Objective To investigate the relationship between adverse childhood experiences (ACEs) and health outcomes in childhood-onset SLE (cSLE). Methods We conducted a retrospective cohort study of cSLE outpatients aged 9–18 years at a Canadian tertiary centre from July 2018 to June 2020. ACEs data were collected from electronic medical records, categorised according to the US Centers for Disease Control-Kaiser framework and in relationship to time of cSLE diagnosis. Primary outcomes included disease activity, disease damage and comorbid psychiatric diagnoses (not attributable to cSLE). Secondary outcomes included neuropsychiatric SLE (NPSLE), lupus nephritis and arthritis. Regression models examined the relationship between (1) presence (yes/no) and (2) timing of ACEs (none vs before vs after cSLE diagnosis) and the outcomes. Covariates included sex, ethnicity, age at diagnosis, disease duration, nephritis/NPSLE and glucocorticoid use. Results Of 224 patients with cSLE, 41% had documented ACEs. The presence of ACEs was associated with NPSLE (adjusted OR=3.40, 95% CI 1.55 to 7.78, p=0.003). ACEs occurring before diagnosis were associated with disease damage (adjusted OR 3.10, 95% CI 1.21 to 8.04, p=0.018) and NPSLE (adjusted OR=2.67, 95% CI 1.02 to 6.98, p=0.043). ACEs occurring after cSLE diagnosis were associated with comorbid psychiatric diagnosis (adjusted OR=5.01, 95% CI 1.20 to 21.12, p=0.025). ACEs were not associated with disease activity, nephritis or arthritis. Conclusion ACEs exposure was prevalent in this cSLE cohort, associated with NPSLE diagnosis, disease damage and comorbid psychiatric diagnoses. These findings suggest that early-life stressors may contribute to cSLE morbidity, particularly neuropsychiatric features, emphasising the importance of addressing psychosocial issues in the context of medical care.
Fevrier et al. (Thu,) studied this question.