Background/Purpose: Childhood-onset systemic lupus erythematosus (cSLE) is an autoimmune disease characterized by multi-organ inflammation, alongside high frequencies of mood disorders and cognitive impairment. Adverse Childhood Experiences (ACEs) quantify traumatic childhood events, which have been linked to altered immune response and increased chronic disease risk. Prior studies indicate those with ≥ 4 ACEs, including adults with SLE, face higher risk of worse health outcomes. Limited research exists on ACEs in cSLE. We aimed to describe the prevalence of ACEs among cSLE patients and investigate associations with i) disease activity, ii) patient-reported outcome measures, and iii) self-reported executive function.

Methods: This cross-sectional study analyzed prospective data from cSLE patients aged 13-19 years at the time of assessment. The Pediatric ACEs and Related Life Events Screener (PEARLS) measured 19 self-reported ACEs. Disease activity over the time since diagnosis was measured by the adjusted mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K). The Patient Reported Outcomes Information System (PROMIS) Pediatric-37 Profile assessed patient-reported anxiety, depression, and fatigue. The Behavior Rating Inventory of Executive Function (BRIEF-2) Global Executive Composite score measured executive function. The frequency of ACEs types was tabulated, and patients were classified into high-risk (≥ 4 ACEs) and low-risk (≤ 3 ACEs) groups. Associations between ACEs risk group and the outcomes were examined using regression analyses with generalized linear models, adjusted for age.

Results: Of 50 cSLE patients (mean age 15.20 ± 1.86 years, 84% female), 72% reported at least 1 ACE, and 30% reported ≥ 4 ACEs (Table 1). The most common ACEs were caregiver verbal abuse, emotional neglect, and separation, as well as community violence (Figure 1). Being in the high-risk ACEs group compared to low risk, was significantly associated with worse scores for PROMIS anxiety (p< 0.001), depression (p< 0.001), and fatigue (p< 0.001), alongside poorer executive function scores (p< 0.001) (Figure 2). No significant associations were observed for disease activity (p=0.263).

Conclusion: Within our cSLE cohort, ACEs were substantially prevalent, with almost a third of patients having experienced ≥ 4 ACEs. The high risk group had significantly worse patient-reported outcomes and executive function. These results underscore the impact of ACEs on patient well-being, emphasizing the need for integrated medical and mental health care approaches. Future research should examine these associations in larger cohorts.

Figure 1 illustrates the distribution of nineteen self-reported adverse childhood experiences (ACEs) types within our cSLE cohort (n=50). Among the total ACEs (n=135) self-reported on the patient PEARLS questionnaire, the most commonly reported ACEs were caregiver verbal abuse (n=18), community violence (n=14), emotional neglect (n=14), and caregiver separation/divorce (n=14).

Figure 2 contains four sets of boxplots depicting differences in mean outcome scores between the high-risk and low-risk ACEs groups. Associations show beta coefficients, confidence intervals, and p-values from regression analyses. Regression analyses showed significant associations for worse PROMIS anxiety (p < 0.001), depression (p < 0.001), and fatigue (p < 0.001) scores alongside poorer executive function (p < 0.001) within the high-risk group. The p-value threshold used for significance was p < 0.05.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adverse-childhood-experiences-prevalence-and-relationship-to-disease-and-mental-health-outcomes-in-childhood-onset-systemic-lupus-erythematosus-csle/