Trauma Associated With Incident Systemic Lupus Erythematosus in Women

Mounting evidence suggests that psychosocial trauma and associated stress responses may lead to the development of autoimmune diseases, including systemic lupus erythematosus (SLE). A longitudinal study published in Rheumatism & Arthritis sought to examine whether exposure to trauma and posttraumatic stress disorder (PTSD) were associated with an increased risk for incident SLE.

A US cohort of 54,763 civilian women was analyzed over a 24-year follow-up period. The presence of incident SLE with ≥4 American College of Rheumatology (ACR) criteria was established by participant self-report and confirmed by medical record review. Trauma exposure and PTSD were evaluated via the Short Screening Scale of DSM-IV PTSD and the Brief Trauma Questionnaire.

Women were categorized as having no trauma, trauma and no PTSD symptoms, subclinical PTSD (defined as having 1 to 3 PTSD symptoms), or probable PTSD (defined as having 4 to 7 PTSD symptoms). The researchers investigated whether longitudinally assessed health risk factors, including smoking, body mass index (BMI), and oral contraceptive (OC) use, was associated with increased SLE risk in study participants with and without a history of trauma exposure or PTSD.

A total of 73 cases of SLE were reported over the 24-year follow-up period. Probable PTSD was significantly associated with an increased risk for SLE in women who experienced trauma vs women with no trauma (hazard ratio [HR], 2.94; 95% CI, 1.19-7.26; P <.05). In contrast, subclinical PTSD was associated with an increased SLE risk, but it was not significant (HR, 1.83; 95% CI, 0.74-4.56; P =.19).

Smoking, BMI, and OC use diminished these associations slightly (probable PTSD adjusted HR, 2.62; 95% CI, 1.09-6.48; P <.05). Trauma exposure, regardless of presence of PTSD symptoms, was significantly associated with incident SLE (HR, 2.87; 95% CI, 1.31-6.28; P <.01).

The investigators concluded that identification of the biologic pathways by which psychosocial trauma may increase a woman’s risk for autoimmune disorders is critical and may offer greater insight into disease etiology and strategies for prevention. Future studies are warranted in order to determine whether treatment of PTSD affects these pathways and lifestyle interventions can reduce the risk for autoimmune disorders following trauma or PTSD.

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Reference

Roberts AL, Malspeis S, Kubzansky LD, et al. Association of trauma and posttraumatic stress disorder with incident systemic lupus erythematosus (SLE) in a longitudinal cohort of women [published online September 20, 2017]. Arthritis Rheumatol. doi:10.1002/art.40222