Lupus is an inflammatory autoimmune condition that affects multiple organ systems. Each patient experiences a slightly different variation of disease. The most common lupus diagnosis is systemic lupus erythematosus, which is often simply called lupus.
While the cause of lupus in a patient is often unknown, it is possible a combination of genetics and the environment may predispose an individual to lupus. Triggers that initiate symptoms range from sunlight to infection and even medication. As a matter of fact, a subset of lupus that accounts for 10 to 15 percent of SLE cases is known as “drug-induced lupus” and is triggered specifically by medication.
Systemic Lupus Erythematosus (SLE)
There may be a genetic component to the development of SLE, as some patients tend to have a family history of lupus. Many studies have identified specific genes that are mutated or differentially expressed in patients with SLE. However, there is a low degree of overlap among patients’ genes. There are no mutated genes that are expressed by all lupus patients. Fewer than half of lupus cases can be explained by genetic variations.
Everyday environmental exposures may also contribute to the development of SLE. Sunlight and ultraviolet (UV) light exposure is a common trigger for SLE. Patients with SLE tend to have greater photosensitivity, or greater skin sensitivity to the sun. When photosensitive patients are exposed to the sun, UV light easily penetrates their skin. UV light is damaging to skin cells and induces cell death, or apoptosis; sunburns are particularly damaging and cause massive skin cell apoptosis.
Researchers have found that cell death is slower in patients with SLE, which means dying cells remain in the body for a longer time and elevate immune responses during that time. The initiated inflammatory response results in a rash.
Another environmental trigger is infection. Viruses and other pathogens live on the human body and are constantly entering the body. Under normal homeostatic conditions, cells in the body are able to recognize pathogenic invaders using surface proteins called “toll-like receptors” (TLRs). In patients with lupus, genetic mutations in TLRs can prevent normal cell signaling pathways to be initiated, leading to autoimmune reactions and inflammation.
Drug-induced Lupus (DIL)
Many seemingly unrelated medications can trigger lupus-like side effects. More than 90 drugs have been reported to cause DIL, many developed in the last decade during an increase in drug classes that inhibit proteins involved in immunity. When certain phases of the immune system are altered or blocked completely, changes in patients’ health can take place. The most common symptoms of DIL are fever and musculoskeletal pain. These symptoms typically appear within a month of starting drug treatment and usually disappear within a month of halting treatment.
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