Childhood maltreatment linked to higher risk of rheumatoid arthritis and psoriasis, study finds

A new study published in Heliyon has found that people who experienced abuse, neglect, or domestic abuse during childhood have a significantly higher risk of developing certain chronic immune disorders later in life—specifically, rheumatoid arthritis and psoriasis. The association was particularly strong among women, raising questions about how early life adversity may shape lifelong health outcomes.

The researchers aimed to investigate how early exposure to abuse might relate to the development of immune-mediated inflammatory disorders, a group of chronic illnesses that includes rheumatoid arthritis, psoriasis, multiple sclerosis, and inflammatory bowel diseases.

While previous studies have hinted at a connection between early trauma and immune disorders, most of the research has relied on self-reported surveys or hospital records, often with small sample sizes. The current study sought to overcome these limitations by analyzing data from a large, representative sample using electronic health records from primary care practices in the United Kingdom.

“As a public health researcher and clinician, I’ve long been interested in how early life adversity shapes long-term health outcomes,” said study author Joht Singh Chandan, a clinical professor of public health at the University of Birmingham. “Childhood maltreatment is a widespread yet under-acknowledged public health issue. We know it’s linked to mental health and cardiovascular outcomes, but its relationship with chronic immune diseases has been less explored, particularly in the UK context. This study aimed to fill that gap using robust, large-scale primary care data.”

The researchers used the IQVIA Medical Research Database, which includes de-identified electronic health records from general practices across the United Kingdom. These records contain clinical notes, diagnoses, and other medical data, including childhood maltreatment codes recorded by general practitioners. The study period covered over two decades, from January 1995 to January 2021.

The researchers identified 256,130 individuals with a documented history of childhood maltreatment before age 18 and matched them with 712,478 unexposed individuals based on age, sex, socioeconomic deprivation, and medical practice. Maltreatment was identified using a broad set of clinical codes, capturing both confirmed instances and concerns about potential abuse or neglect. Participants were followed over time to see whether they developed one of six chronic immune disorders: rheumatoid arthritis, psoriasis, coeliac disease, multiple sclerosis, systemic lupus erythematosus, or inflammatory bowel disease.

The analysis revealed that people exposed to childhood maltreatment had a 39% higher risk of developing rheumatoid arthritis and a 16% higher risk of developing psoriasis compared to those without such exposure. These associations held even after adjusting for factors such as age, sex, and socioeconomic status. Notably, the increased risk was more pronounced in women. For example, women who had experienced childhood maltreatment were 54% more likely to be diagnosed with rheumatoid arthritis, while the increase in risk for men was not statistically significant.

“Experiences of childhood maltreatment can have enduring effects on physical health, not just mental wellbeing,” Chandan told PsyPost. “Our findings suggest that individuals exposed to maltreatment are at increased risk of developing conditions like rheumatoid arthritis and psoriasis. This reinforces the need for early prevention and support, and highlights the long arm of early trauma on the immune system.”

By contrast, the study did not find statistically significant differences in the risk of developing multiple sclerosis, systemic lupus erythematosus, or inflammatory bowel disease. Interestingly, those exposed to childhood maltreatment were found to be at a lower risk of developing celiac disease. The reasons for this unexpected result are unclear, but researchers speculated that differences in healthcare access, disease detection, or dietary factors may play a role.

“We were surprised to find a lower risk of celiac disease among those exposed to childhood maltreatment,” Chandan said. “While we don’t believe maltreatment is protective, this may reflect underdiagnosis or health inequalities, where symptoms are overlooked or access to care is limited. It highlights the complex intersection of trauma, healthcare access, and disease presentation.”

The authors also conducted several sensitivity analyses to strengthen their findings. When restricting the analysis to patients whose medical records contained direct evidence of maltreatment—as opposed to indirect concerns—the associations with rheumatoid arthritis and psoriasis were even stronger.

There are several possible explanations for the link between childhood maltreatment and these diseases. One is that early life stress may interfere with the development of the body’s stress regulation and immune systems, leading to chronic inflammation. Studies have shown that people exposed to maltreatment often have elevated levels of inflammatory markers such as interleukin-6 and C-reactive protein, which are also found in individuals with rheumatoid arthritis and psoriasis. Other behavioral factors, such as higher rates of smoking, alcohol use, and obesity among those with a history of maltreatment, may also contribute to an elevated risk.

Despite its strengths, the study has important limitations. The analysis relied on medical records, which may underreport or misclassify cases of childhood maltreatment. The coding system used had high specificity but relatively low sensitivity, meaning that many cases likely went undetected. Additionally, information on potentially important confounding factors such as alcohol use, ethnicity, education, and family history was often missing or inconsistently recorded. The researchers also noted that follow-up time was shorter in the exposed group, which could affect estimates of long-term disease risk.

Another limitation concerns the outcomes themselves. Although rheumatoid arthritis and psoriasis are well captured in general practice records, the recording of other immune disorders like lupus and multiple sclerosis may be less consistent, and the shorter follow-up period may not have been long enough to detect these conditions, which often develop later in life.

“Our study relies on clinical records, so it’s limited by how often and accurately GPs record maltreatment and IMID diagnoses,” Chandan noted. “There’s also the possibility of underreporting in both exposure and outcomes. Additionally, while we adjusted for some confounders like deprivation, there may be unmeasured factors—like family history or environmental exposures—that influence risk.”

Nevertheless, the study’s findings suggest that childhood maltreatment may play a more significant role in the development of certain immune-mediated conditions than previously understood. Because both childhood adversity and immune disorders are common in the population, even a modest increase in risk translates into a meaningful public health concern. The authors emphasize that early intervention and prevention efforts should not only focus on psychological outcomes but also consider the long-term physical health consequences of early life trauma.

Future research will be needed to explore how different types and severities of maltreatment affect disease risk, whether there is a dose-response relationship, and which biological pathways are involved. Researchers are particularly interested in whether chronic stress-induced inflammation could be a key mechanism. Expanding these investigations to other countries and healthcare systems will also help determine how generalizable the findings are.

“We hope to explore how different types, severities, and timings of childhood maltreatment influence physical health outcomes, including whether there’s a dose-response relationship,” Chandan explained. “We’re also keen to understand the biological mechanisms — particularly the role of chronic inflammation — and to inform policy around early intervention and trauma-informed care.”

“While this study adds to the evidence that childhood adversity has lasting health impacts, it’s also a call to action. Preventing maltreatment and supporting survivors isn’t just a moral or legal obligation — it’s a public health priority. Integrating this knowledge into routine clinical care could help mitigate long-term harm.”

The study, “The risk of immune-mediated inflammatory diseases following exposure to childhood maltreatment: A retrospective cohort study using UK primary care data,” was authored by Liam Snook, Sonica Minhas, Vrinda Nadda, Ben Hammond, Krishna M. Gokhale, Julie Taylor, Caroline Bradbury-Jones, Siddhartha Bandyopadhyay, Krishnarajah Nirantharakumar, Nicola J. Adderley, and Joht Singh Chandan.