Environmental and drug exposures have been related to rheumatological disorders for a long time. Lupus is one of the most well known of the rheumatological disorders, but there are others, such as Polyartritis and Kawasaki’s syndrome. These are complex and often very difficult to pin down disorders and syndromes. A syndrome is term for a disorder that is a host for several diseases and disorders that can stand on their own.
Four types of Lupus Syndrome can be diagnosed. They are systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus and neonatal lupus. Systemic lupus is the most dangerous and most common form. In lupus, the body’s immune system attacks the body itself, causing damage to any type of tissue or cell and causing inflammation, particularly to heart, lungs, joints, skin, kidneys, blood vessels and the brain.
The mechanism for the self attack is the antinuclear antibody, or ANA. Wherever there is systemic or even weak and temporary positivity in tests for ANA, it is first surmised that Lupus may be involved.
When the blood vessels become so inflamed that blood will not pass through them, vasculitis is the result. Many Lupus sufferers go through multiple episodes of vasculitis, called systemic vasculitis. But Some forms of Lupus include up to 11 stand alone disorders that are each very serious and challenging to life.
Lupus was considered to be a deadly disease, with a poor prognosis for living to old age, but advancements have been made to lengthen and to improve the lives of sufferers, at least where wealth allows the top levels of medical care.
An exact choice between environment and genetics has not been made. There is reasoning that there are genetic predispositions, as opposed to being born with the full blown syndrome, that may enhance a persons ability to develop the lupus syndrome in response to certain environmental factors.
Indications are that Lupus is partially influenced by genetics and partially influenced by the environment or by lifestyle. The environmental influence involves both the causes of the syndrome and factors which can aggravate the various disorders that make up the syndrome. The term “xenobiotics” is used to describe “…occupational, inadvertent or theraputic exposure to drugs, environmental chemicals and biological materials.” 1
Xenobiotics include over 70 types of drugs that are associated with the development of Lupus like symptoms, especially drugs that have hydrazine components. The hydrazines that are used in drugs, plastics, pesticides, herbicides, rubber, textiles, dyes and anticorrosives are a major environmental culprit.
Cigarette smoking, mushrooms and penecillin also have some hydrazine components. This is how cigarette smoking associates with Lupus. Aromatic Amines are another environmental culprit. These are found in hair dyes, drugs and food dyes. The Bhopal disaster involved deaths that had some hints of lupus-like conditions.
Chemicals include a growing list that includes inorganic interleukin-2, chromium, benzine, trichlorethane, tuolene, xylene, perchlorethylene. Minerals include cadmium, gold and mercury.
The biologicals include amino acid l-canavanine that is in alfalfa and other sprouts and diets that are high in highy calorie polyunsaturated fatty acids.
There are bacterial and viral elements to the environment that have some associations with the symptoms of systemic Lupus erythematosus, but it is difficult to determine whether the element or its metabolite is responsible or whether something else is going on. The Epstein-Barr virus produces symptoms that are very much like Systemic Lupus erythematosus.
The most famous environmental hazard for Lupus sufferers is photosensitivity, or sensivity to U-V radiation. The exposure is not the cause of the Lupus, but it is an aggravating factor.
In fact, it many cases is difficult to determine whether an enviromental factor is the direct or active agent that causes the lupus like symptoms of is only associated with the onset of the symptoms. The presence of ANA, for example, can be for a wide variety of reasons that have nothing to do with Lupus or any rheumatological disorder. Humans are rarely tested for ANA, so the data on the comings and going of the antibody, not to mention anti-dna is vastly in unknown territory.
Lupus of any type, in summary, is a very, very complex disorder that is very difficult to diagnose, let alone associate with a particular environmental, biological, drug or chemical factor. But much research and progress has been made in identifying many of the likely culprits and in prolonging life.
1. E.V. Hess, “Environmental Lupus Syndromes”, British Journal Of Rheumatology, 1995;34:597-601
