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What Causes Lupus?

Updated on August 09, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kelly Crumrin
Article written by
Amanda Jacot, PharmD

The cause of lupus is unknown. Scientists have proven that lupus is autoimmune in origin. In other words, the damage in lupus is caused by the body’s immune system attacking its own tissues. However, researchers have not yet solved the puzzle of why this process begins.

Although researchers have established links between certain factors and a person’s risk for developing lupus, none have identified why some people get lupus and some don’t. Most scientists believe the condition is most likely caused by a combination of hereditary, hormonal, and environmental factors.

Risk Factors

Scientists have identified many risk factors for lupus and continue to study them, but they haven’t pinpointed any as the cause of the condition. It is important to note that while science is good at finding correlations, or apparent relationships, between factors and disease, correlation does not prove that the factor causes the disease.

Although the cause of lupus is unknown, certain factors may increase a person’s risk of developing the disease.

  • Gender — Women are more likely than men to develop lupus, according to the Centers for Disease Control and Prevention (CDC). The Lupus Foundation of America notes that 90 percent of people living with lupus are women.
  • Age — Most people are diagnosed with lupus between the ages of 15 and 45.
  • Race and ethnicity — Researchers have found that lupus is more prevalent among nonwhite people than white people.
  • Family history — People with relatives living with lupus are more likely to develop the disease themselves.

Hereditary Factors

Scientists have identified more than 100 genetic variants involved in the body’s immune response that are more prevalent in people living with lupus. Still, more research is needed to understand how inherited genes can make a person more susceptible to the condition.

Although many genes are involved in a person’s risk of developing lupus, the condition doesn’t appear to be directly inherited from one’s parents in any clear genetic pattern. Studies show that the relatives of people with lupus have a higher chance of developing the disease themselves.

In the U.S., the prevalence of lupus is between 0.05 percent and 0.1 percent. However, if a person has a first-degree relative (like a parent, sibling, or child) with the disease, the risk is 17 times higher. In identical twins, if one twin is diagnosed with lupus, the chances of the other twin developing the condition is between 24 percent and 40 percent, according to Frontiers in Immunology .

A person’s risk for lupus also increases if one or more of their family members have other autoimmune diseases, such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, or multiple sclerosis.

Race and ethnicity also influences a person’s risk of developing lupus. According to the Lupus Foundation of America, “Lupus is more common in people of color than in the Caucasian population. This includes African Americans, Hispanics/Latinos, Asian Americans, Native Americans, Native Hawaiians, and Pacific Islanders.”

A 2016 study from Arthritis Rheumatology found that Black women were more than three times as likely to be diagnosed with lupus than white women. In addition to being more likely to develop the disease, people of different racial and ethnic groups may experience symptoms differently.

Hormonal Factors

Lupus affects women more than men. Women are nine times more likely than men to develop lupus, according to the National Resource Center on Lupus. In general, autoimmune diseases affect women at much higher proportions than men. According to Nature Reviews Immunology, “80 percent of autoimmune disease occurs in females.” Women’s immune systems are believed to be more effective than men’s, giving women greater protection from infections but making them more vulnerable to autoimmune disorders.

Hormones such as estrogen, which women produce in a much higher proportion than men, may also influence the risk of developing lupus. In many women, lupus tends to flare during menstruation and pregnancy, when hormone levels are highest.

Environmental Factors

Researchers have identified many environmental triggers linked to the development of lupus.

Viral Infection

Scientists have investigated specific viruses for links with systemic lupus erythematosus (SLE), the most common type of lupus that affects many organs.

Several studies have found an association between people who have had mononucleosis (or “mono”). This disease is caused by the Epstein-Barr virus (EBV). The thought is that EBV can trigger the immune system to make proteins called autoantibodies that cause inflammation. A 2017 study found that more than two-thirds of people with lupus also had EBV.

Other viruses can pave the way for developing lupus by causing genetic changes in some people. These viruses include herpes zoster (responsible for chickenpox and shingles) and cytomegalovirus.

Medication

Certain medications have been associated with drug-induced lupus — a form of the condition caused by specific prescription medications. The medications that cause drug-induced lupus are usually used to treat chronic conditions, meaning people generally take them over a long period of time.

In general, the symptoms of drug-induced lupus are not as severe as SLE. The symptoms are distinct from other side effects of the medication and usually go away shortly after the medication is stopped.

The most common medications associated with drug-induced lupus are:

  • Procainamide, used to treat irregular heartbeat
  • Hydralazine, used to treat high blood pressure
  • Quinidine, used to treat irregular heartbeat

Exposure to Ultraviolet Light

Exposure to ultraviolet (UV) light (e.g., sunlight, fluorescent lights, tanning beds) is known to trigger lupus flare-ups in many people. Scientists theorize that ultraviolet light can trigger an inflammatory response in some people. Exposure to higher ultraviolet light is associated with a higher risk of developing SLE. Certain antibiotics increase photosensitivity (sensitivity to light) and may increase the risk of developing lupus as well.

Stress

Physical and emotional stress are well-known flare triggers that some researchers believe encourage lupus to develop. Many people experience their first lupus symptoms after stressful events such as:

  • Traumatic injury
  • Giving birth
  • Death of a loved one
  • Divorce
  • Surgery

Exposure to Toxins

Scientists suspect a variety of toxins may trigger development of lupus. These include:

  • Silica dust (a compound found in quartz rock and a common byproduct of many industries)
  • Pesticides
  • Cigarette smoke
  • Mercury

Prevention

There is no way to prevent lupus, but if you are aware of your personal risk factors, you may be able to avoid triggers.

You can take these steps to avoid triggers:

  • Limit your time in direct sunlight and wear sunscreen
  • Quit smoking
  • Manage stress

Watch for common symptoms of lupus such as fatigue, joint pain, or a butterfly-shaped rash on the face. A doctor specializing in diseases that affect muscles, joints, and bones — called a rheumatologist — can help make an early diagnosis using your medical history, blood tests, and imaging. You and your doctor will develop a treatment plan to help avoid complications of lupus, like damage to internal organs, lupus nephritis, and osteoporosis.

Condition Guide

References
  1. Lupus Basics — Centers for Disease Control and Prevention
  2. Autoimmune Diseases — MedlinePlus
  3. Lupus Risk Factors — Johns Hopkins Medicine
  4. Lupus in Women — Centers for Disease Control and Prevention
  5. Lupus Facts and Statistics — Lupus Foundation of America
  6. Understanding the Epidemiology and Progression of Systemic Lupus Erythematosus — Seminars in Arthritis and Rheumatism
  7. Population-Based Incidence and Prevalence of Systemic Lupus Erythematosus — Arthritis & Rheumatology
  8. Family History of Systemic Lupus Erythematosus and Risk of Autoimmune Disease: Nationwide Cohort Study in Denmark 1977-2013 — Rheumatology
  9. Environmental Factors, Toxicants, and Systemic Lupus Erythematosus — International Journal of Molecular Sciences
  10. Association of Viral Infection With the Development and Pathogenesis of Systemic Lupus Erythematosus — Frontiers in Medicine
  11. Epstein Barr Virus and Autoimmune Responses in Systemic Lupus Erythematosus — Frontiers in Immunology
  12. Correlation Between Epstein-Barr Virus Infection and Disease Activity of Systemic Lupus Erythematosus: A Cross-Sectional Study — Asian Pacific Journal of Cancer Prevention
  13. Viruses and Autoimmunity: A Review on the Potential Interaction and Molecular Mechanisms — Viruses
  14. Drug-Induced Lupus Erythematosus: An Update on Drugs and Mechanisms — Current Opinion in Rheumatology
  15. Medications That Can Cause Drug-Induced Lupus — Lupus Foundation of America
  16. Procainamide — MedlinePlus
  17. Hydralazine — MedlinePlus
  18. Quinidine — MedlinePlus
  19. UV Exposure: What You Need To Know — Lupus Foundation of America
  20. Acute Skin Exposure to Ultraviolet Light Triggers Neutrophil-Mediated Kidney Inflammation — PNAS
  21. Association of Ultraviolet-B Radiation and Risk of SLE Among Women in the Nurses’ Health Studies — Arthritis Care & Research
  22. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women — Arthritis & Rheumatology
  23. Silica-Associated Systemic Lupus Erythematosus With Lupus Nephritis and Lupus Pneumonitis: A Case Report and a Systematic Review of the Literature — Medicine
  24. Pesticides, Chemical, and Industrial Exposures in Relation to Systemic Lupus Erythematosus — Lupus
  25. Cigarette Smoking and the Risk of Systemic Lupus Erythematosus and Rheumatoid Arthritis — Annals of Rheumatic Disease
  26. Mercury in Hair Is Inversely Related to Disease Associated Damage in Systemic Lupus Erythematosus — International Journal of Environmental Research and Public Health
  27. Genetic Factors Predisposing to Systemic Lupus Erythematosus and Lupus Nephritis — Seminars in Nephrology
  28. Understanding the Genetics of Lupus — Lupus Foundation of America
  29. Familial Lupus Erythematosus: Clinical and Immunologic Features of 125 Multiplex Families — Medicine
  30. A Revised Estimate of Twin Concordance in Systemic Lupus Erythematosus — Arthritis & Rheumatism
  31. The Incidence and Prevalence of Systemic Lupus Erythematosus, 2002-2004: The Georgia Lupus Registry — Arthritis & Rheumatology
  32. What Role Do Sex and Gender Play in Lupus? — Lupus Foundation of America
  33. Sex Differences in Immune Responses — Nature Reviews Immunology
  34. Can Hormones Trigger the Development of Lupus? — Lupus Foundation of America
  35. Screening Characteristics for Enrichment of Individuals at Higher Risk for Transitioning to Classified SLE — Lupus
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

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