System lupus erythematosus and the environment

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease. Several factors may contribute to disease appearance, course, and manifestations. Among these factors, environmental triggers are associated with the loss of immune tolerance, production of autoantibodies, followed by appearances of overt autoimmunity. Infectious agents have been linked to the development of SLE (e.g., Epstein-Barr virus), as well as drugs, both of which are related to induction of disease as well as with its different phenotypes. Other triggers such as exposure to ultraviolet light, cigarette smoke, vaccines, and chemicals are related to SLE development. Notably, exposure to some of these triggers may be avoided and thus enable primary and/or secondary prevention of disease. In this chapter we provide the evidence regarding the complex interplay between the environment and SLE as well as suggested modes of intervention and prevention.