Drug-induced, Ro/SSA-positive cutaneous lupus erythematosus
Drug-induced, Ro/SSA-positive cutaneous lupus erythematosus
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DOI：
10.1001/archderm.139.1.45
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发表时间：
2003-01-01
影响因子：
--
通讯作者：
Nousari, CH
中科院分区：
文献类型：
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作者：
Srivastava, M;Rencic, A;Nousari, CH
目的：研究药物诱导的Ro/SSA阳性皮肤红斑狼疮（CLE）的临床和免疫病理学结果。设计：回顾性医疗和实验室记录审查。设置：免疫皮肤科约翰霍普金斯医院（巴尔的摩，马里兰州）。患者：120例患者通过血凝和/或免疫双扩散发现有抗Ro/SSA抗体，70例有临床和免疫病理学确认的CLE。这70例患者中有15例有新药暴露史，定义为不到6个月，与疾病development.Results：疾病相关的药物包括氢氯噻嗪（5例），血管紧张素转换酶抑制剂（3例），钙通道阻滞剂（3例），干扰素（2例）和他汀类药物（2例）。最常见的表现是光分布的弥漫性红斑和亚急性CLE型病变，没有明显的全身性疾病的证据。所有标本均显示界面皮炎和沿着基底膜区和整个表皮的细小颗粒状IgG沉积。大多数患者在8周内出现临床病变的改善或消退，在停药后8个月内Ro/SSA滴度下降。结论：抗高血压药物是最常见的与Ro阳性CLE。这种药物诱导的变异的临床和免疫病理学特征似乎与特发性疾病没有区别。在大多数情况下，疾病改善或停止违规药物治疗解决。目前尚不清楚这些药物是否会导致亚临床疾病患者的疾病。药物诱导的Ro/SSA阳性CLE应包括在光敏性或亚急性CLE型皮疹患者的鉴别诊断中。
Objective: To study the clinical and immunopathologic findings of drug-induced, Ro/SSA-positive cutaneous lupus erythematosus (CLE).Design: Retrospective medical and laboratory record review.Setting: Immunodermatology Division of Johns Hopkins Hospital (Baltimore, Md).Patients: Of 120 patients found to have anti-Ro/SSA antibodies by hemagglutination and/or double immunodiffusion, 70 had clinical and immunopathologic confirmation of CLE. Fifteen of these 70 patients had a history of new drug exposure, defined as less than 6 months, associated with disease development.Results: The disease-associated drugs included hydrochlorothiazide (5 patients), angiotensin-converting enzyme inhibitors (3 patients), calcium channel blockers (3 patients), interferons (2 patients), and statins (2 patients). The most common presentations were photo-distributed diffuse erythema and subacute CLE-type lesions without evidence of significant systemic disease. All specimens revealed interface dermatitis and fine granular IgG deposition along the basement membrane zone and throughout the epidermis. Most patients experienced improvement or resolution of clinical lesions within 8 weeks and decrease of Ro/SSA titers within 8 months after discontinuation of drug treatment.Conclusions: Antihypertensive drugs are the most commonly associated with Ro-positive CLE. Clinical and immunopathologic features of this drug-induced variant do not seem to differ from the idiopathic disease. In most cases, the disease improves or resolves on discontinuation of the offending drug treatment. It is not known if these drugs precipitate disease in patients who have subclinical disease. Drug-induced Ro/SSA-positive CLE should be included on the differential diagnosis in patients presenting with photosensitive or subacute CLE-type eruptions.