Background/Purpose:  It has been well acknowledged that both genetic and environmental factors are important in the pathogenesis of systemic lupus erythematosus (SLE). To elucidate the environmental factors associated with SLE pathogenesis, we investigated the seasonal differences in the disease onset and the exacerbation of SLE.

Methods: In the present study, we retrospectively reviewed the medical records of 122 patients with SLE (88.5% female and the average age of 43 years) fulfilling the 1997 revised ACR classification criteria. The mean observation period was 7.2 years. The disease exacerbation was defined as either a new appearance of clinical manifestations of SLE or the clinical condition requiring the start or dose increment of glucocorticoids by at least 50%.

Results: The disease onset was the most frequently observed in Spring (31.0%) and the least in Fall (16.1%). A total of 167 disease exacerbations were observed among 879 patient-years, and more interestingly, the disease exacerbation was significantly more frequently observed in Spring (38.3%) and significantly less frequently observed in Fall (10.8%) as compared with other seasons. It should be noted that the both disease onset (0.0%) and exacerbation (2.4%) of SLE were the least in September. Disease manifestation at the exacerbation was similar throughout the seasons, and 60.0% of the disease exacerbation did not accompany serological activity defined by the increase in anti-DNA antibody or the decrease in complement activity.

Conclusion: Concordant seasonal differences between the disease onset and the exacerbation implicated the crucial role of environmental factors in the pathogenesis of SLE, possibly through the activation of innate immune systems.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/seasonal-differences-in-the-disease-onset-and-the-exacerbation-of-systemic-lupus-erythematosus/