Psychological stress is thought to play a major role in the development and exacerbation of autoimmune diseases in general, as well as in rheumatoid arthritis (RA) in particular. The aims of the current study are to compare retrospective self-reports of childhood maltreatment and lifetime major life/traumatic experiences of American and Israeli RA patients, using standardised instruments, while adjusting for concomitant mental disorders and psychological distress, in order to rule out their part in the subjective reports, thus addressing the trans-cultural robustness of the association between childhood maltreatment, traumatic experiences and RA.
RA patients at the participating study centres were recruited by their physicians, both in Israel and the USA. Patients filled out questionnaires regarding demographic data, disease activity, psychological distress, potential anxiety and potential depression. In addition, patients answered questions regarding pain and childhood maltreatment.
83 RA patients were recruited in the US and 23 patients in Israel. The comparison of CTQ-subscales between the US and Israeli cohorts showed significant differences between the groups only in the subscales of emotional neglect (US 10.30±5.05, Israeli 22.67±3.68, p<0.05) and emotional abuse (US 10.46±5.77, Israeli 7.13±4.84, p<0.05). 87% of Israeli patients had severe emotional neglect. Severe emotional abuse was associated with probable depression (OR 7.778, CI [1.907-31.716]). Using Pain Disability Index (PDI) score, Americans reported more pain during sexual activity than Israelis (US PDI Score 5.64±3.70. Israeli 3.16±3.86, p<0.05). PDI score was also associated with a previous traumatic event (36.89±18.57 vs. 16.82±14.85, p<0.05).
A high degree of similarity was demonstrated between American and Israeli populations of RA patients, regarding psychological stressors and previous traumatic events. As expected, the results indicated a link between emotional abuse and depression in these patients. In addition, a previous traumatic event was associated with more significant pain. Physicians caring for RA patients should be vigilant regarding the possible association with childhood adversity and should consider appropriate consultations when indicated. In addition, while dealing with pain management in RA patients, physicians should keep in mind the possible contribution of distant childhood adversity.