Roberts AL, et al. - A longitudinal cohort study is conducted to analyze whether trauma exposure and posttraumatic stress disorder (PTSD) are related to the increased risk of incident systemic lupus erythematosus (SLE) in a civilian cohort. The outcome suggests that this study contributes to growing proof that psychosocial trauma and related stress responses may lead to autoimmune disease.

Methods

• In this study, they analyzed the relationship between trauma exposure and PTSD symptoms with SLE incidence of more than 24 years of follow-up in a U.S. longitudinal cohort of women (N=54,763).
• Incident SLE with ≥ 4 American College of Rheumatology criteria was determined by self-report and confirmed by medical record review.
• PTSD and trauma exposure were evaluated with the Short Screening Scale for DSM-IV PTSD and the Brief Trauma Questionnaire.
• Women were categorized as having: no trauma, trauma and no PTSD symptoms, subclinical PTSD (1-3 symptoms), or probable PTSD (4-7 symptoms).
• They inspected whether longitudinally assessed health risk factors (e.g., smoking, body mass index (BMI), oral contraceptive (OC) use) accounted for increased SLE risk among women with versus without trauma exposure and PTSD.

Results

• In this study, they found 73 cases of SLE occurred amid the follow-up.
• Compared to women with no trauma, probable PTSD was related to increased SLE risk (HR4-7 symptoms =2.94, 95% CI=1.19-7.26, p<0.05).
• Subclinical PTSD was related to increased SLE risk, though this did not reach statistical importance (HR1-3 symptoms =1.83, 95% CI=0.74-4.56, p=0.19).
• Smoking, BMI and OC use slightly attenuated associations (e.g., probable PTSD adjusted HR=2.62, 95% CI=1.09-6.48, p<0.05).
• Trauma exposure, regardless of PTSD symptoms, was firmly connected with incident SLE (HR=2.87, 95% CI=1.31, 6.28, p<0.01).