The clinical onset requires an interaction of genetic predisposition, environmental triggers, and immunological and hormonal factors. Environmental triggers are considered: Ultraviolet light (the most recognized), drugs/supplements (echinacea, trimethoprim/sulfamethoxazole), smoking, infections (Epstein-Barr virus in particular, silica, mercury. Psychological stress has also been linked to a 50% increase risk of developing lupus, (Fava & Petri, 2019).