Adults with lupus who report having had adverse childhood experiences (ACEs), such as abuse, neglect and household challenges, report higher disease activity, depression and poorer overall health compared to those without such experiences, according to a study by researchers at UC San Francisco.

"Our results support the notion that stress in the form of ACEs may be a factor in poor health in systemic lupus, both in disease development and in more severe outcomes," said lead author Kimberly DeQuattro, MD, a clinical fellow in rheumatology at UCSF. "These findings are a call to action to focus efforts on ACE prevention in childhood, as well as clinical and mental health interventions that foster resilience in adulthood."

Studies have shown that a large percentage of adults have had adverse childhood experiences. According to the U.S. Centers for Disease Control and Prevention, ACEs have been linked to risky health behaviors, chronic health conditions, low life potential and early death. They also are believed to be a risk factor for autoimmune diseases such as lupus.

In the Arthritis Care & Research study, DeQuattro and her colleagues surveyed 269 lupus patients in the California Lupus Epidemiology Study (CLUES) who completed the ACE questionnaire, a 10-item survey covering abuse, neglect and household challenges. These patients were compared to 6,107 participants from the 2015 California Behavioral Risk Factor Surveillance System (BRFSS), which also includes an ACE questionnaire. The researchers then examined five patient-reported outcomes (lupus flares, damage, depression, physical function and quality of life) with three physician-assessed measures (lupus flares, damage and severity indices) made during an in-person study visit with the patients.

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