TOPLINE:

Childhood-onset systemic lupus erythematosus (SLE) coupled with adverse childhood experiences (ACEs) raises the risk for neuropsychiatric SLE, a study found. 

METHODOLOGY:

• A retrospective cohort study was conducted to assess the link between ACEs and disease outcomes in patients with childhood-onset SLE at a Canadian tertiary center.
• Researchers analyzed data on 224 patients with childhood-onset SLE (median age, 15.86 years; median age at diagnosis, 13.24 years; 84.8% girls) obtained from two cohorts.
• ACEs were identified using electronic health records, with supplemental data from the Kiddie Schedule for Affective Disorders and Schizophrenia for a subset of 43 patients.
• ACEs, classified by whether they occurred before or after diagnosis of childhood-onset SLE, included adversities such as the separation/divorce of parents, abuse, neglect, and domestic violence.
• Primary outcomes were disease activity, the presence of disease damage, and comorbid psychiatric diagnoses; secondary outcomes were clinical manifestations — lupus nephritis, arthritis, and neuropsychiatric SLE.

TAKEAWAY:

• Among the 224 patients with childhood-onset SLE, 92 (41.1%) had at least one ACE, of whom 50 had an ACE before the diagnosis and 14 after the diagnosis.
• ACEs occurring before the diagnosis of childhood-onset SLE were linked to higher odds of disease damage (adjusted odds ratio [aOR], 3.10; P = .018) and neuropsychiatric SLE (aOR, 2.67; P = .043).
• ACEs occurring after disease diagnosis were associated with increased odds of comorbid psychiatric diagnosis (aOR, 5.01; P = .025).
• ACEs were associated with more than threefold higher odds of neuropsychiatric SLE diagnosis (aOR, 3.40; P = .003) but were not associated with disease activity, lupus nephritis, or arthritis.

IN PRACTICE:

The study findings “highlight the complex relationship between ACEs and their implications for clinical and psychosocial outcomes,” the authors wrote, underscoring “the need for a comprehensive healthcare approach that addresses social determinants of health like ACEs, through targeted strategies for trauma-informed care.” They suggest that clinical screening for ACEs among all patients with SLE may be warranted. 

SOURCE:

This study was led by Stephanie Fevrier, MS, The Hospital for Sick Children in Toronto, Ontario, Canada. It was published online on April 20, 2026, in Lupus Science & Medicine.

LIMITATIONS:

The single-center design may affect the generalizability of the findings. Incomplete reporting and documentation may have led to some cases not being identified. Delays between symptom onset and childhood-onset SLE diagnosis may have affected the classification of timing of ACEs.

DISCLOSURES:

The study received funding from the Lupus Research Alliance Program Administrative Supplement, Lupus Research Alliance Novel Research Grant and Empowering Lupus Research Career Development Award, US Department of Defense Lupus Research Program Impact Award, and Canadian Institutes of Health Research Canada Research Chair in Mental Health of Chronic Disease of Childhood. No conflicts of interest were declared by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.