Environmental Factors Contribute to Lupus Development and Progression, Review Suggests

Environmental factors, including UV light and air pollution, can significantly contribute to the development or progression of systemic lupus erythematosus (SLE), according to a new review.

The review, titled “Environmental triggers in systemic lupus erythematosus,” was led by Dr. Gaurav Gulati, MD, a physician-researcher at the University of Cincinnati College of Medicine, and published in the journal Seminar in Arthritis and Rheumatism.

Patients with lupus tend to have diverse symptoms as well as a varied disease course. While extensive research has identified genetic factors that may be associated with lupus, they are not enough to explain the great variation in terms of disease manifestations, age of onset, and progression of the disease.

In fact, studies have shown that only 24 percent of twins both develop lupus, indicating there is more than genetics to account for the disease.

As a result, there has been a lot of interest in the research community to look beyond genetics, particularly at the environment and the epigenome — or which genes are turned on or off. The environment can affect the genome and the epigenome.

To find out more information on the environment’s contribution to lupus, researchers conducted an extensive review of currently existing literature that addressed the role of environmental factors in lupus development.

One of the environmental contributors is ultraviolet radiation, as the sun’s UV rays can have damaging effects on the skin. Air pollution, such as diesel exhaust from vehicles, may also play a role in the development of lupus.

The researchers also discussed the role of trace elements, such as heavy metals, in lupus development. Animal studies have indicated that uranium, lead, and cadmium can lead to autoimmune disease. And lupus tends to occur more frequently in dental workers and other people exposed to mercury, indicating that mercury could also contribute to lupus.

The authors also show that women of reproductive age have a high prevalence of the disease, because women who take oral contraceptives are more likely to develop lupus. Also, compounds such as bisphenol A (BPA), which is used to make certain types of plastics and resins and is considered an environmental pollutant, can also be a trigger for lupus.

The authors concluded that these environmental factors can lead to epigenetic changes in individuals, leading to certain genes being turned on or off, which is likely to contribute to the development and progression of lupus.

To lessen the environmental factors that can trigger lupus symptoms, Gulati offers some suggestions in a press release. He suggests patients stay away from direct sunlight as much as possible and use sunscreen to avoid UV radiation, and to stop smoking because cigarettes contain multiple compounds that can worsen lupus manifestations.