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Copyright 2012. Nova Science Publishers, Inc. All rights reserved.

. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 18 Ana Maria Abreu Velez and Michael S. Howard

Causes of Lupus
Lupus is a complex disease, and its precise cause is unknown. As previously noted, while
a persons genes may increase the chance that he or she will develop lupus, an environmental
trigger is likely also needed to incite the initial illness or a flare [29]. Examples of
environmental triggers may include: ultraviolet (UV) light, an infection, exhaustion, a
physical injury, emotional stress(such as a divorce, illness, death in the family, or other life
complication), surgery, pregnancy, or giving birth [30-35]. Hormones(especially the sex
hormone estrogen) play a role in lupus. Men and women both produce estrogen, but estrogen
production is much greater in females. Many women have more lupus symptoms before
menstrual periods and/or during pregnancy, when estrogen production is high [30-37]. Thus,
estrogen may somehow regulate the severity of lupus. However, this finding does not
necessarily indicate that estrogen or any other hormone triggers lupus [30-37].
As noted, these findings suggest that genetics play an important role in the pathogenesis
of lupus; however, the findings also confirm the central role of environmental triggers. Some
of the environmental factors scientists have recently studied include sunlight, stress,
hormones, cigarette smoke, medications, and infectious agents such as viruses [21,30-35].
Recent research has confirmed that one virus, Epstein-Barr virus (EBV), which causes
mononucleosis, is a likely trigger of lupus in genetically susceptible people. As previously
noted, scientists believe there is no single gene that predisposes people to lupus [30-35].

Diagnosing Lupus
Diagnosing lupus can be difficult. No single test can determine whether a person has
lupus, but multiple laboratory tests may help a physician confirm the diagnosis of lupus, or
rule out other causes for a patients symptoms. In 1982, the Diagnostic and Therapeutic
Criteria Committee of the American College of Rheumatology (ACR) published revised
criteria for the classification of SLE (see Table 1) [36]. During the ensuing decades, several
investigators have described the presence of antiphospholipid antibodies in patients with SLE.
In addition, the primary antiphospholipid syndrome (Hughes syndrome) has been described in
these patients, and it has been suggested that the 1982 ACR revised criteria be re-evaluated in
light of these discoveries [37].

Autoantibodies in Lupus
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The most useful serologic tests identify selected autoantibodies often present in the blood
of people with lupus, such as antinuclear antibodies (ANAs). Most people with lupus test
positive for ANAs; however, there are other causes of a positive ANA besides lupus,
including infections and other autoimmune diseases; occasional positive results are found in
healthy people [36]. Thus, ANA testing provides another clue for the physician in
establishing a diagnosis. In addition, there are blood tests for autoantibodies that are more
specific to lupus; however, not all people with lupus test positive for these antibodies, and not

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