Systemic lupus erythematosus risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

The most potent risk factor in the development of systemic lupus erythematosus is gender; females are more likely to develop SLE. Other risk factors include HLA genetic mutations; being African American, Asian, or non-Causcasian; and previous exposure to certain infections.

Risk Factors

The underlying cause of this autoimmune disease is not clear. Clinical data suggests that the onset of systemic lupus erythematosus is associated with the following factors:

• Female gender: SLE affects women nine times more than men
• Age: Occurs more commonly in people younger than 50
• Race: African Americans, Asians, and other non-Causcasians are affected more often than people of other races
• Drugs: The following drugs carry the greatest risk of developing drug-induced lupus erythematosus
  • Chlorpromazine
  • Hydralazine
  • Isoniazid
  • Methyldopa
  • Penicillamine
  • Procainamide
  • Quinidine
  • Sulfasalazine
• Familial history of:
  • SLE
  • Rheumatoid arthritis
  • Thrombotic thrombocytopenic purpura

• Infections can stimulate some antigen specific cells and lead to SLE disease:
  • Epstein-Barr virus (EBV) may induce anti-DNA antibodies or even lupus-like symptoms. It is associated with higher risk of SLE and also triggering the active course of disease in children
  • Trypanosomiasis or mycobacterial infections may have the same effect as EBV
• Ultraviolet (UV) light
• Cigarette smoking
• Crystalline silica exposure in work environment (e.g. cleaning powders, soil, pottery materials, cement, etc.)
• Drug allergy
• Caring for a pet (especially a dog)

• This table must include the cardinal manifestations of differential diagnosis and the list of diseases must be prioritize based on mortality rate and prevalences of the diseases. For example, if you want to write a differential diagnosis table for heat stroke, sepsis, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome first, you need to mention the cardinal manifestations for these conditions as, hyperthermia and altered mental status. Second, prioritize your list based on disease mortality or prevalence then, create the table. You can find the example here.

Differential Diagnosis	Similar Features	Differentiating Features
Differential 1	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].