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lüll Lupus-like syndrome attributable to anti-tumor necrosis factor alpha therapy in 14 patients during an 8-year period at Mayo Clinic Wetter DA; Davis MDMayo Clin Proc 2009[Nov]; 84 (11): 979-84OBJECTIVE: To examine clinical characteristics, laboratory features, and outcomes of patients with lupus-like syndrome attributable to anti-tumor necrosis factor alpha (TNF-alpha) therapy. PATIENTS AND METHODS: We performed a retrospective review of patients with lupus-like syndrome attributable to anti-TNF-alpha therapy at Mayo Clinic's site in Rochester, MN, between July 1, 2000, and June 30, 2008. RESULTS: Of 14 patients (mean age at disease onset, 46.2 years), 12 (86%) were female. Ten patients (71%) had Crohn disease, and 4 (29%) had rheumatoid arthritis. Thirteen patients (93%) originally were treated with infliximab, and 1 (7%) was treated with adalimumab. A lupus-ike syndrome occurred after a mean treatment duration of 16.2 months. Features of lupus included presence of antinuclear antibodies (14 patients [100%]), arthritis (13 patients [93%]), anti-double-stranded-DNA antibodies (10 patients [71%]), cutaneous findings (malar rash, discoid rash, or photosensitivity, 4 patients [29%]), serositis (4 patients [29%]), hematologic abnormalities (4 patients [29%]), oral ulcers (4 patients [29%]), and lupus anticoagulant (1 patient [7%]). No patient had renal or neurologic abnormalities. All patients improved after stopping anti-TNF-alpha therapy (mean time to improvement, 2.9 months). Four (80%) of 5 patients tolerated an alternative TNF-alpha inhibitor (adalimumab, 3 patients; etanercept, 1 patient) without recurrence of lupus-like syndrome. CONCLUSION: Compared with previous studies, cutaneous findings were less frequent and arthritis was more frequent in our cohort of patients. Some patients were able to tolerate an alternative TNF-alpha inhibitor without recurrence of lupus-like syndrome.|Academic Medical Centers[MESH]|Age Distribution[MESH]|Antibodies, Monoclonal/*adverse effects/therapeutic use[MESH]|Crohn Disease/diagnosis/*drug therapy[MESH]|Dose-Response Relationship, Drug[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Incidence[MESH]|Infliximab[MESH]|Infusions, Intravenous[MESH]|Lupus Erythematosus, Systemic/*chemically induced/epidemiology/physiopathology[MESH]|Male[MESH]|Middle Aged[MESH]|Minnesota[MESH]|Retrospective Studies[MESH]|Risk Assessment[MESH]|Sampling Studies[MESH]|Sex Distribution[MESH]|Syndrome[MESH]|Time Factors[MESH]|Tumor Necrosis Factor-alpha/*antagonists & inhibitors[MESH] |