[Development of systemic lupus erythematosus with focal proliferative lupus nephritis during anti-TNF-alpha therapy for psoriatic arthritis].

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-alpha receptor etanercept.
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.
Anti-TNF-alpha therapy in patients with psoriatic arthritis or other autoimmune diseases may lead to induction of systemic lupus with renal involvement.
AuthorsHendrik Haake, Jens Köneke, Kerstin Amann, Jürgen vom Dahl, Ulf Janssen
JournalMedizinische Klinik (Munich, Germany : 1983) (Med Klin (Munich)) Vol. 102 Issue 10 Pg. 852-7 (Oct 15 2007) ISSN: 0723-5003 [Print] Germany
Vernacular TitleEntwicklung eines systemischen Lupus erythematodes mit fokaler proliferativer Lupusnephritis unter einer Anti-TNF-alpha-Therapie bei Psoriasisarthritis.
PMID17928969 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Adrenal Cortex Hormones
  • Antibodies, Antinuclear
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Cyclophosphamide
  • Etanercept
  • Adrenal Cortex Hormones (therapeutic use)
  • Aged
  • Antibodies, Antinuclear (blood)
  • Arthritis, Psoriatic (drug therapy)
  • Biopsy
  • Cyclophosphamide (therapeutic use)
  • Drug Therapy, Combination
  • Etanercept
  • Humans
  • Immunoglobulin G (adverse effects, therapeutic use)
  • Immunosuppressive Agents (adverse effects, therapeutic use)
  • Kidney (pathology)
  • Kidney Function Tests
  • Lupus Erythematosus, Systemic (chemically induced, diagnosis)
  • Lupus Nephritis (chemically induced, diagnosis)
  • Male
  • Receptors, Tumor Necrosis Factor (therapeutic use)
  • Tumor Necrosis Factor-alpha (antagonists & inhibitors)

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