Perceived Stress and Prediction of Worse Disease Activity and Symptoms in a Multiracial, Multiethnic Systemic Lupus Erythematosus Cohort

• Published in: Arthritis care & research (2010) 2023-08, Vol.75 (8), p.1681-1689
• Main Authors: Patterson, Sarah, Trupin, Laura, Hartogensis, Wendy, DeQuattro, Kimberly, Lanata, Cristina, Gordon, Caroline, Barbour, Kamil E., Greenlund, Kurt J., Dall'Era, Maria, Yazdany, Jinoos, Katz, Patricia
• Format: Article
• Language: English
• Subjects: Adult; Autoimmune diseases; Autoimmunity; Epidemiology; Fatigue; Fatigue - complications; Fatigue - diagnosis; Fatigue - epidemiology; Female; Humans; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - epidemiology; Male; Middle Aged; Pain; Pain - complications; Racial Groups; Severity of Illness Index; Stress, Psychological - diagnosis; Stress, Psychological - epidemiology; Systemic lupus erythematosus
• ISSN: 2151-464X; 2151-4658; 2151-4658
• DOI: 10.1002/acr.25076

Objective Studies have suggested a potential link between traumatic experiences, psychological stress, and autoimmunity, but the impact of stress on disease activity and symptom severity in systemic lupus erythematosus (SLE) remains unclear. The present study was undertaken to examine whether increases in perceived stress independently associate with worse SLE disease outcomes over 3 years of follow‐up. Methods Participants were drawn from the California Lupus Epidemiology Study (CLUES). Stress was measured annually using the 4‐item Perceived Stress Scale (PSS). Participants with increases of ≥0.5 SD in PSS score were defined as having an increase in stress. Four outcomes were measured at the year 3 follow‐up visit: physician‐assessed disease activity (Systemic Lupus Erythematosus Disease Activity Index); patient‐reported disease activity (Systemic Lupus Activity Questionnaire); pain (Patient‐Reported Outcomes Measurement Information System [PROMIS] pain interference scale); and fatigue (PROMIS fatigue scale). Multivariable linear regression evaluated longitudinal associations of increase in stress with all 4 outcomes while controlling for potential confounders. Results The sample (n = 260) was 91% female, 36% Asian, 30% White, 22% Hispanic, and 11% African American; the mean ± SD age was 46 ± 14 years. In adjusted longitudinal analyses, increase in stress was independently associated with greater physician‐assessed disease activity (P = 0.015), greater self‐reported disease activity (P