Why is SLE more common in females?
Association with genes on the X-chromosome
Women are at ten times more risk of developing SLE than men,
Risk of SLE is 14 times more in Klinefelter syndrome (47, XXY).
This suggests an association with genes on the X-chromosome.
Hormonal influence –
Hormonal influence – Significant risk factors for SLE.
Estrogen stimulates –
- CD8+ and CD4+ T cells,
- B cells, macrophages, thymocytes,
- Release of some specific cytokines (e.g., IL-1),
- Expression of HLA and endothelial cell adhesion molecules (VCAM, ICAM).
Estrogens and prolactin promote autoimmunity,
- Increase the B-cell activation factor production
- Modulate lymphocyte and plasmacytoid dendritic cells (pDC) activation.
Estrogen-containing Contraceptives and HRT :
The use of estrogen-containing contraceptives and postmenopausal hormone replacement therapy can cause flares in patients with SLE and have been associated with a higher incidence of SLE.
Elevated levels of prolactin are seen in patients with SLE.
Androgens is immunosuppressive.