Drug-induced rheumatic disorders - Incidence, prevention and management

The purpose of this article is to review the causes, the clinical manifesta tions and the management of the more frequent drug-induced rheumatic disord ers. These include: (i) articular and periarticular manifestations induced by fluoroquinolones, nonsteroidal anti-inflammatory drugs, injections of co rticosteroids, and retinoids; (ii) multisystemic manifestations such as dru g-induced lupus and arthritis induced by vaccination, Bacillus Calmette-Gue rin therapy and cytokines; (iii) drug-induced disorders of bone metabolism (corticosteroid-induced osteoporosis, drug-induced osteomalacia and osteone crosis); and (iv) iatrogenic complex regional pain syndromes. Disorders cau sed by nonpharmacological and rarely used treatments have been deliberately excluded. Knowledge of these drug-induced clinical symptoms or syndromes allows an ea rlier diagnosis and treatment, and earlier drug withdrawal if necessary. Wi th the introduction of new medications such as the recombinant cytokines an d antiretroviral treatments, the number of drug-induced rheumatic disorders is likely to increase.