Stages of lupus pathogenesis. Genetic factors and environmental triggers, whether exogenous or endogenous, along with stochastic events, act on the immune system to initiate autoimmunity. Autoantibodies and their antigens, cytokines and chemokines amplify immune system activation and generate tissue damage. Autoantibody production occurs years prior to the development of clinical signs and symptoms of systemic lupus erythematosus (SLE). Organ damage has likely occurred by the time lupus is diagnosed. Sx, symptoms; Dx, diagnosis.