Concepts of pathogenesis of systemic lupus erythematosus

It is likely that different disease-inducing factors interfere with normal immune regulatory processes in different patients (1, 3). Some people may have such a strong genetic predisposition to disease that environmental insults may not be very important. Other individuals, with a much weaker genetic predisposition, may require strong environmental stimulation for disease induction (2). Defects in self-tolerance mechanisms could provide the genetic basis of disease or the target for environmental triggers. However, induction and perpetuation of pathogenic autoantibody production may frequently be a "multi-hit" process. The greater the number and/or degree of abnormalities (genetic and environmental), the greater the probability of disease.