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363 Anti – tnf alfa induced lupus : a case report
  1. A Fikry and
  2. P Faridin
  1. Hasanuddin University, Internal Medicine, Makassar, Indonesia

Abstract

Background and aims The use of protein based anti-TNF alfa therapies such as antibodies and soluble TNF alfa receptors is commonly associated with the induction of autoantibodies, whereas anti-TNF induced lupus (ATIL) is rare. ATIL can occur with any of the available TNF inhibitors, but the frequency and clinical characteristics of ATIL vary between different drugs.

Methods Observational.

Results A 25 years old girl was diagnosed Rheumatoid Arthritis. Patient got MTX and Prednison 1 year ago. We add treatment with anti-TNF alfa (golimumab), after 2 weeks she got treatment, patient was suffer with hipertermia, dispnea, moon face,extremitals oedema and vasculitis. Laboratory result is anaemia, trombositopenia, LED was rise, C3 and C4 was decreased, hipoalbuminemia, ANA profile for any autoantibodies were positive. Then we diagnosed her anti-TNF Alfa drug induced Lupus (ATIL). We stop gift her anti-TNF Alfa and treated her with Prednison, MTX, and Furosemide Injection.

Conclusions Anti-TNF induced autoantibodies are common following therapy with all of the currently available anti-TNF therapies.However, the incidence of ‘fullblown’ ATIL is rare. Nevertheless, cerebral and renal involvement has been reported more frequently in ATIL compared with classical DIL. The incidence/prevalence of dsDNA antibodies and hypocomplementaemia is also greater in ATIL, whilst anti histone antibodies, the serological hallmark of classical DIL, are less commonly found. Due to the potentially serious complications of ATIL,screening for this prior to and during anti-TNF therapy might assume greater importance. If the diagnosis is suspected then anti-TNF therapy should be withdrawn unless symptoms are very mild.

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