Environment and lupus-related diseases

  1. G Zandman-Goddard1,2
  2. M Solomon2,3
  3. Z Rosman1
  4. E Peeva4
  5. Y Shoenfeld2,5

  1. 1Department of Medicine C, Wolfson Medical Center, Israel;

  2. 2Sackler Faculty of Medicine, Tel-Aviv University, Israel;

  3. 3Department of Dermatology, Sheba Medical Center, Israel;

  4. 4Department of Medicine, Albert Einstein College of Medicine, New York, USA;

  5. 5Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
  1. Correspondence to: G Zandman-Goddard, 63 Halochamim Street, Holon, 58100 Email: goddard{at}wolfson.health.gov.il

Clinical manifestations of lupus are encountered in a variety of disease entities, including isolated cutaneous lupus, undifferentiated connective tissue disease, mixed connective tissue disease, drug-induced lupus, overlap syndrome, and systemic lupus erythematosus (SLE). While each entity has been recognized as a specific disease with its own diverse clinical and serological pattern, one could argue that many findings are common. Could it be that all of these entities actually represent a spectrum of one disease? Could it be that rather than the genetic predisposition and hence controlled factors that govern this spectrum of diseases, that environmental factors associated with SLE could also play a role in the different entities of this spectrum? The traditional environmental triggers in SLE include sunlight and ultraviolet (UV) light, infections, smoking, and medications including biologics such as tumor necrosis factor alpha (TNF-a) blockers. In this review, we update and further substantiate these traditional factors in the various lupus-related syndromes. We will also discuss the association with vaccine exposure, industrial estrogens, and other factors.

  • Received April 18, 2011.
  • Accepted September 20, 2011.
  • © The Author(s), 2012. Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav