, Issue 3, pp 443–444 | Cite as

A patient with ankylosing spondylitis who developed infliximab-induced lupus and treated with etanercept

  • Özgür Akgül
  • Gamze Kılıç
  • Erkan Kılıç
  • İsa Cüce
  • Salih Özgöçmen
Letter to the Editors


We read the paper by Diaz et al. [1] which reported patients with rheumatoid arthritis (RA) who developed drug-induced lupus erythematosus (DILE) who were treated with rituximab. Although treatment recommendations for DILE are not currently available, patients with RA may have different drug options like rituximab which is also approved for the treatment of RA. However, in patients with ankylosing spondylitis (AS), options for the treatment of DILE are highly restricted since biologics other than anti-TNF agents (i.e., rituximab) have no proven efficacy [2, 3]. The challenge is the treatment of patients with AS who developed DILE while on the treatment of anti-TNF drugs; patients may inevitably exacerbate when TNF blockers stopped for the reversal of DILE symptoms and to continue non-steroid anti-inflammatory drugs (NSAIDs) alone may not be sufficient for the management.

Anti-TNF drugs are effective therapies for AS in terms of signs, symptoms, and functioning [4]. Since the...


Rheumatoid Arthritis Inflammatory Bowel Disease Infliximab Ankylose Spondylitis Etanercept 
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  1. 1.
    Diaz JC, Vallejo S, Canas CA (2012) Drug-induced lupus in anti-TNF-alpha therapy and its treatment with rituximab. Rheumatol Int 32(10):3315–3317Google Scholar
  2. 2.
    Song IH, Heldmann F, Rudwaleit M, Listing J, Appel H, Braun J et al (2010) Different response to rituximab in tumor necrosis factor blocker-naive patients with active ankylosing spondylitis and in patients in whom tumor necrosis factor blockers have failed: a twenty-four-week clinical trial. Arthritis Rheum 62(5):1290–1297PubMedCrossRefGoogle Scholar
  3. 3.
    Kiltz U, Heldmann F, Baraliakos X, Braun J (2012) Treatment of ankylosing spondylitis in patients refractory to TNF-inhibition: are there alternatives? Curr Opin Rheumatol 24(3):252–260PubMedCrossRefGoogle Scholar
  4. 4.
    Heldmann F, Dybowski F, Saracbasi-Zender E, Fendler C, Braun J (2010) Update on biologic therapy in the management of axial spondyloarthritis. Curr Rheumatol Rep 12(5):325–331PubMedCrossRefGoogle Scholar
  5. 5.
    Costa MF, Said NR, Zimmermann B (2008) Drug-induced lupus due to anti-tumor necrosis factor alpha agents. Semin Arthritis Rheum 37(6):381–387PubMedCrossRefGoogle Scholar
  6. 6.
    Sarzi-Puttini P, Atzeni F, Capsoni F, Lubrano E, Doria A (2005) Drug-induced lupus erythematosus. Autoimmunity 38(7):507–518PubMedCrossRefGoogle Scholar
  7. 7.
    Williams EL, Gadola S, Edwards CJ (2009) Anti-TNF-induced lupus. Rheumatology (Oxford) 48(7):716–720CrossRefGoogle Scholar
  8. 8.
    De Bandt M, Sibilia J, Le Loet X, Prouzeau S, Fautrel B, Marcelli C et al (2005) Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther 7(3):R545–R551PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Ramos-Casals M, Brito-Zeron P, Munoz S, Soria N, Galiana D, Bertolaccini L et al (2007) Autoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases. Medicine (Baltimore) 86(4):242–251CrossRefGoogle Scholar
  10. 10.
    Lin J, Ziring D, Desai S, Kim S, Wong M, Korin Y et al (2008) TNF alpha blockade in human diseases: an overview of efficacy and safety. Clin Immunol 126(1):13–30PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Subramanian S, Yajnik V, Sands BE, Cullen G, Korzenik JR (2011) Characterization of patients with infliximab-induced lupus erythematosus and outcomes after retreatment with a second anti-TNF agent. Inflamm Bowel Dis 17(1):99–104PubMedGoogle Scholar
  12. 12.
    van Rijthoven AW, Bijlsma JW, Canninga-van Dijk M, Derksen RH, van Roon JA (2006) Onset of systemic lupus erythematosus after conversion of infliximab to adalimumab treatment in rheumatoid arthritis with a pre-existing anti-dsDNA antibody level. Rheumatology (Oxford) 45(10):1317–1319CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Özgür Akgül
    • 1
  • Gamze Kılıç
    • 1
  • Erkan Kılıç
    • 1
  • İsa Cüce
    • 1
  • Salih Özgöçmen
    • 1
  1. 1.Department of PMR, Division of RheumatologyErciyes University, Faculty of MedicineKayseriTurkey

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