Background/Purpose: Prior studies demonstrated associations between post-traumatic stress disorder and increased risk of incident SLE and between childhood trauma and increased risk of hospitalization for autoimmune disease during adulthood. Severe stressors may alter immune function and result in increased inflammation and cytokine release, thereby increasing risk of SLE. We examined if childhood abuse is associated with increased risk of incident SLE.

Methods: Data are from the Nurses’ Health Study II, a longitudinal cohort of female U.S.-based nurses enrolled in 1989 followed with biennial questionnaires. To measure childhood physical and emotional maltreatment, we used the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire (CTQ), for sexual abuse, the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scales (CTS-SA), and for childhood physical assault, the Physical Assault Scale of the Conflict Tactics Scales (CTS-PA), all administered in 2001 with 75% response rate (68,505/91,268). Higher scores indicate more frequent abuse. We defined incident SLE through 2015 by self-report, confirmed by medical record review with >4 SLE ACR criteria. We excluded 1,071 women with missing childhood abuse exposure data or with self-reported, unconfirmed connective tissue disease. Multivariable Cox regression models evaluated the association (hazard ratio [HR] and 95% CI) between childhood abuse and incident SLE. We examined whether biennially assessed risk factors (e.g. smoking, BMI, alcohol use, oral contraceptive use) and potential confounders (e.g. age, race, median household income, parental education) accounted for increased SLE risk among those with vs. without childhood abuse exposure.

Results: Among 67,434 women, with a mean age of 34.6 (SD 4.8) in 1989, with >24 years of follow-up, there were 93 incident SLE cases. In age and race-adjusted models, exposure to the highest vs. lowest physical and emotional maltreatment was associated with >2-fold greater risk of SLE (HR 2.21 (95% CI 1.29-3.80)). Exposure to moderate and high levels of physical assault was associated with 1.70 (95% CI 1.08-2.68) times higher risk of SLE vs. no exposure. We did not find statistically significant associations between sexual abuse and SLE risk. After additionally accounting for potential lifestyle, reproductive and socioeconomic factors in separate models, HRs were only slightly attenuated (Table).

Conclusion: In this longitudinal cohort, we observed significantly increased risk of incident SLE among women who experienced childhood physical and emotional abuse compared with women who had not. Our findings suggest that exposure to extreme childhood stress and adversity may contribute to SLE development. Further studies are needed to investigate the role of timing and of the socioenvironmental context of abuse exposures and potential underlying mechanisms.