In one of the biggest ever cohort studies in the United States, the link between the incidence of trauma and lupus in women has been established.
Autoimmune diseases have perplexed specialists in the medical community for decades, as there is no single reason that seems to explain the cause of the lost sanity of the body's immune system. It is said that to know this is easy, but to understand it can be a little difficult. So far, researchers know that in lupus, the immune system attacks various bodily systems, resulting in a varied clinical picture. It's also important to say that there are no two cases of lupus are comparable to each other. But, still, there is not much understanding of what makes the body's immune system cause lupus.
Even with several years of observations and trials, there are a few things that are well known, while others are still being discovered. It has been long known that lupus occurs mostly in women, and it often develops after some significant event, whether it be a disease, a psychological trauma or some other stressful condition. Before we look at the latest finding of an association between lupus and a trauma, let us see the different reasons that are often found to be linked to lupus.
Current understanding about causes of lupus
There are lots of studies that have been done regarding the genetic risk factors in lupus; it seems that like most autoimmune disorders, weakness towards lupus is the result of a collection of several feeble genes, rather than due to single or few genes. In those people who are genetically predisposed, environment factors work as a trigger.
Quite like genes, things with the environment are complicated too. There is no single environmental factor which has shown strong association with lupus. Thus entirely possible that several environmental factors have their role to play in the development of lupus.
Some of the most common factors that seem to lead to lupus are hypertension, allergies (especially to drugs), sun exposure, certain skin types, and smoking. But, on the contrary, it appears that alcohol may actually have a protective role when it comes to lupus (1).
It should also be noted that studies have shown an only mild link between smoking and risk of lupus.
So far, hypertension has emerged as one of the most common risk factors, but many doubt that it could be somewhat an early manifestation of lupus rather than being purely a cause.
However, out of these causes allergies and infections, especially some type of viral infections like herpes zoster, have shown a strong link to lupus.
Many clinical studies and observations noticed the exacerbation of lupus in the spring or summer, and thus it has been proposed that prolonged exposure to the sun with particular skin types may actually increase the risk of lupus.
Other factors like hormonal changes and exposure to the particular chemical may also play a role. However, understanding the factors that cause lupus is still not completely understood, thus can be regarded as an ongoing process. Therefore, a recent study linking it with trauma may better our understanding of lupus.
Newer study and link to trauma
It is now well known that reactions to stress, when it is either due to a physical or psychological injury, may alter the immune responses of our bodies. Moreover, the stress reaction to the injury can actually make the consequences in our bodily systems graver than they are meant to be. Since the incidence of lupus has lots to do with the altered immune response, it makes sense to consider the link between the two in a more systemic manner, rather than looking at both of them separately as some studies have already done.
Recently, one of the first longitudinal studies examining the link between lupus and the exposure to trauma or post-traumatic stress disorder (PTSD) published in the journal Rheumatism & Arthritishas confirmed the association between traumatic events and lupus, especially when women are involved.
It is a study that would change the way we see as lupus, as it involved the analyses of the medical data of about 54,763 women spanning over a period of 24 years. The data was scanned for the presence of lupus in women using the preset criteria of American College of Rheumatology (ACR). To find the presence of PTSD, researchers applied the standards set by the DSM-IV and a trauma questionnaire.
The study compared the risk of developing lupus as a result of PTSD and sub-clinical PTSD. They also took into consideration the presence of other risk factors like obesity, smoking, and the use of oral contraceptives.
Results of the studies came as a surprise as no one expected to find such a strong association between lupus and PTSD, especially since PTSD has been once looked at as something that correlated with it, not something that can directly be a cause. The presence of PTSD was shown to increase the risk of developing lupus by almost three times, though subclinical PTSD was not as strongly associated with lupus. The data analysis also showed that the presence of other factors like smoking, oral contraceptives and obesity had only minor effect in comparison (2).
This study can very well be considered a milestone in the medical community as it has concluded the actual need to further investigate this role trauma and PTSD plays in the development of lupus and other autoimmune diseases. This study also warrants the need of finding more of the effective measures that could prevent autoimmune conditions like lupus in those with trauma or PTSD. Even so, by revealing this as a cause, the study also brings us one step closer to finding a cure.
1. Bengtsson AA, Rylander L, Hagmar L, Nived O, Sturfelt G. Risk factors for developing systemic lupus erythematosus: a case–control study in southern Sweden. Rheumatology. 2002;41(5):563-571. doi:10.1093/rheumatology/41.5.563.
2. Roberts AL, Malspeis S, Kubzansky LD, et al. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women. Arthritis Rheumatol Hoboken NJ. 2017;69(11):2162-2169. doi:10.1002/art.40222.