CHANGING AUTOANTIBODY PROFILES WITH VARIABLE CLINICAL MANIFESTATIONS IN A PATIENT WITH RELAPSING SYSTEMIC LUPUS-ERYTHEMATOSUS AND POLYMYOSITIS

The production of autoantibodies characteristic of different autoimmun e disease subsets is thought to be controlled primarily by genetic fac tors, whereas non-genetic factors are generally believed to be of seco ndary importance. A patient with systemic lupus erythematosus (SLE) an d polymyositis (PM) who experienced frequent relapses associated with changing clinical manifestations and autoantibody specificities is rep orted. Her initial presentation as SLE with anti-Sm antibodies shifted to the onset of PM with temporal production of a different set of aut oantibodies. The latter antibodies disappeared when myositis resolved, followed by the reappearance of autoantibodies and clinical manifesta tions characteristic of SLE. The shifts of autoantibody profiles in as sociation with variable clinical manifestations in this patient argue that environmental factors may play a more important role in autoimmun ity than previously supposed, and that interplay between environmental triggers and genetic predisposing factors may lead to the constellati on of autoimmune disease manifestations exhibited at a particular time .