Background/Purpose: Adverse Childhood Experiences (ACEs) measure traumatic experiences in childhood. ACEs are associated with epigenetic changes, are known to increase stress response and inflammation, and can contribute to the onset and progression of chronic disease. Childhood-onset systemic lupus erythematosus (cSLE) is a chronic autoimmune disorder characterized by inflammation of multiple organs in children. ACEs may therefore play a role in cSLE, however, there is a lack of studies on the impact of ACEs in cSLE. This study aimed to describe the prevalence of ACEs and to determine the association between ACEs and i) disease activity, and ii) disease damage in patients with cSLE.

Methods: A retrospective cohort study of 106 adolescents aged 9-18 years with cSLE who were followed in the SickKids lupus clinic and seen by Adolescent Medicine between July 2018-July 2020 was conducted. The presence of ACEs was determined through medical chart review in EPIC and Chartmaxx. Disease activity was measured by the SLEDAI-2K, and disease damage by the SLICC damage index (SDI defined as score >0). Separate multivariable logistic regression models were used to examine the relationship between the presence of ACEs and the disease measures, adjusting for age of diagnosis, gender, comorbid psychiatric diagnosis, and comorbid medical diagnosis.

Results: 37% of patients reported at least 1 ACE, of which 90% experienced the ACE >1 year before diagnosis. The most common ACE was separated/divorced parents (n=21). In multivariable regression analyses, there were no significant associations between ACEs and disease activity or damage. ACEs were significantly associated with comorbid psychiatric diagnoses.

Conclusion: We found that ACEs were prevalent in our cSLE cohort, and associated with psychiatric diagnosis, but not cSLE disease measures. Future study is needed to better understand the impact of ACEs on inflammation and neuropsychiatric function in cSLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adverse-childhood-experiences-prevalence-and-relationship-to-disease-in-childhood-onset-lupus/