Summary
Development of drug-induced systemic lupus erythematosus (SLE) is an uncommon complication of the use of D-penicillamine and sulphasalazine. We report two cases of patients with rheumatoid arthritis (RA) who developed symptoms and signs of SLE and suggest that increasing use of these two agents as combination therapy in RA may cause an additive risk to the occurrence of this complication.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Martin, M., Dixon, J., Hickling, P., Bird, H., Golding, J., Wright, V. A combination of D-penicillamine and hydroxychloroquine for the treatment of rheumatoid arthritis. Ann Rheum Dis 1982, 41, 208.
Shiroky, J.B., Watts, C.S., Neville, C. Combination methotrexate and sulphasalazine in the management of rheumatoid arthritis: case observations. Arthritis Rheum 1989, 32, 1160–1164.
Schwarzer, A.C., Arnold, M.H., Kelly, D. et al. The cycling of combination antirheumatic drug therapy in rheumatoid arthritis. Br J Rheum 1990, 29, 445–450.
Taggart, A.J., Astbury, C., Dixon, J.S., Bird, H.A., Wright, V. Sulphasalazine alone or in combination with D-penicillamine in rheumatoid arthritis. Br J Rheum 1987, 26, 32–36.
Dawes, P.T., Sheeran, T.P., Fowler, P.D., Shadforth, M.F. Improving the response to gold or D-penicillamine by addition of sulphasalazine. A pilot study in 25 patients with rheumatoid arthritis. Clin Exp Rheumatol 1987, 5, 151–153.
Dawkins, R.L., Zilko, P.J. Immunobiology of D-penicillamine. J Rheumatol 1981, 7, 56–61.
Chalmers, A., Thompson, D., Stein, H.E., Reid, G., Patterson, A.C. Systemic lupus erythematosus during penicillamine therapy for rheumatoid arthritis. Ann Int Med 1982, 97, 659–663.
Vyse, T., So, A.K.L. Sulphasalazine-induced autoimmune syndrome. Br J Rheum 1992, 31, 115–116.
Mongey, A., Hess, E.V. Drug-related lupus. Curr Op Rheumatol 1989, 1, 353–359.
Fischman, A.S., Abeles, M., Zanetti, M., Weinstein, A., Rothfield, N.F. The coexistence of rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 1981, 405–415.
Barnett, E.V., North, A.E., Condemi, J.J. et al. Anti-nuclear factors in systemic lupus erythematosus and rheumatoid arthritis. Ann Intern Med 1965, 63, 100–108.
Condemi, J.J., Barnett, E.V., Atwater, E.C. et al. The significance of antinuclear factors in rheumatoid arthritis. Arthritis Rheum 1965, 8, 1080–1093.
Elling, P. On the incidence of antinuclear factors in rheumatoid arthritis. Acta Rheum Scand 1967, 13, 101–112.
Linn, J.E., Hardin, J.G., Halla, J.T. A controlled study of ANA+ and RF- arthritis. Arthritis Rheum 1978, 21, 645–651.
Walshe, J.M. Toxic reactions to penicillamine in patients with Wilson's disease. Postgrad Med J 1968, (suppl) 6–8.
Chalmers, A., Thompson, D., Stein, H.E., Reid, G., Patterson, A.C. Systemic lupus erythematosus during penicillamine for rheumatoid arthritis. Ann Int Med 1982, 97, 659–663.
Ramsey-Goldman, R., Franz, T., Solano, F.X., Medsger, T.A. Jr. Hydralazine-induced lupus and Sweet's syndrome. Report and review of the literature. J Rheumatol 1990, 17, 682–684.
Batchelor, J.R., Welsch, K.I., Mansilla-Tinoco, R., et al. Hydralazine-induced systemic lupus erythematosus: Influence of HLADR and sex on susceptibility. Lancet 1980, 1, 1107.
Alarcon-Segovia, D., Herskovic, T., Dearing, W.H. et al. Lupus erythematosus cell phenomena in patients with chronic ulcerative colitis. Gut 1965, 6, 39–47.
Griffiths, I.D., Kane, S.P. Sulphasalazine-induced lupus syndrome in ulcerative colitis. Br Med J 1977, 2, 1188–1189.
Crisp, A.J. Sulphasalazine in rheumatoid arthritis. Br J Rheum 1984, 23, 232–236.
Hoffmann, B.J. Sensitivity of sulphadiazine resembling acute disseminated lupus erythematosus. Arch Dermatol Syph 1945, 53, 190.
Gold, S. Role of sulphonamides and penicillin in the pathogenesis of systemic lupus erythematosus. Lancet 1951, 1, 268.
Honey, M. SLE presenting with sulphonamide hypersensitivity reaction. Br Med J 1957, 1, 1272.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Borg, A.A., Davis, M.J., Dawes, P.T. et al. Combination therapy for rheumatoid arthritis and drug-induced systemic lupus erythematosus. Clin Rheumatol 13, 522–524 (1994). https://doi.org/10.1007/BF02242956
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02242956