Nature and Nurture in Systemic Lupus Erythematosus
Nowhere across the spectrum of rheumatic and dermatological disease is the interaction of nature and nurture more relevant than in the connective tissue diseases such as SLE. While genetic and environmental factors are clearly involved in both the triggering of the disease and its expression, the interaction is complex with different combinations of factors contributing in different patients. For example, while genetic factors contribute substantially to susceptibility to lupus, this does not follow a simple Mendelian pattern of inheritance and mathematical models suggest that there may be varying contribution from at least four genes with differing inheritances. A variety of candidate genes and environmental factors have been highlighted in SLE but to dissect out the complexity of how these might interact requires the study of patient groups with a better defined clinical and serological phenotype. For example, studies of patients with subacute cutaneous lupus (SCLE) have shown associations with various genes in the MHC region (including HLA, complement and TNF) and suggest that the biological effect of inheriting an extended MHC region may be greater than its individual parts. One can now speculate on how interaction with an environmental factor such as UV light explains pathogenesis.
KeywordsMigration Arthritis Testosterone Glutamine Leucine
Unable to display preview. Download preview PDF.
- 2.Manger K, Repp R, Rascu A, et al. FcγIIa polymorphism in Caucasian SLE patients: Association with clinical symptoms. Arthritis Rheum 40: S59, 1997.Google Scholar
- 3.Wu J, Bansal V, Redecha P, et al. A novel polymorphism of FcγIIIA, which alters function, associated with the SLE phenotype. J Invest Med 45: 200A, 1997.Google Scholar
- 5.Tsao BP, Cantor RM, Badsha H, et al. A susceptibility gene for SLE maps to a 5cM region of chromosome 1q. Arthritis Rheum 40: S315, 1997.Google Scholar
- 6.Rubin RL. Drug-induced lupus. In Dubois’ Lupus Erythematosus 5th edition. Eds Wallace DJ, Hahn BH. pp 871–901, Williams and Wilkins, Baltimore, 1997.Google Scholar
- 7.Gilliam JN. The cutaneous signs of lupus erythematosus. Continuing Education for the Family Physician 6: 34–70, 1977.Google Scholar
- 9.Arnett FC Jr. The genetics of human lupus. In Dubois’ Lupus Erythematosus 5th edition. Eds Wallace DJ, Hahn BH. pp 77–117, Williams and Wilkins, Baltimore, 1997.Google Scholar