Stress and Disease Onset in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

Christina V Golemati,Dimitrios Karaiskos,Sophia Lionaki,Clio P Mavragani,Haralampos M Moutsopoulos

doi:10.3389/fpsyt.2017.00286

Abstract

To explore the potential contribution of stress as a trigger for disease onset in patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). 53 AAV and 85 rheumatoid arthritis (RA) patients as well as 53 healthy controls (HC) were thoroughly asked for the number and impact of stressful life events, coping strategies, and available social support 12 months prior to disease onset. Anxiety, depression, personality dimensions, insomnia, and fatigue were also determined. AAV patients reported higher scoring of the impact of stressful life events compared to the RA and HC group prior to disease onset (2.8 ± 3.1 vs 1.8 ± 2.1 vs 1.7 ± 2.3, p-values: 0.047 and 0.053, respectively). While the number of reported stressful events was found to be significantly higher in AAV vs RA patients but not HC, certain coping strategies and social support features were more commonly implemented by AAV patients compared to HC, but not RA patients. As far as personality and other psychosocial characteristics, AAV patients displayed significantly higher psychoticism traits compared to RA, with no other differences being detected between AAV patients and both RA and HC. After adjusting for potential cofounders, scoring of the impact of stressful life events >3 was independently associated with AAV development compared to both RA and HC [ORs (95% CI): 4.6 (1.6-13.4) and 4.4 (1.0-19.0), respectively]. The perceived impact of stressful life events prior to disease onset emerged as a contributing factor for AAV development.

Highlights

Antineutrophil cytoplasmic antibody (ANCA)-associated vas culitis (AAV) is a group of rare clinical conditions affecting mainly middle aged individuals, characterized by vascular destruction and tissue necrosis [1,2,3]
The final sample consisted of 53 AAV patients, 53 age- and gender-matched healthy controls (HC) and 85 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology [37] classification criteria with similar timing of disease onset with AAV cohort
Demographic variables, disease characteristics, smoking, and alcohol habits are presented in Table S1 in Supplementary Material

Summary

Introduction

Antineutrophil cytoplasmic antibody (ANCA)-associated vas culitis (AAV) is a group of rare clinical conditions affecting mainly middle aged individuals, characterized by vascular destruction and tissue necrosis [1,2,3]. It is widely accepted that genetic, environmental, and hormonal contributors are implicated in the development of autoimmune diseases [5] with emotional and physiological sensitivity to stress, less coping resources and imbalanced immune responses being important contributors. Stress has been previously emerged as a critical determinant of disease onset in autoimmune populations, including Grave’s disease, Sjogren’s syndrome (SS), and childhood arthritis [6,7,8,9]. Mounting evidence link childhood adversities with immune dysregulation in adult life [11]. Children exposed to high stress in families showed enhanced immune responses against diabetes associated autoantigens in relation to controls [12]

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Discussion

Conclusion