CHICAGO — Women who experienced physical or emotional abuse as a child demonstrated a significantly increased risk for incident systemic lupus erythematosus, according to data presented by Candace H. Feldman, MD, ScD, of Brigham and Women's Hospital and Harvard Medical School.
“We embarked on this study because our patients always ask us what causes their lupus,” Feldman said, addressing attendees at the ACR/ARHP 2018 Annual Meeting. “A number of adult rheumatology patients have suffered from trauma or abuse, either in adulthood or childhood, and a number of them have asked me the degree to which this may have contributed to the development of their disease.”
To examine the association between childhood physical, emotional and sexual abuse with the risk for incident SLE among women, Feldman and colleagues gathered data on group of participants in the Nurses’ Health Study II, a longitudinal cohort of female, American-based nurses. Participants enrolled in 1989 and completed questionnaires every 2 years. Feldman and colleagues used validated questionnaire-based measures to determine the level of childhood physical, emotional and sexual abuse experienced by the participants.
Women who experienced physical or emotional abuse as a child demonstrated a significantly increased risk for incident SLE, according to data.
The researchers focused on 67,434 participants with more than 24 years of follow-up. Physical and emotional abuse was assessed using the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire, in which participants reported whether and how often as a child they had experienced physical abuse from a family member, or yelling, screaming or insulting remarks from a family member.
Feldman and colleagues also evaluated physical assault using questions from the Conflict Tactics Scale. Sexual abuse was examined using the Sexual Maltreatment Scale of the Parent-Child Conflicts Tactics Scale, in which participants recalled incidents of forced sexual activity by either adults or older children during their childhood or adolescence.
According to Feldman, 93 cases of lupus developed among the 67,434 women included in the study. After accounting for age and race, the researchers found that women with the highest exposure to physical and emotional abuse, compared with the lowest exposure, had a more than twofold greater risk for lupus. In addition, moderate or high levels of physical assault were associated with a 1.7 times greater risk for lupus, compared with no exposure. There was no statistically significant association between sexual abuse and lupus risk.
“We feel that our findings add to a growing body of evidence that suggests that exposure to severe childhood stressors have profound and far-reaching effects later in life, including in autoimmune disease,” Feldman said. “With the high prevalence of abuse in this population, and likely even high prevalence of those who are unwilling to report, it is clear that more needs to be done to prevent childhood abuse from occurring in order to mitigate both the short- and long-term consequences.”
Feldman also noted that “rheumatologists and other caregivers should consider screening their adult patients for experiences of childhood abuse, as well as other stressors, and consider the implications of these exposures, even years later.” – by Jason Laday
Feldman CH. Abstract 2807. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.
Disclosure: Feldman reports no relevant financial disclosures.