Medical Health Encyclopedia

Chemicals. Clusters of SLE cases have occurred in populations with high exposure to certain chemicals. For example, in a 2001 study, citizens in a small town in Arizona had two to seven times the prevalence of SLE, which was associated with a high exposure to chlorinated pesticides. Crystalline silica is another suspect. A number of other chemicals are under investigation. However, it is very difficult to determine a causal role for any specific chemicals. (Silicone breast implants have been under intense scrutiny as a possible trigger of autoimmune diseases, including SLE. The weight of evidence to date, however, finds no support for this concern.) Some drugs have been associated with a temporary lupus syndrome (drug-induced lupus), which resolves when these drugs are stopped.

Hormones. Cytokines, major immune factors that are active in SLE, are directly affected by sex hormones. In general, estrogen enhances antibody production and testosterone reduces antibody production, although their exact role in SLE may be more complicated than that since there are various ways in which each hormone might influence various immune cells. Women with SLE may have lower levels of several active male hormones (androgens), and some men who are affected by SLE may also have abnormal androgen levels.

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Oral Contraceptives. Female patients with SLE have long been cautioned against taking oral contraceptives due to the possibility that estrogen could trigger lupus flare-ups. Studies presented at the 2004 annual meeting of the American College of Rheumatology suggested that oral contraceptives are safe for most women with lupus. Women who were at high risk for blood clots due to antiphospholipid syndrome were excluded from these studies, and the researchers advised that such patients should not use oral contraceptives.