Our gut microflora possesses over 100 trilliions guests, each one of which has the potential to be a friend or enemy. Nourishing a beneficial microbiome makes the immune system work smoothly and identify foreign antigens while excluding self antigens. The statement that all diseases begin in the gut is really not far from reality at all

There is a well established sex bias when assessing autoimmune cases. Females are much more prone to present with autoimmune disorders and thus an hormonal predisposition assessment is always necessary. Female hormones, like estrogen, progesterone and several more have been implicated in the process of autoimmunity induction and inflammatory mediation. Sex hormones and the microbiota also influence each other, and sex differences in microbiota composition may also contribute to sex bias in autoimmunity​

Many environmental toxic substances and pharmaceuticals have been implicated in the induction of autoimmune diseases. Bisphenol A, arsenic, mercury, aluminum, asbestos, TCE but also biologic agents used in the treatment of autoimmune disorders, are all known offenders and immune homeostasis disruptors. Searching in the patients’ history it is not uncommon to discover chronic exposure to specific agents or an acute past exposure to one. Knowing which chemical is linked to each autoimmune disorder is very useful in narrowing the list of potential offenders​

It is not uncommon, when it comes to autoimmune diseases, to manifest after an infection. Besides, many studies have linked autoimmunity to specific infectious agents, like EBV, CMV, HSV and others. Also, bacterial infections, like Klebsiella, Proteus, Providencia have been correlated with the induction or worsening of diseases, like ankylosing spondylitis, psoriasis and rheumatoid arthritis