The role of clinical, biological, and socioeconomic factors on the development of resilience in women with autorimmune rheumatic diseases : a cross-sectional study
BACKGROUND: Resilience is considered the capability to positively respond to adverse events. Since this capacity in considered a “continuum” process, long-term stressors and psychosocial factors are thought to be crucial for resilience development, especially in those patients with chronic inflammatory systemic diseases. However, the role of clinical, biological and socioeconomic characteristics in autoimmune rheumatic diseases (ARDs) is still unknown. OBJECTIVE To evaluate the association between resilience and socioeconomic, biological and clinical factors in four autoimmune rheumatic diseases (ARDs) namely: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome (SS) and systemic sclerosis (SSc). METHODS: A cross-sectional study in 188 women with SLE (n= 70), RA (n= 51), SS (n= 32), and SSc (n= 35) was done. Resilience was evaluated by the “Brief Resilience Scale”, whereas independent factors including age, age at onset, duration of disease, socioeconomic status, excersice, severity of symptoms and polyautoimmunity (PolyA) were evaluated by surveys and chart reviews. A panel of 15 serum cytokines and 14 autoantibodies were evaluated simultaneously. Bivariate, classification and regression trees (CART), and multiple linear regressions were used to analyze data. RESULTS: CART analysis showed that patients younger than 48 years with SLE, RA, and SSc who had low socioeconomic status showed the lowest resilience scores, whereas those patients between 48 and 66 years exhibited the highest resilience levels despite socioeconomic status. Interestingly, regular physical activity was associated with highest resilience in SSc. In addition, Interleukin-6 (IL-6) was associated low resilience scores (β= -0.581120, p=0.02) and with severity of symptoms (β=1.8395, p=0.04) in SSc. Neither PolyA nor severity of symptoms influenced resilience in the four ARDs studied. Cytokine levels did not significantly differ between groups based on regular physical activity. CONCLUSIONS: Resilience is a continuum trait associated to socioeconomic status and age. In addition, IL-6 and exercise are key factors for resilience in SSc. These results highlight the relevance of biological and socioeconomic factors in the development of resilience in autoimmunity.