Lupus Develops Over Time—It Is Not a Congenital Condition
Lupus is not present at birth in the vast majority of cases; rather, it develops later in life when genetic susceptibility interacts with environmental triggers. The disease results from a complex interplay of genetic predisposition, hormonal factors, and environmental exposures that accumulate over time to trigger immune dysregulation 1.
Genetic Predisposition vs. Congenital Disease
While lupus has strong genetic components, this does not mean people are born with active disease:
Genetic susceptibility is inherited, but the disease itself develops later 1. Rare inherited complement deficiencies are strongly associated with SLE, but most cases involve polygenic inheritance rather than single-gene mutations 1.
Environmental triggers are required to initiate disease in genetically susceptible individuals, including UV light exposure, Epstein-Barr virus infection, and hormonal factors 1.
Age, sex, geography, and race influence disease onset, with women of childbearing age and certain racial groups being predisposed 1, 2. This demographic pattern demonstrates that lupus emerges at specific life stages rather than being present from birth.
Approximately 20% of SLE is diagnosed before age 18, and genetic components are more common in childhood-onset cases 3. However, even in these pediatric cases, the disease develops during childhood or adolescence—not at birth.
The Exception: Neonatal Lupus
There is one important caveat—neonatal lupus is a distinct, rare condition that differs fundamentally from systemic lupus:
Neonatal lupus is caused by maternal autoantibodies (anti-Ro/La) crossing the placenta, not by the infant's own immune system 4, 5.
Only approximately 1% of women with anti-Ro/La antibodies will have a baby with neonatal lupus 4.
Neonatal lupus is transient (except for congenital heart block, which is permanent once established), with cutaneous lesions typically resolving within weeks to months 4, 5.
This is not the same disease as systemic lupus erythematosus—it represents passive transfer of maternal antibodies rather than the child's own autoimmune disease 4.
Children who had neonatal lupus may have increased risk of developing autoimmune diseases later in childhood or adulthood, but the magnitude of this risk remains uncertain 5.
Clinical Implications
Understanding that lupus develops over time rather than being congenital has important implications:
Late diagnosis contributes to worse outcomes, as the disease may progress before recognition 1.
Disease manifestations and severity vary according to racial/ethnic background and socioeconomic status, with Latin American, North American Mestizo, African descendants, and Native Americans developing lupus earlier and experiencing more severe disease 3.
Mothers who are asymptomatic at delivery of a baby with neonatal lupus often eventually develop signs of autoimmune disease themselves 4, 5, demonstrating the delayed onset pattern typical of lupus.