In general, except for a few drugs, such as minocycline, use of drugs that induce a significant incidence of lupus seems to be decreasing, likely because of a trend in drug development to avoid drugs that form reactive metabolites and to develop more potent drugs so that the total dose is below the threshold required to induce a lupuslike syndrome. One type of drug associated with the induction of lupus that is likely to increase in importance is biological agents such as interferons.

Although the use of drugs that commonly cause lupus is, in general, decreasing, it is important to have a high index of suspicion because the diagnosis is often missed, likely because the onset of symptoms is often insidious and similar to that of other rheumatic diseases. In addition, the association of the adverse event with a drug is less obvious than for most adverse drug reactions because the patient has usually been taking the drug for a long time and the symptoms may take several months to completely resolve.

Although the differences between idiopathic and drug-induced lupus were highlighted at the beginning of this chapter, there are probably several common features in the pathogenesis of the two syndromes, and it is likely that a better understanding of drug-induced lupus could contribute to a better understanding of idiopathic lupus.

Acknowledgements. The author is supported by grants from the Canadian Institutes of Health Research and a Canada Research Chair in Adverse Drug Reactions.

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