AB1351 Systemic rheumatic diseases and cumulative childhood stress

Abstract

Background: It has been suggested that the adaptative stress response may be disrupt by life adverse events. Childhood maltreatment has been linked to increased inflammatory markers such as C reactive protein levels and increased prevalence of autoimmune disorders in adulthood. The mechanisms that underlie such association are not clear but it has been postulated that a dysregulated hypophysis adrenal axis, accelerated immune cell ageing and altered immune cell gene expression pattern may play a role. Objective(s): To study the prevalence of adverse childhood experiences (ACEs) in a sample of patients with systemic lupus erythematosus (SLE), spondyloarthritis (SpA), scleroderma (SSc) and rheumatoid arthritis (RA) comparing them with controls. Method(s): After approval from the local Committee of Ethics in Research, we interview 315 patients with rheumatic disease (100 SLE; 40 SSc; 60 SpA; 115 RA) and 272 controls applying the ACEs Study questionnaire with questions on childhood abuse, negligence, domestic violence and household dysfunctions. This questionnaire score ranges from zero (best result) to 8 (worst scenario). Controls were paired for age (p=0.39), gender p=0.64), monetary income (p=0.20), religiosity (p=0.19) and years of formal education (p=0.62). Result(s): In the whole group of rheumatic patients the median number of ACEs was 3 (IQR 2,5-5); in the controls was 3 (IQR=2-5) with p=0.45. About 201/315 (63.8%) of patients had ACEs score >=3; the controls had 163/272 (59.9%) with p=0.31. In the SLE group 64/100 (64%) of the patients have had at least 3 ACEs; in SSc group 24/40 (60%); in SpA 36/60 (60%); in RA 77/115 (66.9%) and in controls 163/272 (59.9%). Studying the prevalence of ACEs according to the rheumatic disease it was found that patients did not differ from controls in SLE (p=0.47 for ACEs scale and 0.87 in the number of ACEs>=3); in SSc (p=0.67 for ACEs scale and 0.72 in the number of ACEs>=3); in SpA (p=0.92 for ACEs scale and 0.21 in the number of ACEs>=3); neither in RA (p=0.06 for ACEs scale and 0.14 in the number of ACEs>=3). Conclusion(s): In this sample, it was not possible to associate the ocurrance of ACEs with the appearance of rheumatic diseases in adulthood.