How do you approach the continued use of TNF inhibitors in a patient with inflammatory arthritis who develops a positive dsDNA without clinical evidence of drug-induced lupus?

This is a good question and more common than we think. Most of us are not routinely drawing dsDNA ab when the patient does not have symptoms; some reviews suggest up to 29% (see review below). I have seen this, however, and continued medication with monitoring (following dsDNA ab levels with C3 and ...

In the absence of clinical evidence of more than RA, something to suggest evolution into lupus or a “lupus-like syndrome” I would not abandon successful treatment of RA by TNF blockade based on such new serological findings. As noted previously, I would monitor closely and change in the face of anyt...