CHICAGO -- Women who develop systemic lupus erythematosus (SLE) as adults often question rheumatologist Candace Feldman, MD, ScD, an assistant professor of rheumatology at Harvard Medical School in Boston, on whether experiences with physical and emotional abuse in childhood played a role in their developing the autoimmune disease.
Feldman told a press conference Monday at the that she and co-authors indeed uncovered a link between SLE and physical or emotional, but not sexual, abuse.
Their found a greater than double risk of lupus in women exposed to physical or emotional abuse compared with women who were not exposed. This research is apparently the first fully prospective look at the effect of exposure to different forms of childhood abuse on lupus risk in a general population sample of women.
"We were surprised, however, that we did not see a similar association with sexual abuse and lupus risk and hypothesize that the lower prevalence of significant levels of this exposure in our population likely limited our power to detect an association," she said.
Feldman and colleagues analyzed data from 67,434 NHS II participants, who were enrolled in 1989 and filled out questionnaires every two years. The women were 35 years old on average when enrolled and were followed for more than 24 years.
More than half of the cohort reported moderate or high levels of exposure to childhood physical and emotional abuse and 10% reported moderate or high levels of sexual abuse exposure.
Within the database, 94 patients had been newly diagnosed with SLE.
Women with the highest levels of exposure to physical abuse were at increased risk to develop lupus as compared with those with the lowest levels.
"There is more than two times higher risk of lupus associated with high levels of physical and emotional abuse versus very low/no abuse in the full cohort," Feldman said. "We conducted a fully prospective analysis including only lupus cases that occurred after 2001, when the child abuse questionnaire was returned, and in that analysis, there was more than three times higher risk of lupus associated with high levels of physical and emotional abuse versus very low/no abuse."
Those with exposure to moderate to high levels of physical assault were 1.7 times more likely to develop lupus compared with those who reported not being assaulted.
Feldman said, "Several studies to date demonstrate associations between stress exposure and development of autoimmune disease; childhood is a particularly vulnerable period and exposure to stress may significantly alter risk for autoimmune disease."
She cited a study of a similar cohort that demonstrated a three-fold higher risk of SLE among women with high level of PTSD symptoms.
Feldman said a variety of mechanisms have been proposed to explain the connection between stress in childhood and autoimmune disease, including epigenetic modifications, increased circulating inflammatory markers, alterations in immune function and dysregulation of our central stress response system.
Allen Anandarajah, MD, a rheumatologist at the University of Rochester Medical Center in New York, said research like Feldman's is helping to fill in the "undertones" needed to better understand the relationship between stress factors and autoimmune disease.
Feldman said she hopes her study will lead to primary care physicians and rheumatologists taking more complete patient histories and include information about abuse and mental illness.
Disclosures
The study authors disclosed no relevant relationships.
Primary Source
American College of Rheumatology
Feldman CH, et al "Association of exposure to childhood abuse with incident systemic lupus erythematosus in a longitudinal cohort of women" ACR 2018; Abstract 2807.