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  1. L. Moroni1,2,
  2. M. Mazzetti3,
  3. G. A. Ramirez1,2,
  4. S. Zuffada3,
  5. N. Farina1,2,
  6. E. Bozzolo1,
  7. V. Di Mattei2,3,
  8. L. Dagna1,2
  1. 1San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milano, Italy
  2. 2Vita-Salute San Raffaele University, Milano, Italy
  3. 3San Raffaele Hospital, Clinical and Health Psychology Unit, Milano, Italy


Background: Exposure to severe or chronic life stressors may alter immune function and high levels of subsequent distress have been implicated in autoimmune disease pathogenesis. Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition affecting 1-12% of the general population1, occurring in response to traumatic events. Growing evidence supports an association between trauma exposure and PTSD with systemic lupus erythematosus (SLE) onset2.

Objectives: To cross-sectionally assess PTSD prevalence in a cohort of patients with SLE and to examine its correlation with quality of life.

Methods: A 189-item anonymous questionnaire including demographics, disease features, the 9-domain Trauma and Loss Spectrum – Self Report (TALS-SR) and the 8-domain Lupus Quality of Life (Lupus QoL) was administered via web to a cohort of patients with SLE. Patients were classified as PTSD cases based on TALS-SR items corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for PTSD.

Results: Ninety-nine (95% female and 5% male) patients with a median follow-up of 16.5 years completed the questionnaire. Self-reported fatigue prevalence was 75%. Fifteen patients (15%) reportedly were on psychological and/or psychiatric support. Thirty-one patients (31%) met the DSM-5 criteria for PTSD. The average LupusQoL interdomain score was 80/100. PTSD cases reported significantly lower scores compared to non-cases in three LupusQoL domains: planning (83 vs. 100, p=0.035), body image (85 vs. 95, p=0.031), and fatigue (67 vs. 92, p=0.001). An inverse correlation between TALS-SR scores and Lupus QoL subscales was found (Table1). In particular, the degree of stress secondary to losses or upsetting events was strongly correlated to fatigue intensity (rho= -0.458, p<0.001).

Conclusion: PTSD prevalence might be higher in SLE than in the general population and have a detrimental influence on quality of life. Fatigue perception might be more significantly affected by PTSD. Intervention studies are needed to assess the therapeutical effects of psychological support in patients with SLE.

References: [1]Shalev A et al. Post-Traumatic Stress Disorder. New England Journal of Medicine, June 2017.

[2]Roberts AL et al. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women. Arthritis & Rheumatology, November 2017.

Table 1.

Spearman rho coefficients outlining correlation across Lupus QoL and TALS-SR domains. The highest negative correlation has been found between fatigue and reaction to traumatic events. Significant correlations boxes are coloured in yellow (weak, rho 0.20-0.39) and red (moderate, rho 0.40-0.59). * p<0.05, ** p<0.01.

Disclosure of Interests: Luca Moroni: None declared, Martina Mazzetti: None declared, Giuseppe Alvise Ramirez: None declared, Simone Zuffada: None declared, Nicola Farina: None declared, Enrica Bozzolo: None declared, Valentina Di Mattei: None declared, Lorenzo Dagna Consultant of: Abbvie, Amgen, Biogen, BristolMyers Squibb, Celltrion, Galapagos, GlaxoSmithKline, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI, Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, GlaxoSmithKline,Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi Genzyme, and SOBI

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