NIH/National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
Fred Hutchinson Cancer Center, Seattle, Washington.
Arthritis Care Res (Hoboken). 2023 Dec;75(12):2519-2528. doi: 10.1002/acr.25164. Epub 2023 Jul 14.
Growing evidence suggests psychosocial stressors may increase risk of developing autoimmune disease. We examined stressful life events and caregiving in relation to incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in the Women's Health Initiative Observational Study cohort.
The sample of postmenopausal women included 211 incident RA or SLE cases reported within 3 years after enrollment, confirmed by use of disease-modifying antirheumatic drugs (i.e., probable RA/SLE), and 76,648 noncases. Baseline questionnaires asked about life events in the past year, caregiving, and social support. We used Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs), adjusting for age, race/ethnicity, occupational class, education, pack-years of smoking and BMI.
Incident RA/SLE was associated with reporting 3 or more life events (e.g., age-adjusted HR 1.70 [95% CI 1.14, 2.53]; P for trend = 0.0026). Elevated HRs were noted for physical (HR 2.48 [95% CI 1.02, 6.04]) and verbal (HR 1.34 [0.89, 2.02]) abuse (P for trend = 0.0614), 2 or more interpersonal events (HR 1.23 [95% CI 0.87, 1.73]; P for trend = 0.2403), financial stress (HR 1.22 [95% CI 0.90, 1.64]), and caregiving 3 or more days per week (HR 1.25 [95% CI 0.87, 1.81]; P for trend = 0.2571). Results were similar, excluding women with baseline symptoms of depression or moderate-to-severe joint pain in the absence of diagnosed arthritis.
Our findings support the idea that diverse stressors may increase risk of developing probable RA or SLE in postmenopausal women, supporting the need for further studies in autoimmune rheumatic diseases, including childhood adverse events, life event trajectories, and modifying psychosocial and socioeconomic factors.
越来越多的证据表明，心理社会压力源可能会增加自身免疫性疾病的发病风险。我们在妇女健康倡议观察研究队列中研究了生活应激事件和照护与类风湿关节炎（RA）和系统性红斑狼疮（SLE）发病的关系。
该队列包括 211 例报告发病时间在入组后 3 年内的绝经后女性 RA 或 SLE 病例（使用疾病修饰抗风湿药物确诊，即可能的 RA/SLE）和 76648 例非病例。基线问卷询问了过去 1 年的生活事件、照护和社会支持情况。我们使用 Cox 回归模型计算了危险比（HR）和 95%置信区间（95%CI），并调整了年龄、种族/民族、职业阶层、教育、吸烟包年数和 BMI。
RA/SLE 发病与报告 3 次或以上生活事件（如年龄调整 HR 1.70[95%CI 1.14, 2.53]；趋势 P 值=0.0026）相关。躯体虐待（HR 2.48[95%CI 1.02, 6.04]）和言语虐待（HR 1.34[0.89, 2.02]）、2 次或以上人际事件（HR 1.23[95%CI 0.87, 1.73]；趋势 P 值=0.2403）、经济压力（HR 1.22[95%CI 0.90, 1.64]）和每周照护 3 天或以上（HR 1.25[95%CI 0.87, 1.81]；趋势 P 值=0.2571）与 RA/SLE 发病相关。排除基线时有抑郁症状或无诊断性关节炎的中度至重度关节痛的女性后，结果相似。
我们的发现支持这样一种观点，即多种压力源可能会增加绝经后女性发生可能的 RA 或 SLE 的风险，这支持了在自身免疫性风湿病中进一步研究包括儿童期不良事件、生活事件轨迹和调节心理社会及社会经济因素在内的必要性。
