When You Walk Through a Storm: Stress, Resilience, and Coping in Rheumatology

> When you walk through a storm, Hold your head up high, And don’t be afraid of the dark… > > – Rodgers and Hammerstein1 > You may not control all the events that happen to you, but you can decide not to be reduced by them . > > – Maya Angelou2 Our expression is richer for it. It permeates our music, our poems, our art, our dance. We call on it individually and collectively when times are turbulent, to rise. We could not exist without it: resilience, the ability to recover from stress. Stress ranges from minor daily stressors to traumatic events. A trauma is an extreme negative experience that is perceived to be harmful, with pervasive effects on well-being.3 In the nearly 30 years since the original adverse childhood experiences (ACEs) study showed that trauma such as neglect and abuse in childhood profoundly affects development and health in adulthood,4 there have been expanded definitions of trauma (eg, racism, generational trauma, ecological disasters, medical trauma). Efforts have been made to understand how these experiences alter physiologic homeostasis,5 cause immune dysregulation,6 and predispose to autoimmune conditions such as systemic lupus erythematosus (SLE).7 A growing body of work links stress and trauma with SLE onset and outcomes. Among people with trauma history, there is a 2- to 3-times greater risk for incident SLE.8,9 More than 60% of adults with SLE experience trauma in childhood; nearly 1 in 5 experience severe trauma.10 Childhood-onset SLE (cSLE) is also associated with ACEs.11 ACEs occur during a vulnerable period in neural development, predisposing to mental health pathology.4 People with history of ACEs report worse SLE outcomes, including decreased quality … Address correspondence to Dr. K. DeQuattro, Division of Immunology & Rheumatology, Stanford University, 300 Pasteur Dr, East Pavilion Floor 3, Rm H335, Stanford, CA 94305-5755, USA. Email: kdq{at}stanford.edu.