Background Stressful Life Events (SLEs) may play a role in the etiopathogenesis of autoimmune diseases, especially during childhood (early SLEs) and in the year prior to the onset of the disease (recent SLEs). Such a deleterious effect of stressful events seems to be mediated by the inadequate responsiveness to stressors and to chronic inflammation due to a dysregulation of the Hypothalamic-Pituitary-Adrenal axis (HPA axis). Few studies have addressed the relationship between SLEs and SSc and none of them evaluated the effect of both early and recent life events.
Objectives The aims of the present study were to explore the multiple effects of stress on SSc onset and course, and to evaluate the impact of pain perception and health-related quality of life on patients with SSc.
Methods 110 consecutive SSc patients were enrolled. The assessment included a face-to-face interview and the administration of self-reported questionnaires evaluating pain perception and quality of life (Short Form (36) Health Survey (SF-36), Brief Pain Inventory (BPI), Childhood Experience of Care and Abuse Questionnaire and Florence Psychiatric Interview). Clinical status was assessed by modified Rodnan Skin Score and Raynaud Condition Score, nailfold videocapillaroscopy and instrumental examination of internal organs.
Results Compared to a group of matched controls (n=110), a higher proportion of patients reported at least one Stressful Life Events (56.3% vs 34.5%, p<0.01). All early life events were more frequently reported by SSc patients, even though a significantly difference was obtained only for “loss of mother” and for “sexual abuse” (13.6% vs 5.4%, p<0.05 and 16.4% vs 8.2%, p<0.05, respectively). Patients displayed a worse quality of life and a higher pain perception (all the subscales of SF-36 and of BPI were significantly different between the two groups, p<0.01). SSc patients, with a significant clinical worsening (33.6%), reported more frequently the occurrence of severe recent life events compared to patients without a significant clinical worsening (54.0% vs 26.0% p<0.05).
Conclusions Early SLEs can be considered potential risk factors for the onset of SSc. The occurrence of recent SLEs may have a role in the course of the disease, being linked to a significant clinical worsening.
Disclosure of Interest None declared