Rubinstein Tamar B, Bullock Danielle R, Ardalan Kaveh, Mowrey Wenzhu B, Brown Nicole M, Bauman Laurie J, Stein Ruth E K
Division of Pediatric Rheumatology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY.
Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
J Pediatr. 2020 Nov;226:243-250.e2. doi: 10.1016/j.jpeds.2020.06.046. Epub 2020 Jun 15.
To determine whether there is an association between adverse childhood experiences (ACEs) and childhood-onset arthritis, comparing youth with arthritis to both healthy youth and youth with other acquired chronic physical diseases (OCPD); and to examine whether ACEs are associated with disease-related characteristics among children with arthritis.
In a cross-sectional analysis of data from the 2016 National Survey of Children's Health we examined whether ACEs were associated with having arthritis vs either being healthy or having a nonrheumatologic OCPD. ACE scores were categorized as 0, 1, 2-3, ≥4 ACEs. Multinomial logistic regression models examined associations between ACEs and health status while adjusting for age, sex, race/ethnicity, and poverty status. Among children with arthritis, associations between ACEs and disease-related characteristics were assessed by Pearson χ analyses.
Compared with children with no ACEs, children with 1, 2-3, and ≥4 ACEs had an increased odds of having arthritis vs being healthy (adjusted OR for ≥4 ACEs, 9.4; 95% CI, 4.0-22.1) and vs OCPD (adjusted OR for ≥4 ACEs, 3.7; 95% CI-1.7, 8.1). Among children with arthritis, ACEs were associated with worse physical impairment.
Children with higher numbers of ACEs are more likely to have arthritis, when arthritis status is compared either with being healthy or with having OCPD. Further studies are needed to determine the direction of the association between ACEs and childhood arthritis, its impact on disease course, and potential intervention targets that might mitigate these effects.
通过将患有关节炎的青少年与健康青少年以及患有其他后天性慢性身体疾病（OCPD）的青少年进行比较，确定童年不良经历（ACEs）与儿童期关节炎之间是否存在关联；并研究ACEs是否与关节炎患儿的疾病相关特征有关。
在对2016年全国儿童健康调查数据的横断面分析中，我们研究了ACEs是否与患有关节炎、健康或患有非风湿性OCPD相关。ACE得分分为0、1、2 - 3、≥4次ACEs。多项逻辑回归模型在调整年龄、性别、种族/民族和贫困状况的同时，研究了ACEs与健康状况之间的关联。在患有关节炎的儿童中，通过Pearson χ分析评估ACEs与疾病相关特征之间的关联。
与没有ACEs的儿童相比，有1次、2 - 3次和≥4次ACEs的儿童患有关节炎而非健康的几率增加（≥4次ACEs的调整比值比为9.4；95%置信区间为4.0 - 22.1），患有关节炎而非OCPD的几率也增加（≥4次ACEs的调整比值比为3.7；95%置信区间为1.7 - 8.1）。在患有关节炎的儿童中，ACEs与更严重的身体损伤有关。
当将关节炎状况与健康状况或患有OCPD进行比较时，ACEs次数较多的儿童更有可能患有关节炎。需要进一步研究来确定ACEs与儿童关节炎之间关联的方向、其对疾病进程的影响以及可能减轻这些影响的潜在干预靶点。
