Minocycline induced lupus: Case series in the West of Scotland

Objective. To describe the clinical symptoms and serology of drug-induced l upus in patients treated with the semisynthetic tetracycline derivative, mi nocycline. Methods For a 5-year period, all consultant rheumatologists and dermatologi sts in the West of Scotland were asked to report any suspected cases of a l upus-like syndrome to one center. Twenty cases were identified on the basis of arthritis, positive antinuclear factor and at least one other extraarti cular feature following treatment for acne with minocycline. Case histories were reviewed to determine any demographic, clinical, or serological corre lations. Results. Minocycline had been prescribed for a mean of 25 months for the 20 patients identified with drug-induced lupus; 15 were female, 5 were male w ith a mean age of 24 years. All patients had arthritis and most had at leas t one other extraarticular feature including lethargy, myalgia, fevers, Ray naud's phenomenon, abdominal pain, and butterfly rash. None had renal invol vement. All symptoms resolved at a mean of 15.7 weeks after discontinuation of minocycline treatment, Conclusions Minocycline is widely used in the treatment of acne and increas ingly in the treatment of rheumatic diseases. Although the absolute risk of developing drug-induced lupus is relatively low, it has been estimated tha t current use of minocycline is associated with an 8.5 fold increased risk of developing a lupus-like syndrome. Prescribing physicians must be vigilan t for any of the characteristic symptoms to avoid unnecessary morbidity, in vestigations, and therapy.