Abstract
Objectives
Trauma has been linked to incident SLE, but its relationship with SLE disease activity is unknown. This analysis examines associations between trauma exposures and patient-reported SLE disease activity and flares.
Methods
Data were from the California Lupus Epidemiology Study (CLUES). Flares were self-reported as any flare and, of those, flares accompanied by medical care (hospitalization or physician contact). The Systemic Lupus Activity Questionnaire (SLAQ) assessed disease activity. The Brief Trauma Questionnaire (BTQ) assessed all historical trauma exposures. The Adverse Childhood Experiences (ACEs) questionnaire was available for a subset. Multivariable regression analyses (n=252) examined whether trauma exposure was associated with flares or SLAQ controlling for age, sex, poverty, race/ethnicity, comorbidities, perceived stress, disease duration, and self-reported disease damage.
Results
Excluding exposure to serious illness, 63.4% reported ≥1 trauma exposure. Any traumatic event, excluding illness, doubled the odds of a flare (OR 2.27 [95% CI 1.24, 4.17]) and was associated with significantly higher SLAQ scores ( 2.31 [0.86, 3.76]). Adjusted odds of any flare and flare with medical care were significantly elevated for those with both BTQ and ACE exposures (5.91 [2.21, 15.82] and 4.69 [1.56, 14.07], respectively). SLAQ scores were also higher for those with both exposures ( 5.22 [3.00, 7.44]).
Conclusion
In this cohort, those with a history of trauma reported more flares and greater disease activity. Identifying mechanisms of associations between trauma and disease activity and flares, as well as interventions to mitigate the effects of trauma exposures is critical, given the high rates of trauma exposures.
Trauma has been linked to incident SLE, but its relationship with SLE disease activity is unknown. This analysis examines associations between trauma exposures and patient-reported SLE disease activity and flares.
Methods
Data were from the California Lupus Epidemiology Study (CLUES). Flares were self-reported as any flare and, of those, flares accompanied by medical care (hospitalization or physician contact). The Systemic Lupus Activity Questionnaire (SLAQ) assessed disease activity. The Brief Trauma Questionnaire (BTQ) assessed all historical trauma exposures. The Adverse Childhood Experiences (ACEs) questionnaire was available for a subset. Multivariable regression analyses (n=252) examined whether trauma exposure was associated with flares or SLAQ controlling for age, sex, poverty, race/ethnicity, comorbidities, perceived stress, disease duration, and self-reported disease damage.
Results
Excluding exposure to serious illness, 63.4% reported ≥1 trauma exposure. Any traumatic event, excluding illness, doubled the odds of a flare (OR 2.27 [95% CI 1.24, 4.17]) and was associated with significantly higher SLAQ scores ( 2.31 [0.86, 3.76]). Adjusted odds of any flare and flare with medical care were significantly elevated for those with both BTQ and ACE exposures (5.91 [2.21, 15.82] and 4.69 [1.56, 14.07], respectively). SLAQ scores were also higher for those with both exposures ( 5.22 [3.00, 7.44]).
Conclusion
In this cohort, those with a history of trauma reported more flares and greater disease activity. Identifying mechanisms of associations between trauma and disease activity and flares, as well as interventions to mitigate the effects of trauma exposures is critical, given the high rates of trauma exposures.
| Original language | English |
|---|---|
| Article number | keac690 |
| Journal | Rheumatology |
| Early online date | 8 Dec 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 8 Dec 2022 |
Keywords
- Systemic lupus erythematosus
- stress
- Trauma
- self-reported flares
- self-reported disease activity