MADRID (FRONTLINE MEDICAL NEWS) – Adult patients with systemic lupus erythematosus (SLE) who had several adverse experiences as children generally had a worse disease state than did similar adult lupus patients with no adverse childhood experiences in a study of 166 California lupus patients.

Higher numbers of self-reported episodes of household challenges, neglect, and especially childhood abuse were associated with worse SLE outcomes, Kimberly DeQuattro, MD , said while presenting a poster at the European Congress of Rheumatology.

Adult SLE patients with a history of several such episodes were relatively common, with 18% of patients self-reporting four or more episodes, said Dr. DeQuattro, a rheumatologist at the University of California, San Francisco.

It remains unclear “why there is an association between childhood trauma and outcomes of chronic disease, especially autoimmune disease,” she said in an interview. “We want to know, What does it mean [clinically] to have been abused or neglected, and is it irreversible?” She called for further understanding of childhood adverse experiences and their consequences. These patients might benefit from referrals to psychologists or social workers, Dr. DeQuattro suggested.

The data for her analysis came from 166 adult SLE patients who participated in the California Lupus Epidemiology Study and completed several disease activity surveys, as well as the Adverse Childhood Experience survey , which measures episodes of abuse, neglect, and household challenges. The patients averaged 44 years old and had been diagnosed with SLE for an average of about 16 years. More than 60% of the 166 participants reported at least one episode on this survey. “One event does not make a big difference,” Dr. DeQuattro said, but that wasn’t the case for the SLE patients who reported having four of more of these childhood events.

Patients with a higher number of adverse childhood experiences had worse disease states, as measured by the Systemic Lupus Activity Questionnaire; the Brief Index of Lupus Damage ; the 36-Item Short Form Health Survey , a measure of quality of life; and the Patient Health Questionnaire 8 , a measure of depression, the researchers said in their report . For example, the average score on the Systemic Lupus Activity Questionnaire was 6.0 in 66 patients with no adverse childhood experiences and 11.8 in the 30 patients who reported having four or more adverse childhood experiences.

Dr. DeQuattro had no relevant financial disclosures.

On Twitter @mitchelzoler


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