Guest guest Posted February 25, 2003 Report Share Posted February 25, 2003 on 2/25/03 1:59 PM, , at higgy59@..., wrote: > I would like to see the totals > before I would be concerned. Obviously you should be aware, but don't obsess > over it. I think that is exactly right, . Besides Remicade, and other biologics, sulfasalazine was also mentioned in the various reports. Personally, I have far fewer side effects from minocycline, and much more success, than with any other antirheumatic drug I've tried, including NSAIDS. When friends with lupus ask abut the treatment, I tell them both The New Arthritis Breakthrough and rheumatic.org recommend erythromycin for lupus. If I had lupus and had been using mino with no problems, I probably wouldn't change because of this information. -- Jean jpro2@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2003 Report Share Posted February 25, 2003 Hi Jean You wrote: >The reactions described really don't fit the definition of a >Herxheimer reaction, which occurs when the antibiotic is first >introduced, or when the dosage is increased. The lupus like >syndrome appears to happen after weeks or months or years of >uneventful use of the antibiotic, or other unrelated drugs which >can also cause drug induced lupus. The report stated that: >Five patients who got better after stopping minocycline developed a >recurrence of symptoms within hours of resuming the antibiotic and >consuming a single 100-mg tablet of minocycline. In 7 subjects, the >symptoms of malaise and joint pains developed within 12 hours of >taking a single dose of minocycline, and were free of symptoms >after 2 weeks. Incidentally, my own doctor has personally seen Lupus Like Syndrome in several of his patients treated for acne with Minocin. He actually referred to it as 'drug induced Lupus'. Two of his patients developed the symptoms almost immediately the drug was introduced, which is why he refused to prescribe for me as he felt the risk was too high. Fortunately my rheumie authorised him to prescribe. Although my doctor has his doubts, he did concede that without prior testing he had no way of knowing if those patients affected had pre existing antibodies. Lindy > > > Reading the reports on 'Drug Induced Lupus Like Syndrome' in > > patients treated with Minocin for acne, it makes me question whether > > Mycoplasma are actually responsible for the acne. The symptoms of > > the 'Lupus Like Syndrome' appear to accurately resemble a Herxheimer > > reaction brought on by toxins produced by Mycoplasma die-off. > >> -- > Jean > jpro2@s... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2003 Report Share Posted February 25, 2003 on 2/25/03 2:22 PM, purpleoranges2002 <melinda159@...>, at melinda159@..., wrote: > Hi Jean > > You wrote: > >> The reactions described really don't fit the definition of a >> Herxheimer reaction, which occurs when the antibiotic is first >> introduced, or when the dosage is increased. The lupus like >> syndrome appears to happen after weeks or months or years of >> uneventful use of the antibiotic, or other unrelated drugs which >> can also cause drug induced lupus. Yes, that's correct. > The report stated that: > >> Five patients who got better after stopping minocycline developed a >> recurrence of symptoms within hours of resuming the antibiotic and >> consuming a single 100-mg tablet of minocycline. In 7 subjects, the >> symptoms of malaise and joint pains developed within 12 hours of >> taking a single dose of minocycline, and were free of symptoms >> after 2 weeks. This is correct. Please note they are speaking of _resuming_ the antibiotic after the initial lupus like syndrome had presented and abated. If I reintroduce any drug I'm allergic to, the allergy symptoms resume in a matter of minutes to hours. It doesn't follow that this is a herx, or is anything new at all. Once sensitized, a reintroduction of the drug brings about rapid recurrence. This seems to hold true for drug induced lupus, similarly to drug allergy. The report from the Journal of Rheumatology http://www.jrheum.com/abstracts/abstracts01/1004.html says " " Minocycline had been prescribed for a mean of 25 months for the 20 patients identified with drug-induced lupus " What that means is statistically, something along the lines of an average amount of time the drug was used before onset of the drug induced lupus symptoms appeared was 25 months. That is what I am referring to when I said the cases reported didn't begin for weeks or months or years after the drug was introduced: 25 months was the mean onset time. > Incidentally, my own doctor has personally seen Lupus Like Syndrome > in several of his patients treated for acne with Minocin. He > actually referred to it as 'drug induced Lupus'. Two of his > patients developed the symptoms almost immediately the drug was > introduced, which is why he refused to prescribe for me as he felt > the risk was too high. Fortunately my rheumie authorised him to > prescribe. Although my doctor has his doubts, he did concede that > without prior testing he had no way of knowing if those patients > affected had pre existing antibodies. Certainly, onset time will vary. In the several studies I read, it varied from a short amount of time to several years. I wouldn't dispute that it can occasionally begin very early on. For someone with a pre-existing rheumatic disease for whom the reaction begins almost immediately, this might well be a herx rather than drug-induced lupus. I wouldn't be able to tell you from my vantage point. That's what we need good AP doctors for. -- Jean jpro2@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2003 Report Share Posted February 26, 2003 Hi Jean You wrote: >I wouldn't dispute that it can occasionally begin very early on. >For someone with a pre-existing rheumatic disease for whom the >reaction begins almost immediately, this might well be a herx >rather than drug-induced lupus. Which is the point I made... Mycoplasma die-off could be causing a Herx in these individuals rather than 'Lupus Like Syndrome'. Whatever the disease, whether it be RA, PA, Scleroderma etc, Mycoplasma is the antigen believed to stimulate our immune system to attack. I was simply debating whether or not Mycoplasma could be responsible for causing Acne. Lindy > > > >> The reactions described really don't fit the definition of a > >> Herxheimer reaction, which occurs when the antibiotic is first > >> introduced, or when the dosage is increased. The lupus like > >> syndrome appears to happen after weeks or months or years of > >> uneventful use of the antibiotic, or other unrelated drugs which > >> can also cause drug induced lupus. > > Yes, that's correct. > > > The report stated that: > > > >> Five patients who got better after stopping minocycline developed a > >> recurrence of symptoms within hours of resuming the antibiotic and > >> consuming a single 100-mg tablet of minocycline. In 7 subjects, the > >> symptoms of malaise and joint pains developed within 12 hours of > >> taking a single dose of minocycline, and were free of symptoms > >> after 2 weeks. > > This is correct. Please note they are speaking of _resuming_ the antibiotic > after the initial lupus like syndrome had presented and abated. If I > reintroduce any drug I'm allergic to, the allergy symptoms resume in a > matter of minutes to hours. It doesn't follow that this is a herx, or is > anything new at all. Once sensitized, a reintroduction of the drug brings > about rapid recurrence. This seems to hold true for drug induced lupus, > similarly to drug allergy. > > The report from the Journal of Rheumatology > http://www.jrheum.com/abstracts/abstracts01/1004.html says " > > > " Minocycline had been prescribed for a mean of 25 months for > the 20 patients identified with drug-induced lupus " > > What that means is statistically, something along the lines of an average > amount of time the drug was used before onset of the drug induced lupus > symptoms appeared was 25 months. That is what I am referring to when I said > the cases reported didn't begin for weeks or months or years after the drug > was introduced: 25 months was the mean onset time. > > > Incidentally, my own doctor has personally seen Lupus Like Syndrome > > in several of his patients treated for acne with Minocin. He > > actually referred to it as 'drug induced Lupus'. Two of his > > patients developed the symptoms almost immediately the drug was > > introduced, which is why he refused to prescribe for me as he felt > > the risk was too high. Fortunately my rheumie authorised him to > > prescribe. Although my doctor has his doubts, he did concede that > > without prior testing he had no way of knowing if those patients > > affected had pre existing antibodies. > > Certainly, onset time will vary. In the several studies I read, it varied > from a short amount of time to several years. I wouldn't dispute that it can > occasionally begin very early on. For someone with a pre-existing rheumatic > disease for whom the reaction begins almost immediately, this might well be > a herx rather than drug-induced lupus. I wouldn't be able to tell you from > my vantage point. That's what we need good AP doctors for. > > -- > Jean > jpro2@s... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2003 Report Share Posted February 26, 2003 Hi socjog, My point in posting was only to further our knowledge about this topic. I am a newbie (3 .5 months on AP) and I have not been dissuaded at all the antibiotic protocol by reading this information. (The AP offers real hope where other options are depressing). If anything is dissuading me it is the sometimes argumentative and dogmatic tone of the dialogue on this site. Mostly, I found the dialogue on the topic of lupus to be very interesting. I ignored the hair-splitting and tried to focus on the substance of the debate. I certainly want to be aware of all side effects of all drugs I'm taking in case I experience one of those side effects, even if they may be rare. Since the symptoms of drug induced lupus closely resemble RA and PA, this is especially inportant to me. Also, I have been trying to decide on whether to go with doxy or mino. Dr. Merkin had some useful info that is helping me make the decision (i.e., his view is that mino is more effective, but has a higher risk of side effects, including drug induced lupus). I thought others (especially newbies) trying to make that decision might find Dr. Mirkins info useful. Also, I posted info from medical sites written by doctors, since many of the conflicting opinions were not explicitly referenced, I thought that medical opinions might be valued by some. Sharon > Hi Sjssis an Ginger , > You know we are beating a dead horse here . I personally think you made your point I made mine now lets move on . By continuing to post info regarding MIL /DIL this is extremely misleading and can be frightening to newbies . I dont believe this was your intent !! > This is NOT an issue for us with auto immune disease .I think you guys are missing the point that I and others were trying to make . These patients are NOT auto immune patients but rather teenagers undiagnosed prior to any treatment they received for acne . In the literature you both shared it states it is SO rare . So maybe it is not my place here but Im going to say it anyway ENOUGH its ridiculous to beat a dead horse here and I think your both doing the board a disservice by posting lengthy arguments about teenagers with acne and this RARE occurrence . > Most of us with auto immune disease have more issues with YEAST which is listed as the number one side effect and is also easily treated . They dont even list this rare occurrence in the side effects of most drug related books . Could we just move on here . > You already dissuaded Pris . Its great to have knowledge of this rare possibility but this is just an overwhelming amount of info which doesn't pertain to us . If you wanted to make us aware of the rare reaction you most definitely have done that but do you think it is good to dissuade others from a treatment option that most of us here are using successfully . BTW they still use this minocycline drug as the NUMBER 1 choice in treating acne because the occurrences are so rare LOL!!! > BTW are either of you on antibiotic therapy ??? Warm regards, > socjog ( paragraphs put in for those with difficulty reading an all white blurb ) > > From: " sjssjs0000 <sjssjs00@h...> " <sjssjs00@h...> > Subject: minocycline induced lupus > > Thanks to all who answered question about Minocycline induced Lupus > (or " lupus-like " condition) . Since there were conflicting answers > I decided to do some research to see if I could find any recent > studies on the topic in the context of rheumatic diseases (i.e., not > just acne). Here are a couple that that shed a bit of light. > You'll notice that many of the lupus symptoms described below > resemble a bad RA or PA flare. Also, in the studies the minocycline > induced lupus cases resolved eventually, although some cases took up > to 2 years and a few required treatment with steroids: > > > From the periodical " Rheumatology " 2001; 40: 329-335: > Minocycline-Induced Lupus ( http://www.nanay.com/MEDICAL% > 20NEWS/English%20Edition/March-April%202001/Minocycline%20and% > 20Lupus.htm ) : > > Minocycline is an antibiotic that is widely prescribe for the long- > term treatment of " acne vulgaris " (or extensive pimples especially > among teenagers), It is also used for rheumatoid arthritis. Common > side effects associated with minocycline are nausea, vomiting, skin > rashes, dizziness, increased sensitivity to light, and more rarely, > toxic effects on the liver and inflammation in the lungs > (pneumonitis). Approximately 57 cases of lupus have also been > reported, mostly from Europe. This report describes the clinical > features in patients who develop lupus as a complication of > minocyclin. > > The patients were seen between 1994 and 2000, and were diagnosed to > have minocycline-induced lupus based on the association of symptoms > with long-term use of minocycline, a positive laboratory test for > antinuclear antibodies (ANA), and the resolution of symptoms after > cessation of minocycline therapy. > > A wide spectrum of symptoms were observed in 23 patients and > consisted of polyarthralgia (multiple joint pains), malaise > (generalized discomfort), early morning stiffness, fever, > inflammation of the smaller joints (wrists and fingers), increased > fluid in the knees, inflammation of the skin vessels, hair loss, > weight loss, jaundice (yellow discoloration of skin and sclera or > white part of the eye), mouth ulcers, and mental impairment. These > were associated with abnormal laboratory findings such as anemia > (low blood count), abnormal liver enzyme levels, and presence of > anti-nuclear antibodies. Discontinuation of minocycline use resulted > in the resolution of symptoms and signs in all cases. Ten subjects > became symptom-free within one month, while others took up to 2 > years to get better. Four patients with severe disease required > treatment with steroids. > > Five patients who got better after stopping minocycline developed a > recurrence of symptoms within hours of resuming the antibiotic and > consuming a single 100-mg tablet of minocycline. In 7 subjects, the > symptoms of malaise and joint pains developed within 12 hours of > taking a single dose of minocycline, and were free of symptoms after > 2 weeks. > > The investigators advice clinicians to be aware of the association > between minocycline and the development of lupus-like illness, > particularly among patients with rheumatoid arthritis, in whom the > diagnosis could be easily overlooked. > (Lawson TM, Amos N, Bulgen D, BD. Minocycline-induced > lupus: clinical features and response to rechallenge. Rheumatology > 2001; 40: 329-335.) > > > From the " Journal of Rheumatology " ( > http://www.jrheum.com/abstracts/abstracts01/1004.html ): > > Minocycline Induced Lupus: Case Series in the West of Scotland > MARGARET-MARY GORDON and DUNCAN PORTER > ABSTRACT. > > Objective. To describe the clinical symptoms and serology of drug- > induced lupus in patients treated with the semisynthetic > tetracycline derivative, minocycline. > > Methods. For a 5-year period, all consultant rheumatologists and > dermatologists in the West of Scotland were asked to report any > suspected cases of a lupus-like syndrome to one center. Twenty cases > were identified on the basis of arthritis, positive antinuclear > factor and at least one other extraarticular feature following > treatment for acne with minocycline. Case histories were reviewed to > determine any demographic, clinical, or serological correlations. > 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 with a mean age of 24 years. All patients had arthritis > and most had at least one other extraarticular feature including > lethargy, myalgia, fevers, Raynaud's phenomenon, abdominal pain, and > butterfly rash. None had renal involvement. 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 > increasingly in the treatment of rheumatic diseases. Although the > absolute risk of developing drug-induced lupus is relatively low, it > has been estimated that current use of minocycline is associated > with an 8.5 fold increased risk of developing a lupus-like syndrome. > Prescribing physicians must be vigilant for any of the > characteristic symptoms to avoid unnecessary morbidity, > investigations, and therapy. > > (J Rheumatol 2001;28:1004-6) > Key Indexing Terms: > MINOCYCLINE > DRUG INDUCED LUPUS > CLINICAL OUTCOME > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2003 Report Share Posted February 26, 2003 Hi Sharon, Thank you for that wonderful information and l agree with you completely. Yes socjog l am on AP therapy and have been for several years. Ginger minocycline induced lupus > > > > Thanks to all who answered question about Minocycline induced > Lupus > > (or " lupus-like " condition) . Since there were conflicting > answers > > I decided to do some research to see if I could find any recent > > studies on the topic in the context of rheumatic diseases (i.e., > not > > just acne). Here are a couple that that shed a bit of light. > > You'll notice that many of the lupus symptoms described below > > resemble a bad RA or PA flare. Also, in the studies the > minocycline > > induced lupus cases resolved eventually, although some cases took > up > > to 2 years and a few required treatment with steroids: > > > > > > From the periodical " Rheumatology " 2001; 40: 329-335: > > Minocycline-Induced Lupus ( http://www.nanay.com/MEDICAL% > > 20NEWS/English%20Edition/March-April%202001/Minocycline%20and% > > 20Lupus.htm ) : > > > > Minocycline is an antibiotic that is widely prescribe for the long- > > term treatment of " acne vulgaris " (or extensive pimples especially > > among teenagers), It is also used for rheumatoid arthritis. Common > > side effects associated with minocycline are nausea, vomiting, > skin > > rashes, dizziness, increased sensitivity to light, and more > rarely, > > toxic effects on the liver and inflammation in the lungs > > (pneumonitis). Approximately 57 cases of lupus have also been > > reported, mostly from Europe. This report describes the clinical > > features in patients who develop lupus as a complication of > > minocyclin. > > > > The patients were seen between 1994 and 2000, and were diagnosed > to > > have minocycline-induced lupus based on the association of > symptoms > > with long-term use of minocycline, a positive laboratory test for > > antinuclear antibodies (ANA), and the resolution of symptoms after > > cessation of minocycline therapy. > > > > A wide spectrum of symptoms were observed in 23 patients and > > consisted of polyarthralgia (multiple joint pains), malaise > > (generalized discomfort), early morning stiffness, fever, > > inflammation of the smaller joints (wrists and fingers), increased > > fluid in the knees, inflammation of the skin vessels, hair loss, > > weight loss, jaundice (yellow discoloration of skin and sclera or > > white part of the eye), mouth ulcers, and mental impairment. These > > were associated with abnormal laboratory findings such as anemia > > (low blood count), abnormal liver enzyme levels, and presence of > > anti-nuclear antibodies. Discontinuation of minocycline use > resulted > > in the resolution of symptoms and signs in all cases. Ten subjects > > became symptom-free within one month, while others took up to 2 > > years to get better. Four patients with severe disease required > > treatment with steroids. > > > > Five patients who got better after stopping minocycline developed > a > > recurrence of symptoms within hours of resuming the antibiotic and > > consuming a single 100-mg tablet of minocycline. In 7 subjects, > the > > symptoms of malaise and joint pains developed within 12 hours of > > taking a single dose of minocycline, and were free of symptoms > after > > 2 weeks. > > > > The investigators advice clinicians to be aware of the association > > between minocycline and the development of lupus-like illness, > > particularly among patients with rheumatoid arthritis, in whom the > > diagnosis could be easily overlooked. > > (Lawson TM, Amos N, Bulgen D, BD. Minocycline-induced > > lupus: clinical features and response to rechallenge. Rheumatology > > 2001; 40: 329-335.) > > > > > > From the " Journal of Rheumatology " ( > > http://www.jrheum.com/abstracts/abstracts01/1004.html ): > > > > Minocycline Induced Lupus: Case Series in the West of Scotland > > MARGARET-MARY GORDON and DUNCAN PORTER > > ABSTRACT. > > > > Objective. To describe the clinical symptoms and serology of drug- > > induced lupus in patients treated with the semisynthetic > > tetracycline derivative, minocycline. > > > > Methods. For a 5-year period, all consultant rheumatologists and > > dermatologists in the West of Scotland were asked to report any > > suspected cases of a lupus-like syndrome to one center. Twenty > cases > > were identified on the basis of arthritis, positive antinuclear > > factor and at least one other extraarticular feature following > > treatment for acne with minocycline. Case histories were reviewed > to > > determine any demographic, clinical, or serological correlations. > > 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 with a mean age of 24 years. All patients had > arthritis > > and most had at least one other extraarticular feature including > > lethargy, myalgia, fevers, Raynaud's phenomenon, abdominal pain, > and > > butterfly rash. None had renal involvement. 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 > > increasingly in the treatment of rheumatic diseases. Although the > > absolute risk of developing drug-induced lupus is relatively low, > it > > has been estimated that current use of minocycline is associated > > with an 8.5 fold increased risk of developing a lupus-like > syndrome. > > Prescribing physicians must be vigilant for any of the > > characteristic symptoms to avoid unnecessary morbidity, > > investigations, and therapy. > > > > (J Rheumatol 2001;28:1004-6) > > Key Indexing Terms: > > MINOCYCLINE > > DRUG INDUCED LUPUS > > CLINICAL OUTCOME > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2003 Report Share Posted February 27, 2003 Also, I > posted info from medical sites written by doctors, since many of the > conflicting opinions were not explicitly referenced, I thought that > medical opinions might be valued by some. > > Sharon > > Sharon, I strongly agree with this point. We need facts and medical references. You can't take someone else's opinion to a doctor with you and expect to be heard. (RA 25+ years, AP since Nov. 97) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2006 Report Share Posted December 19, 2006 Hi Maggy, Here's a couple abstracts of lupus and minocycline. It looks like you just need to keep an eye on your ANA, liver function tests etc., as well as any new symptoms. Hope this helps, Emma Minocycline-induced lupus erythematodes] [Article in German] Egger SS, Studer IG, Ratz Bravo AE, Krahenbuhl S. Klinische Pharmakologie & Toxikologie, regionales Pharmacovigilance-Zentrum, Universitatsspital, Basel. eggers@... We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies. PMID: 16970139 [PubMed - indexed for MEDLINE] Minocycline-induced lupus. A systematic review. Schlienger RG, Bircher AJ, Meier CR. Division of Clinical Pharmacology, University Hospital, Basel, Switzerland. rschlienger@... BACKGROUND: Minocycline has increasingly been associated with different adverse auto-immune reactions including drug-induced lupus. Objective: To identify the scope of minocycline-induced lupus and to characterise its typical features. METHODS: Comprehensive Medline and Embase search of the English and non-English literature for case reports of minocycline-induced lupus. RESULTS: We included 57 cases of minocycline-induced lupus (mean age +/- SD at onset: 21.6+/-8.6 years, median time of exposure: 19 months, range 3 days to 6 years). All patients showed the clinical features of polyarthralgia/polyarthritis often accompanied by liver abnormalities. Twelve patients had evidence of dermatological manifestations (i.e rash, livedo reticularis, oral ulceration, subcutaneous nodules, alopecia). The ANA test was positive in all patients. CONCLUSION: Long-term exposure to minocycline may be associated with drug-induced lupus. Baseline and periodic liver function and ANA tests accompanied by appropriate clinical monitoring are suggested for patients receiving long-term minocycline therapy. Copyright 2000 S. Karger AG, Basel. PMID: 10828631 [PubMed - indexed for MEDLINE] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2006 Report Share Posted December 19, 2006 Yes, this is helpful. My ANA is always positive even before starting AP but so far liver function has always been fine. Thanks, Maggy rheumatic minocycline induced lupus Hi Maggy, Here's a couple abstracts of lupus and minocycline. It looks like you just need to keep an eye on your ANA, liver function tests etc., as well as any new symptoms. Hope this helps, Emma . Quote Link to comment Share on other sites More sharing options...
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