ACR Study: Childhood Abuse Increases the Risk of Lupus in Women

Systemic lupus erythematosus (SLE), characterized by systemic inflammation in multiple organs, has a higher probability of being diagnosed in women who experienced emotional or physical abuse when growing up, according to a study presented at the 2018 American College of Rheumatology (ACR)/The Association of Rheumatology Health Professionals Annual Meeting.

Previous work by the same group of researchers—from the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital/Harvard Medical School—who presented the current results has found an association between posttraumatic stress disorder and the risk of developing SLE.¹ The study confirmed that psychosocial trauma and the associated stress response from the human body may lead to autoimmune disease.

The current retrospective analysis² used data from 67,434 women, with an average age of 34.6 years, who were a part of the Nurses’ Health Study II, a longitudinal study of US nurses that was initiated in 1989 and involved the nurses filling out a health questionnaire once every 2 years. Validated questionnaire-based measures were used to assess the level of childhood physical abuse, emotional maltreatment and sexual abuse experienced by study participants:

• Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire for childhood physical and emotional maltreatment
• Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scales for sexual abuse
• Physical Assault Scale of the Conflict Tactics Scales for childhood physical assault

Higher scores indicated more frequent abuse. The questionnaires, administered in 2001, had a 75% response rate. Multivariable Cox regression analysis was used to identify the association between childhood abuse and incident SLE, in addition to the influence of other risk factors, such as smoking, body mass index, alcohol use, or contraceptive use, as confounders in those with and without exposure to childhood abuse.

“In prior work, exposure to stress and stress-related disorders, notably post-traumatic stress disorder, has been associated with increased risk of subsequently developing autoimmune diseases, including lupus,” lead author Candace H. Feldman, MD, ScD, assistant professor, Harvard Medical School, said in a press release. “Exposure to adverse childhood experiences has specifically been associated with higher levels of inflammation, as well as with changes in immune function.”

Development of new SLE through 2015 (over 24 years of follow-up) was defined using a self-report following physician diagnoses; 2 rheumatologists reviewed the individual’s medical record to validate the diagnosis.

The analysis identified 93 cases of incident SLE; exposure to the highest level of physical and emotional abuse was associated with more than a 2-fold increase in the risk of developing SLE (hazard ratio [HR], 2.21; 95% CI, 1.29-3.80; P = .01). Moderate or high levels of exposure to physical assault had a 1.7-fold greater risk of SLE (95% CI, 1.08-2.68; P = .02). Sexual assault, the authors found, did not have a significant association with the risk of developing SLE (0.89; 95% CI, 0.42-1.86; P = .84).

The authors point to recall bias as a significant study limitation. However, even after accounting for a potential recall bias, and excluding lupus cases that were reported to have been diagnosed prior to 2001, the association between physical and emotional abuse and the risk of SLE remained.

The authors concluded that exposure to extreme childhood stress and adversity may contribute to SLE development.

“The strong association observed between childhood abuse and lupus risk suggests the need for further research to understand biological and behavioral changes triggered by stress combined with other environmental exposures. In addition, physicians should consider screening their patients for experiences of childhood abuse and trauma,” said Feldman.

References

1. Roberts AL, Malspeis S, Kubzansky LD, et al. Association of trauma and posttraumatic stress disorder with incident systemic lupus erythematosus in a longitudinal cohort of women. Arthritis Rheumatol. 2017;69(11):2162-2169. doi: 10.1002/art.40222.
2. Feldman CH, Malspeis S, Leatherwood C, et al. Association of exposure to childhood abuse with incident systemic lupus erythematosus in a longitudinal cohort of women. In: Proceedings from the 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 2807.