Recently, a fashion campaign sparked controversy with a slogan: 

“Sydney Sweeney Has Great Jeans.”

It was meant to be a pun on jeans and genes. But it left some people uncomfortable due to how beauty, identity, and biology are marketed.

And yet… it made me think.

I get questions about genes all the time! Not in a fashion context, but in my clinic. 

Often, after we’ve finished discussing diagnosis and treatment, patients will pause and ask:

“Did I inherit this?”

“No one in my family has this disease, so how did I get it?”

“Can I pass it on to my kids?”

As someone with rheumatoid arthritis (RA) and Sjögren’s syndrome (SJS), I’ve asked those questions too. No one in my family, as far as I know, has an autoimmune disease.

So why me?

Let’s unravel this. 

Genes and Autoimmune Diseases: It’s Complicated

Autoimmune diseases often run in families, but rather unpredictably. Most autoimmune conditions are polygenic, involving many genes, each contributing a small risk. Even then, having the “right” combination of genes doesn’t guarantee disease.That’s actually good news, even if a family member has an autoimmune disease, it doesn’t mean you’ll develop it too.

You also need triggers. Examples include infections, stress, hormonal changes, medications, or environmental exposures. They can flip the switch and activate those genes. For example, Epstein-Barr virus, chronic stress, smoking, and silica exposure have all been linked to a higher risk of developing RA.

So while you may inherit a predisposition for autoimmunity, developing an autoimmune disease is more like a perfect storm than a simple inheritance. The stars have to align.

But What If No One in My Family Has This?

You’re not alone and it doesn’t mean your illness isn’t explainable.

Here’s why it still happens:

• Your family may carry silent autoimmune tendencies (like thyroid disease or vague fatigue) that were never diagnosed.

• You may be the first in your family to express it due to unique environmental or life stressors.

• And sometimes, it’s just bad luck, a mix of biology and randomness.

I didn’t check any of the usual boxes either.

Believe me, I’ve asked “Why me?” many times.

Yet here I am: a rheumatologist, a mom, and a person living with RA and Sjögren’s. I guess the stars did align for me.

Can I Pass This On to My Kids?

I sometimes wonder about this while watching my baby playing with her toys. Will she develop RA and Sjogren’s?

While you can pass on a genetic predisposition, your child would still need specific triggers to develop the disease, and it’s still not guaranteed.

Being aware is important. Share with your family. Pay attention. But don't let fear drive you.

So, What Can You Actually Do?

You can’t change your genes but you can take steps to protect your health and future:

• Know your family health history if possible, even vague symptoms matter.

• Listen to your body. Don’t ignore fatigue, joint pain, dry eyes, or other subtle signs.

• Prioritize rest, nutrition, and stress management. Lifestyle isn’t everything, but it matters.

Final Stitch

Whether we’re talking about jeans or genes, nothing is as perfect or indestructible as it seems in a campaign.

Even great jeans fray. 

Even great genes come with complications.

And that’s okay.

What matters most isn’t what you were handed but rather how you care for what you’ve got.

Sometimes, the strongest people are the ones putting themselves back together, one thread at a time.

Whether it’s jeans or genes, your story is important. Have you faced a health challenge? I'd like to hear your story.