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Research ArticleSystemic Lupus Erythematosus

Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women

Candace H. Feldman, Susan Malspeis, Cianna Leatherwood, Laura Kubzansky, Karen H. Costenbader and Andrea L. Roberts
The Journal of Rheumatology December 2019, 46 (12) 1589-1596; DOI: https://doi.org/10.3899/jrheum.190009
Candace H. Feldman
From the Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
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  • For correspondence: cfeldman@bwh.harvard.edu
Susan Malspeis
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Cianna Leatherwood
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Laura Kubzansky
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Karen H. Costenbader
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Andrea L. Roberts
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Abstract

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

Methods. Data were drawn from the Nurses’ Health Study II, a cohort of US 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 cases of incident SLE. In adjusted models, exposure to the highest versus 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 had experienced childhood physical and emotional abuse compared with women who had not. Exposure to childhood adversity may contribute to development of SLE.

Key Indexing Terms:
  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • EPIDEMIOLOGY
  • RISK FACTORS
  • NURSES’ HEALTH STUDY II

Footnotes

  • Dr. Feldman was supported by US National Institutes of Health (NIH) K23 AR071500 and Dr. Costenbader was supported by NIH R01 AR057327 and K24 AR066109. The Nurses’ Health Study II is supported by UM1 CA176726.

  • Accepted for publication April 24, 2019.
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The Journal of Rheumatology
Vol. 46, Issue 12
1 Dec 2019
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Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women
Candace H. Feldman, Susan Malspeis, Cianna Leatherwood, Laura Kubzansky, Karen H. Costenbader, Andrea L. Roberts
The Journal of Rheumatology Dec 2019, 46 (12) 1589-1596; DOI: 10.3899/jrheum.190009

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Association of Childhood Abuse with Incident Systemic Lupus Erythematosus in Adulthood in a Longitudinal Cohort of Women
Candace H. Feldman, Susan Malspeis, Cianna Leatherwood, Laura Kubzansky, Karen H. Costenbader, Andrea L. Roberts
The Journal of Rheumatology Dec 2019, 46 (12) 1589-1596; DOI: 10.3899/jrheum.190009
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Keywords

SYSTEMIC LUPUS ERYTHEMATOSUS
EPIDEMIOLOGY
RISK FACTORS
NURSES’ HEALTH STUDY II

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