Lupus onset and progression – environmental factors

Environmental factors may trigger lupus onset, a new study confirms. They may also trigger lupus progression. Ultraviolet light and particulates of air pollution, for example, are environmental factors.

Lupus is a chronic, systemic, autoimmune disease. Chronic means long term. Systemic means it affects either the whole body or many parts of it. If your body’s immune system attacks good cells and tissues, i.e., attacks itself, you have an autoimmune disease.

As lupus attacks many different parts of the body, doctors prescribe several medications. That is one of the reasons the lupus pharmaceutical market is so big.

Lupus onset – triggers

Experts are not completely sure what triggers lupus onset. Most of them say it is a combination of genetic, hormonal, and environmental factors.

Gaurav Gulati, MD, a researcher at the University of Cincinnati (UC) College of Medicine, said:

“The tough part about Lupus is that treatment options remain limited and the understanding of the disease in terms of its onset and progression is also limited.”

“The disease has a wide spectrum in terms of age distribution, so it can also affect children or young adults who can have more severe manifestation and long-term damage from disease as it progresses over time.”

Dr. Gulati is also an assistant professor in the UC Division of Immunology, Allergy and Rheumatology and a UC Practicing Doctor.

Lupus onset and progression - environmental factors
We know that environmental factors cause lupus symptoms to get worse. They are also one of the risk factors for lupus onset. A combination of environmental, hormonal, and genetic factors probably cause lupus.

Study – literary review

Prof. Gulati and Hermine Brunner M.D. carried out a literary review of over 100 research articles on lupus. They concluded that genetics is not the only cause of the disease.

Dr. Brunner is Director of Cincinnati Children’s Hospital Medical Center’s Division of Rheumatology. She is also a Professor at the UC Department of Pediatrics.

Prof. Gulati and Prof. Brunner wrote about their study and findings in the journal Seminars in Arthritis and Rheumatism (citation below).

According to the University of Cincinnati Academic Health Center:

Researchers studying Lupus have identified a triad relationship of one’s genome or genetic background; epigenome or how genetic material is modified over a lifetime; and exposome, which refers to the environmental factors individuals are exposed to over time.”

Triad,’ in this context, means a set or group of three related things.

Lupus onset and progression - the authors
Prof. Brunner’s research focuses on biomarker discovery and the testing of new lupus medications. Prof. Gulati specializes in systemic lupus erythematosus, connective tissue diseases, rheumatology, vasculitis, arthritis, and osteoarthritis. (Images: University of Cincinnati website)

Lupus onset – identical twins

Genetics is a lupus onset factor, but there are many cases of people with identical genes who have different outcomes.

Prof. Gulati quotes a study that found that among identical twins, lupus occurred in both twins in only 24% of cases. If genetics were the only factor, then both twins would have had the disease in every case.

It is much more likely that genetic risk factors alongside environmental and hormonal factors play a pivotal role in lupus onset.


Some lupus symptoms get rapidly worse if the patient exposes his or her skin to ultraviolet light. Exposure to ultraviolet light can trigger flare-ups.

Sunlight consists of ultraviolet, infrared, and visible light. In this context, ultraviolet light exposure refers to sunlight exposure.

Air pollution

Particulate air pollution can also worsen symptoms; especially diesel exhaust from cars, vans, trucks, etc.

Regarding air pollution and lupus onset and progression, Prof. Gulati said:

“This is of particular interest in Cincinnati,” says Gulati. “We live in a city that is surrounded by many major roads and highways. There are several in our city, and there is a huge amount of truck traffic which slows down allowing exposure to particulate air pollution even more.”

Prof. Gulati says that trace metals can be lupus triggers; especially heavy metals. Heavy metals trace elements are prevalent in our environment.

Animal studies have shown that, for example, cadmium, lead, and uranium can induce autoimmunity.

The authors explained that mercury, gold, and nickel have potentiate delayed hypersensitivity reactions in people with connective tissue disease.

Experts consider the resulting worsening inflammation as a pathogenic factor in exacerbations of inflammatory and autoimmune diseases. Lupus is an autoimmune disease and also an inflammatory disease.

Dental workers are particularly vulnerable to the inflammatory or autoimmune effects of mercury. Other workers who are exposed to mercury are also vulnerable.

Lupus onset – reproductive-age women

Reproductive-age females have a significantly higher risk of lupus onset than other women. The authors cited a British study that found a greater risk of lupus among women who took oral contraceptives.

Exposure to xenoestrogens is an example of a hormonal lupus risk factor, experts believe. Xenoestrogens are chemical or natural components that mimic estrogen (UK: oestrogen).

Bisphenol A, a pollutant in our environment, for example, is a xenoestrogen that might trigger lupus, the authors explained.

We use Bisphenol A or BPA to make polycarbonate plastic and epoxy resins. BPA is a common contaminant of many packaged drinks and foods.

Reducing lupus onset and progression risk

Prof. Gulati offers the following suggestions for patients with lupus. Specifically, suggestions that may lessen some environmental risk factors.

Have regular checkups

Have regular follow-ups with your rheumatologist for lupus diagnosis and management. This is crucial for early diagnosis and to avoid long-term damage.

Sunlight exposure

Stay away from direct sunlight. UV radiation can cause flare-ups. It can also cause skin cells to die.


Use sunscreen, preferably with a high SPF factor, whenever you expose your skin to sunlight. In fact, UV radiation can even get through clouds.

Tobacco smoking

Give up smoking. Cigarettes, for example, can worsen lupus symptoms significantly. Researchers do not know if smoking can be responsible for lupus onset.

Cigarettes contain several lupus symptom triggers, including polycyclic hydrocarbons and cadmium.


Environmental triggers in systemic lupus erythematosus,’ Gaurav Gulati M.D., Hermine I. Brunner M.D. Seminars in Arthritis and Rheumatism. Volume 47, Issue 5, April 2018, Pages 710-717. DOI:

Interesting article: University of Michigan researchers believe that lupus patients are photosensitive because of an immune ‘alarm’ in the skin.