Integrative and Complementary Approach to Drug-Induced Lupus: Testing, Nutrition, and Supplements

Autoimmune diseases continue to rise in the U.S. In the case of Lupus, this autoimmune condition has risen by an astounding 44% in the last 25 years, and 6% to 12% out of those Lupus cases are Drug-Induced Lupus (DIL). You may have guessed how DIL occurs from the name. This condition arises from taking a particular drug. However, there are risk factors to consider in this condition and common medications that cause the development. This article will explain the onset of DIL and explore the various integrative approaches to address this autoimmune condition.

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What is Drug-Induced Lupus?

DIL is an intriguing autoimmune condition that occurs after a patient consumes certain drugs and develops symptoms that are like Systemic Lupus Erythematosus (SLE). However, DIL tends to be less severe than SLE. SLE is the most common form of Lupus, an autoimmune disorder that can affect multiple parts of the body, including joints, skin, brain, lungs, kidneys, and blood vessels. Although there are differences in these conditions, the similarities can make diagnosing DIL difficult. There are up to 30,000 new cases annually in the U.S. of DIL.

Causes And Risk Factors Of Drug-Induced Lupus

There is a pretty apparent environmental trigger that leads to the development of Lupus in DIL, as this condition develops after exposure to certain drugs. It may take a few months or several years of being on a particular medication therapy before symptoms show up. Although the pathophysiology is still uncertain, certain genetic risk factors increase the risk of DIL, such as those with a congenital deficiency of N-acetyltransferase. N-acetyltransferase is an enzyme responsible for metabolizing medicinal, environmental, occupational, and dietary exposures. It is thought that this genetic variant, other genetic factors, along with the intake of certain medications for a period of time contribute to the development of lupus-like autoimmunity.

Common Medications Associated With Drug-Induced Lupus

Over 100 drugs have been specified to cause DIL, and the list continues to grow with the development of newer drugs each year.

Here are some of the most common drugs indicated to cause DIL:

● Hydralazine - commonly prescribed for hypertension

● Procainamide - medication for irregular heart rhythms 

● Isoniazid - tuberculosis medication

Procainamide and hydralazine are reported to have the highest rate of causing DIL, with up to 30% of cases with procainamide. Some other drugs include all anti-TNF agents, statins, ace inhibitors, proton pump inhibitors, gold salts, non-steroidal anti-inflammatories (NSAIDs), oral contraceptives, and several others. The incidence is related to the population taking the medication. For instance, hydralazine-induced Lupus is more common in the elderly population. It is important to note that just because you take these medications doesn't necessarily mean you will develop the disease.

Clinical Manifestations And Symptoms Of Drug-Induced Lupus

The clinical manifestation and symptoms can vary for each person with DIL and can also depend on the specific drug that induced it.

Here are some common clinical manifestations and symptoms:

• Skin rash is the most common symptom
• Arthralgia (joint pain)
• Myalgia (muscle pain)
• Fever
• Weight Loss
• Sensitivity to light
• Pleuritis (inflammation of the lung pleura)

How Integrative Medicine Practitioners Diagnose Drug-Induced Lupus

The diagnosis of DIL involves excluding other autoimmune conditions and symptom resolution after removing medications. Skin biopsies may also be performed as skin rashes are a common symptom of DIL.

Here are some standard labs that integrative medicine practitioners use to help assess for DIL:

Antinuclear Antibody Evaluation (ANA)

A positive ANA will reveal autoantibodies that are present in autoimmune conditions. Most people with an autoimmune disorder will have a positive ANA, making this a prioritized test for autoimmune conditions.

Anti-Histone Antibodies

These antibodies show up in 75% of DIL cases. This test can help differentiate from other autoimmune conditions. However, it does also show up in people diagnosed with SLE.

Anti-dsDNA antibodies

Testing for these antibodies can help differentiate DIL from SLE. Anti-dsDNA is present in more than 50% of SLE and less than 5% of DIL.

Antineutrophil Cytoplasmic Antibodies (ANCA)

ANCA has been reported in DIL, which is induced by procainamide, a common drug associated with DIL. This test should be considered If a patient has been taking this medication and presents with Lupus-like symptoms.

Other Antibody Tests

These antibodies have also been reported rarely in DIL, and testing for these antibodies can help differentiate DIL from other autoimmune conditions. These antibodies include Sm/RNP antibodies, Scl-70, and Anti-Jo-1.

Functional Medicine Labs That Can Help Individualize Treatment for Patients With Drug-Induced Lupus

Here are some functional medicine labs considerations used to assess DIL and to help individualize treatments:

3X4 Genetics

Since there is a genetic component as a risk factor for developing DIL, it would be beneficial to do a genetic test to assess for various genes that may increase the risk. This genetic test analyzes over 134 genes associated with detoxification, inflammation, enzyme production, and immune regulation allowing. The results of this test can allow for individual risk assessments for DIL.

Environmental Toxins

This toxin screen can be beneficial as different toxins can exacerbate autoimmune conditions such as SLE. These various chemicals may also contribute to the onset of autoimmunity. Utilizing the results of this panel can provide some insights into avoidance strategies and proper management protocols for reducing autoimmune-related symptoms.

Markers of Inflammation

This comprehensive test analyzes the stool for microbial imbalances, markers of inflammation, digestion, and immune function. Chronic inflammation has been associated with exacerbating symptoms in autoimmune conditions such as SLE. Therefore, assessing for these inflammatory reactions can provide some insights into the management of SLE-like symptoms that are often produced in DIL.

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Integrating Conventional and Integrative Approaches

There are many prescription drugs that can contribute to the onset of DIL. Often these medications are prescribed by multiple practitioners. Therefore, collaboration between these practitioners is essential to provide the best care for the patient. With the prevalence of CIM therapies in treating diseases such as autoimmune conditions, complementary healthcare providers, such as functional medicine doctors, are frequently sought after to address these conditions. 

Since DIL has an autoimmune component and a drug component, it may be beneficial for these patients to work with both types of providers. Strategies may involve having the conventional provider assess the drugs that may be causing DIL and having them withdraw from those medications with a possible alternative prescription. At the same time, the complementary provider can work with the patient on integrative approaches to address the autoimmune symptoms, as it may take up to six months for symptoms to resolve after withdrawal of the medication.

Conventional Treatment for Drug-Induced Lupus

The conventional treatment for DIL is to recognize and discontinue the medication associated with the development of the condition. Conventional providers may sometimes offer NSAIDs for symptom relief or high-dose corticosteroids for severe symptoms such as pericardial effusion. DIL symptoms will usually resolve after the discontinuation of the drug.

Integrative and Complementary Approaches to Drug-Induced Lupus

Integrative and complementary approaches can be very helpful in managing the symptoms associated with DIL. Here are some of the top approaches:

Best Nutrition For Patients With Drug-Induced Lupus

The best nutritional plan for patients with DIL is the AIP diet. This autoimmune protocol diet's goal is to reduce inflammation and reduce toxin burden, all of which can benefit symptoms associated with DIL. This diet has three phases, remove, re-introduce, and maintain. In the elimination phase, inflammatory foods, such as grains, eggs, and dairy, are removed. During the re-introduction phase, foods that are the least likely to cause inflammation are incorporated into the diet to assess for inflammatory reactions such as itchy eyes, dizziness, or fatigue. Then once you get to the maintenance phase, you get to continue to eat the foods that did not cause a reaction and avoid the foods that did.

Supplements and Herbs For Patients With Drug-Induced Lupus

It is important to note that some herbs, such as alfalfa, echinacea, and melatonin, have caused lupus flares. Therefore, labels should be analyzed before recommending any herbal supplements and should have the lowest risk for adverse effects. Although DIL will resolve after discontinuation of the afflicting drug, these supplements are considered low risk and can be considered to help with DIL-related symptoms:

Omega-3

Dietary omega-3s have the potential to help symptoms associated with autoimmune conditions such as SLE. Omega-3s can improve disease activity and circulation and reduce oxidative stress at 3 grams daily.

Curcumin

Arthritic pain is often associated with Lupus-like symptoms in DIL. Curcumin was shown to be effective as an anti-inflammatory and an analgesic for joint pain. This supplement can be taken at 1 gram daily for analgesic effects.

Benefits And Potential Advantages Of An Integrative Approach In Drug-Induced Lupus Treatment

Since integrative medicine utilizes various approaches, such as nutrition, supplementation, and lifestyle changes for health conditions, this approach can be beneficial in addressing DIL. DIL has varying symptoms that can last for some time, even after discontinuing the drug. Nutritional strategies such as the AIP diet and supplements such as curcumin can help manage the inflammation often associated with Lupus-like symptoms. There are also multiple benefits to lifestyle modification, such as low-impact physical activity. Movement can strengthen various body parts associated with Lupus-like symptoms, including the heart, lungs, and joints. It can also improve mental well-being to make it easier to cope with this condition.

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Summary

Forty-one million people are affected by Lupus each year, up to 12% of which are drug-induced, leading to DIL. DIL presents with symptoms similar to Lupus, such as joint pain, muscle pain, and skin rashes, making it difficult to diagnose. Integrating conventional and complementary approaches may be beneficial in this case. Conventional doctors can assess for the medications involved, while integrative practitioners can address the symptoms associated with this condition. Once the drug is identified and discontinued, symptoms will resolve. However, this collaborative practitioner approach can offer well-rounded care to patients coping with DIL and waiting for their symptoms to clear.