Adverse childhood experience and rheumatic diseases

Abstract

It has been suggested that the adaptive stress response may be disrupted by life adverse events such as childhood maltreatment. To investigate if the number of adverse childhood experiences (ACEs) increases susceptibility to systemic lupus erythematosus (SLE), spondyloarthritis (SpA), scleroderma (SSc), and rheumatoid arthritis (RA), we interviewed 315 patients with rheumatic disease (100 SLE; 40 SSc; 60 SpA; 115 RA) and 272 controls, using questions of the ACEs study questionnaire validated to ask about experiences of childhood abuse, negligence, domestic violence, and household dysfunctions. The questionnaire score ranges from zero (best result) to 8 (worst scenario). Patients and controls did not differ regarding the median number of ACEs (3 in both groups, patient IQR = 2.5-5 vs. control IQR = 2-5, p = 0.45). Among the patients, 63.8% (201/315) presented ACE score ≥ 3, compared with 59.9% (163/272) of the controls (p = 0.31). The proportion of patients with at least 3 ACEs did also not differ among those with different rheumatic diseases. Specifically, 64% (64/100) of those with SLE, 60% (24/40) of those with SSc, 60% (36/60) of those with SpA, and 66.9% (77/115) of those with RA reported at least 3 ACEs. There was also no difference between the distribution of ACE scores and number of individuals with ACEs ≥ 3 between patients with different rheumatic diseases and controls. Nevertheless, there was a trend for association between higher ACE score and susceptibility to RA (p = 0.06). In this setting, the occurrence of ACEs was not associated with susceptibility to rheumatic diseases in adulthood.

Adverse childhood experiences predict reaction to multiple sclerosis diagnosis

“…As hypothesized, our preliminary findings indicated that childhood trauma, as measured by the ACEs, significantly predicted poorer health-related quality of life and increased emotional distress in individuals with MS, both at the time of diagnosis, as well as at a one-year follow-up. These findings are consistent with those from previous studies in the general population demonstrating a strong link between ACEs and a range of detrimental medical, behavioral, and psychological outcomes in adulthood ( Chapman et al, 2004 ; Dube et al, 2009 ; Felitti et al, 1998 ; Merrick et al, 2017 , 2019 ), including a variety of autoimmune disorders ( DeQuattro et al, 2020 ; Dube et al, 2009 ; Luiz et al, 2018 ). Our findings also expand on the initial research in individuals with MS, linking childhood trauma to an increased relapse rate ( Spitzer et al, 2012 ) and ACEs with age of onset and cognitive functioning ( Shaw et al, 2017 ).…”

“…Adverse childhood experiences have also been linked to autoimmune disorders, with those experiencing two or more events in childhood at a higher risk for hospitalization with a diagnosis of an autoimmune disorder well into adulthood ( Dube et al, 2009 ). ACEs scores were additionally associated with prevalence and severity of systemic lupus erythematosus (SLE) ( DeQuattro et al, 2020 ) and rheumatic diseases ( Luiz et al, 2018 ). However, the role of childhood trauma has not been well characterized in MS.…”

Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study

“…Among adults, however, conflicting findings exist. In one study, although ACEs were associated with susceptibility to rheumatoid arthritis, prevalence rates were not significantly different between adults exposed to ACEs and those in the general population ( Luiz et al, 2018 ). However, over 75% of adults with rheumatoid arthritis affirmed a history of ACEs in a 2014 study by Lisitsyna et al (2014) .…”

Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease

“…This figure proposes a model for how ACEs may play an underappreciated (but addressable) role in pathogenesis for both disease processes through neuroendocrine changes development (Fig. 1) [15][16][17][18]. These drivers are quite common and, given the high prevalence of chronic pain and its lasting impact on physical, social, and emotional well-being well into adulthood, the relationship between ACEs and chronic pain is of significant interest not just for pain specialists, but all pediatric providers [19].…”