Background/Purpose: Adverse Childhood Experiences (ACEs) are associated with increased risk of chronic disease and poorer health in children and adults. Emerging data suggest an association between exposure to ACEs and autoimmune diseases in adults, but the relationship between ACEs and childhood-onset rheumatologic diseases has not been examined. Our objective was to investigate the relationship between ACEs and arthritis, the most common manifestation of childhood-onset rheumatologic disease, and to examine the relationship between ACEs and health-related outcomes in children with arthritis.

Methods: We examined data from the 2016 National Survey of Children’s Health (NSCH) to describe the distribution of ACEs among children with current arthritis compared to 1) children with other chronic acquired physical conditions (CAPC)* and 2) all other children. The NSCH is a survey of sampled households with children <18 years conducted by the US Census Bureau. We performed bivariate and multivariable logistic regression to determine associations between arthritis and cumulative ACE scores, measured as a categorical variable (0 ACEs, 1 ACE, 2-3 ACEs, ≥4 ACEs). Chi-square tests and non-parametric tests for linear trends were used to assess associations between cumulative ACE scores and health-related outcomes.

Results: Among 138 children with current arthritis, 123 had complete ACE data and were included in the analysis. Sixty-five percent of children with arthritis were reported to have at least one ACE, while 40% (p<0.001) of children without arthritis and 53% (p<0.001) of children with other CAPC were exposed to ACEs. Children with a high exposure (≥4 ACEs) were more likely to have arthritis compared to those without ACE exposure, odds ratio (OR=5.4, 95% confidence interval (CI) (3.2, 9.2) (p<0.001). High ACE exposure compared to none was associated with higher likelihood of having arthritis versus having other CAPC, OR=3.4, 95% CI (2, 5.8) (p<0.001). A graded relationship was observed between ACE scores and arthritis in logistic regression models for both children with CAPC and all children (Table 1). Among children with arthritis, children with high ACE exposure had the highest proportion of physical impairment (95%) and comorbid depression/anxiety (68%) with significant linear trends of increasing proportions of affected children for both outcomes across increasing ACE scores, (p=0.001, p<0.001)

Conclusion: A markedly high prevalence of ACEs is reported among youth with arthritis from a large national survey. Higher ACE scores were associated with increased odds of arthritis and among children with arthritis, increased proportions of mental illness and physical impairment. Future investigations should examine how adversity may play a role in arthritis development, disease severity, and physical and mental health outcomes.