Anti-TNF-alpha-induced lupus in patients with non-infectious uveitis

Purpose Anti-TNF-alpha-induced lupus (ATIL) is a rare condition considered as a drug-induced lupus (DIL) in patients under anti-TNF-alpha therapies. Nowadays it is still unclear if ATIL is a classical DIL or represent a distinct syndrome. Some characteristics of DIL have been described specifically associated with patients with lupus-like syndrome receiving anti-TNF-alpha therapy: the severity of the disease, incidence/prevalence of dsDNA antibodies (anti-dsDNA) and hypocomplementaemia. The objective of this study is to describe the development of ATIL in patients with non-infectious uveitis in a single tertiary center. Methods Retrospective description of a case series. Results We describe three patients with noninfectious uveitis (NIU) of different etiologies who developed antinuclear antibody (ANA) and anti-dsDNA antibody positivity, arthritis and, in one case, skin lesions under adalimumab treatment. The condition resolved in all of them after adalimumab withdrawal. Corticosteroids were required in one patient, non-steroidal anti-inflammatory drugs in two patients, and hydroxychloroquine in one of them. None required another immunosuppressive drug. A subsequent control of the NIU could continue to be carried out without anti-TNF-alpha therapy in two patients and in the remaining a switch was made to another anti-TNF-alpha (golimumab). Conclusion The current report describes three cases of ATIL in patients with different types of NIU which share some common features: ANA positivity, articular symptoms, and a temporal relationship between symptoms onset and anti-TNF-alpha treatment. A review of the literature and comparison with the few previous reported ATIL cases was conducted as well.

Automated summary

This study retrospectively describes three cases of Anti-TNF-alpha-induced lupus (ATIL) in patients with non-infectious uveitis (NIU), who developed antinuclear antibody (ANA) and anti-dsDNA antibody positivity, arthritis, and in one case, skin lesions under adalimumab treatment. The condition resolved in all patients after adalimumab withdrawal, with one patient requiring corticosteroids, two patients requiring non-steroidal anti-inflammatory drugs, and one patient requiring hydroxychloroquine. None of the patients required another immunosuppressive drug. Two patients were able to continue follow-up without anti-TNF-alpha therapy, while the remaining patient switched to another anti-TNF-alpha treatment (golimumab). A review of the literature and comparison with previous ATIL cases was also conducted.