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Features of spontaneous and drug-induced lupus

Clinical feature	Idiopathic SLE	Drug-induced lupus
Gender predisposition (F:M)	9:1	1:1
Acetylation type	Slow = Fast	Slow (described for hydralazine and procainamide)
Symptom onset	Gradual	Abrupt
Usual age	20 to 40	Drug-dependent, tends to be older population than idiopathic (>50)*
Race	All	Less likely to occur in black patients
Fever/malaise	40 to 85 percent	40 to 50 percent
Arthralgias/arthritis	75 to 95 percent	80 to 95 percent
Rash (all)	50 to 70 percent	10 to 30 percent
Rash (discoid)	20 percent	Rare^¶
Rash (malar/acute cutaneous)	42 percent	2 percent
Raynaud's	35 to 50 percent	<25 percent
Pleuritis/pleural effusion	16 to 60 percent	10 to 50 percent (procainamide)
Pulmonary infiltrates	0 to 10 percent	5 to 40 percent (procainamide)
Pericarditis	6 to 45 percent	2 to 18 percent
Hepatomegaly/splenomegaly	10 to 45 percent	5 to 25 percent
Renal involvement	30 to 50 percent	0 to 5 percent
CNS/neurologic involvement	25 to 70 percent	0 to 2 percent
Hematologic	Common	Unusual
Laboratory feature	Idiopathic SLE	Drug-induced lupus
ANA	95 to 98 percent	95 to 100 percent
Anti-dsDNA	50 to 80 percent	<5 percent (rare)
Anti-Smith	20 to 30 percent	<5 percent (rare)
Anti-RNP	40 to 50 percent	20 percent
Anti-Ro/SS-A	30 to 40 percent	Uncertain^§
Anti-histone	60 to 80 percent	90 to 95 percent^Δ
Low complement levels	40 to 65 percent	Rare
Anemia	30 to 90 percent	0 to 46 percent
Leukopenia	35 to 66 percent	2 to 33 percent
Positive Coombs' test	18 to 65 percent	0 to 33 percent^◊

CNS: central nervous system; ANA: anti-nuclear antibody; LE: lupus erythematosus; RNP: ribonucleoprotein; dsDNA: double-stranded deoxyribonucleic acid.
* Minocycline-induced disease tends to occur in young females, consistent with greater use of the medication than other groups.
¶ Case reports of drug-induced discoid lupus with anti-TNF drug exposure.
§ Insufficient data are available to provide an accurate estimate for (systemic) drug-induced lupus. The antibodies are present in 70 to 90 percent of patients with drug-induced subacute cutaneous lupus.
Δ Overall presence of anti-histone antibodies in drug-induced lupus; prevalence varies markedly between implicated drugs (may be less with minocycline or tumor necrosis factor inhibitors, and data are lacking for many agents). (Merola JF. Lupus-like syndromes related to drugs. In: Lupus Erythematosus: Clinical Evaluation and Treatment, Schur PH, Massarotti E. (Eds), Springer, New York, pp. 211-221).
◊ Most common with methyldopa exposure.

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