Higher levels of adverse childhood experiences are associated with worse patient-reported disease activity, depression and health status — but not in physician-assessed measures — in systemic lupus erythematosus, according to data published in Arthritis Care & Research.
“External factors like stress have long been thought to impact systemic lupus erythematosus,” Kimberly DeQuattro, MD, MM, of the University of California, San Francisco, told Healio Rheumatology. “Our results support the notion that stress in the form of adverse childhood experiences plays a role in poor health in SLE.”
To compare the prevalence of adverse childhood events in patients with SLE to that of a group of population-based individuals, and to determine the links between such experiences and health status, DeQuattro and colleagues conducted a cross-sectional analysis of data from the California Lupus Epidemiology Study (CLUES). According to the researchers, CLUES is a prospective, longitudinal cohort of patients with SLE, who were recruited beginning in 2015 through the California Lupus Surveillance Project. Participants in the cohort completed a 10-item questionnaire on adverse childhood experiences, including abuse, neglect and household challenges.
Higher levels of adverse childhood experiences are associated with worse patient-reported disease activity, depression and health status in SLE, according to data.
DeQuattro and colleagues analyzed data from 269 CLUES participants, and compared them to geographically matched respondents to the 2015 California Behavioral Risk Factor Surveillance System (BRFSS). The researchers then evaluated the links between patient- and physician-reported health status and levels of adverse childhood experiences, using multivariable linear regression and controlling for sociodemographics, nephritis and childhood-onset SLE.
According to the researchers, overall levels of adverse experiences during childhood were similar among both CLUES and BRFSS participants. Among patients with SLE, 63.2% had one or more adverse childhood experience, with 19.3% reporting four or more. Such experiences were more prevalent in individuals who were older, women, Latino or African American, as well as those without college degrees and those who have been diagnosed with lupus nephritis.
In their adjusted models, the researchers found that higher levels of adverse childhood experiences were associated with worse patientreported SLE disease activity, depression and health status. However, these experiences were not significantly associated with physicianassessed SLE activity, damage, or severity.
“These findings highlight the importance of asking about ACEs and patient experience in lupus status,” DeQuattro said. “This work in SLE supports more broadly the body of studies on adversity and trauma in childhood that link ACEs and poor health. It is a call to action to focus efforts on ACE prevention in childhood as well as clinical and mental health interventions that foster resilience in adulthood.” – by Jason Laday
Disclosures : The researchers report no relevant financial disclosures.