Citation

Feldman CH, Malspeis S, Leatherwood C, Kubzansky L, Costenbader KH, Roberts AL. J. Rheumatol. 2019; ePub(ePub): ePub.

Affiliation

From the Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA. This study was supported by NIH K23 AR071500 (CH Feldman) and NIH R01 AR057327 and K24 AR066109 (KH Costenbader). We acknowledge the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School for its management of the Nurses' Health Study II. The NHSII is supported by UM1 CA176726. Address correspondence to Candace H. Feldman, MD, ScD, 60 Fenwood Road, Office 6016P, Boston, MA 02115. Email: cfeldman@bwh.harvard.edu.

Copyright

(Copyright © 2019, Journal of Rheumatology Publishing)

DOI

10.3899/jrheum.190009

PMID

31092723

Abstract

OBJECTIVE: Exposure to severe stressors may alter immune function and augment inflammation and cytokine release, increasing autoimmune disease risk. We examined if childhood abuse was associated with heightened risk of incident systemic lupus erythematosus (SLE).

METHODS: Data were from the Nurses' Health Study II, a cohort of U.S. female nurses enrolled in 1989, followed with biennial questionnaires. We measured childhood physical and emotional abuse with the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and sexual abuse with the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale, both administered in 2001. We identified incident SLE (>4 American College of Rheumatology 1997 classification criteria) through 2015. We used multivariable Cox regression models to evaluate the association between childhood abuse and SLE accounting for potential confounders (e.g. parental education, occupation, home ownership) and mediators (e.g. depression, posttraumatic stress disorder (PTSD)).

RESULTS: Among 67,516 women, there were 94 incident SLE cases. In adjusted models, exposure to the highest vs. lowest physical and emotional abuse was associated with 2.57 times greater risk of SLE (95% CI 1.30-5.12). We found that 17% (p<0.0001) of SLE risk associated with abuse could be explained by depression and 23% (p<0.0001) by PTSD. We did not observe a statistically significant association with sexual abuse (HR 0.84, 95% CI 0.40-1.77, highest vs. lowest exposure).

CONCLUSION: We observed significantly increased risk of SLE among women who experienced childhood physical and emotional abuse compared with women who had not. Exposure to childhood adversity may contribute to SLE development.

Language: en