Development of systemic lupus erythematosus with focal proliferative lupus nephritis during Anti-TNF-α therapy for psoriatic arthritis

Background: Treatment with tumor necrosis factor-( TNF-) alpha- blocking agents is used in a variety of autoimmune diseases. In anti- TNF-alpha therapy for rheumatoid arthritis, occasionally, the development of autoantibodies as well as lupus- like syndromes have been observed, rarely, glomerulonephritides are also induced. The authors first report the development of lupus erythematosus with renal involvement in a patient with psoriatic arthritis during therapy with the soluble TNF- a receptor etanercept. Case Report: A 70- year- old patient with long- standing psoriatic arthritis developed pleuritis, pericarditis, as well as marked arthralgias during therapy with etanercept. Laboratory investigation showed markedly increased parameters of inflammation, antinuclear antibodies ( ANA), a proteinuria of 3.2 g/ day, mild impairment of renal function, as well as a nephritic urinary sediment. A subsequently performed renal biopsy was diagnostic for focal proliferative lupus nephritis. After withdrawal of etanercept and initiation of a cyclophosphamide pulse therapy in combination with oral steroids, parameters of inflammation and renal function rapidly normalized; pleuritis and pericarditis were not detectable anymore. Conclusion: Anti- TNF-alpha therapy in patients with psoriatic arthritis or other autoimmune diseases may lead to induction of systemic lupus with renal involvement.