Can You Inherit Lupus?

Lupus is an autoimmune disease that affects your body in various ways. It can also raise a lot of questions, especially since we still don’t know much about how it works or why it happens.

Common questions are often about how this condition affects biological family members: Is lupus hereditary? If an immediate member of your family has lupus, can you develop it, too? Is lupus always inherited, or can you develop it in other ways?

Genetic counselor Alexandria Haseley, MS, CGC, and rheumatologist Emily Littlejohn, DO, MPH, explain what researchers know and what a family history of lupus could mean for you.

Genetic factors that contribute to lupus

Lupus is a multifactorial disease, which means several factors — both genetic and nongenetic — can contribute to its development. And those factors often overlap.

“Lupus is tricky because when it comes to genes, we don’t really understand why people present one way or the other,” says Haseley. “A very small proportion of lupus cases have a single-gene cause, but the vast majority of cases do not.”

Still, she adds that researchers know that genes can play a part in how lupus develops. Here’s what we know so far about the genetic side of the disease.

Having lupus in your family

A family history of lupus doesn’t mean you’re going to develop it. It just means there’s a higher risk that you could.

Studies of twins, for example, have found that when one twin has lupus, both twins are much more likely to have the disease if they’re identical. “For fraternal twins, there’s only a 2% to 10% chance the other twin would get lupus, but if you’re an identical twin, the rate can be 25% or higher,” shares Dr. Littlejohn.

So, while data suggests certain genes can increase risk, they’re not always enough to cause lupus on their own.

“I always ask if any family members have an autoimmune disease, and it’s 50/50. Some people say no — they’re the only ones in their family who have lupus,” she continues. “It just goes to show that we don’t have the complete story yet.”

Rare genetic changes linked to lupus

Most cases of lupus aren’t caused by a single gene, but rare genetic changes can sometimes play a larger role in the development of the disease.

• One study identified that a rare change in the TLR7 gene can push the immune system into overdrive, causing it to attack healthy cells and trigger lupus. “Toll-like receptor genes are like gatekeepers,” Haseley illustrates. “If they’re not working, they can cause your body to act as if it’s under threat and cause symptoms of lupus.”
• TREX1 is a gene that helps clean up old, discarded pieces of DNA that are leftover from normal cellular division. But a specific mutation in TREX1 makes that cleanup ineffective, which triggers your immune system to attack healthy cells. That increases your risk of lupus.
• Your complement system helps your body identify and fight foreign invaders, like viruses, with inflammation. “There’s a whole spectrum of different complement genes, like C4A and C1Q,” says Haseley. “They’re the single-gene causes of lupus we tend to think most about.”

That said, a single-gene change (monogenic lupus) that causes lupus is rare. Most cases tend to occur in childhood, often before age 15.

Common genetic changes that raise your risk of lupus

Some genetic changes raise your risk of developing autoimmune diseases, in general. And that may include lupus.

Human leukocyte antigen (HLA) genes, for example, help your immune system figure out which cells are healthy and which are harmful. But if something disrupts that process, your immune system may start attacking cells it normally wouldn’t.

“Carrying a change in an HLA gene raises your risk of lupus compared to the general population,” says Haseley. “But having that doesn’t mean you have lupus or you’re going to develop it. It just makes it more of a possibility.”

Nongenetic factors that contribute to lupus

Having a genetic change isn’t always enough to develop lupus. Sometimes, your body needs a triggering event.

“Some people who have genetic changes get lupus — but not always,” states Dr. Littlejohn. “Usually, when someone has a genetic predisposition, there’s some second event or exposure that unmasks the gene and actually causes lupus.”

Let’s look closer at some of those external factors.

Hormonal changes

Lupus often develops during periods of significant hormonal change, like:

• Puberty
• Pregnancy and delivery
• Perimenopause

“All of these events involve shifts in estrogen,” Dr. Littlejohn notes. “Those fluctuations can be enough to trigger lupus, especially if you have underlying genetic changes that increase your risk of the disease.”

Sun exposure

Sunlight and UV radiation can damage skin cells and trigger your immune response.

“UV light can cause people to break out in terrible rashes, which often show up on the face or sun-exposed areas when you have lupus,” says Dr. Littlejohn.

Viruses and other infections

Your immune system kicks into high gear to fight off infections. But if you’re already susceptible to lupus, certain infections may pose a larger problem.

“We think viruses can be a trigger,” says Dr. Littlejohn. “A lot of people with lupus have signs of Epstein-Barr virus (EBV) that stick around longer than they do in people who don’t have lupus.”

Research suggests people with lupus may have a harder time keeping EBV at bay, which could allow the virus to remain active or reactivate more often. Frequent infections can then cause symptoms of lupus to resurface, which leads to a cycle of illness.

Medications

Certain medications can affect the way your immune system works. They could cause lupus as long as you’re taking them, including:

• Antibiotics, like minocycline
• Blood pressure medications, like hydralazine
• Heart rhythm medications, like procainamide

“Sometimes, people start taking these medications, and all of a sudden have strange new symptoms, and then their bloodwork shows they have lupus,” shares Dr. Littlejohn. “Fortunately, drug-induced lupus can go away when you stop taking the medication.”

What can you do if lupus runs in your family?

Having a parent or other close relative with lupus doesn’t mean you’ll develop it, too. But if you’re concerned, share your family history with your primary care provider and keep an eye out for the following symptoms:

• Unexplained joint pain, stiffness or swelling
• Sensitivity to sunlight
• Rashes on your face and other areas
• Unexplained hair loss
• Blood in your urine

These symptoms can have several causes other than lupus. But if they continue to occur, they might be worth a closer look, especially if autoimmune diseases run in your family.

“Having a family member with lupus isn’t a 100% guarantee that you’re going to have it,” reassures Dr. Littlejohn. “If you have any questions or concerns about the possibility of lupus, we can help address them.”