“This type of research is making clinicians more aware of the tight connections between trauma and physical health. [Although] one research paper doesn’t have an enormous impact, it is noteworthy that many different lines of research are saying the same things.”
Karen Costenbader, MD, MPH, professor of medicine at Harvard Medical School in Boston and director of the Lupus Program, was the senior author of the study. She says, “The topic of past trauma often doesn’t emerge in lupus treatment until one, two or even three years into a patient’s care. Asking about trauma when a patient first presents is not a routine part of rheumatologic care. After a patient gets to know a clinician, however, they are more likely to open up. Then they can be referred to a mental health provider.
Dr. Costenbader
“The hormonal and immune system disruptions involved in PTSD are measurable, but we don’t know if or how they trigger lupus,” Dr. Costenbader says. “We do know cortisol dysregulation exists in PTSD patients, and cortisol influences the functioning of the immune system. In people with PTSD, the body is stuck in a state of hyper-vigilance, which can lead to lupus flares. Patients often report, ‘I had a flare because of a traumatic event (e.g., a car accident, a death, etc.).’ Then you add in possible poor self-care, lack of sleep and flashbacks. We need more research into the biologic mechanisms involved. There are many different organ systems involved with autoimmune conditions. Getting to the bottom of how stress affects autoimmunity is the next step.”
Mechanism Remains Unknown
Dr. Bermas
Bonnie Bermas, MD, a rheumatologist at the University of Texas Southwestern Medical Center in Dallas, says, “This is important work, and the findings are extremely interesting, yet not completely surprising. If you care for patients with lupus, they will often pinpoint the origin of the disease to a period of stress.
