Stress and Worrying – Rheumatoid Arthritis
In the July 2013 issue of Annals of Rheumatic Diseases, Evers et al. report that stress and worrying predict indicators of rheumatoid arthritis disease activity such as fatigue and pain.
Psychological stress has been linked to the onset and course of rheumatoid arthritis (RA). While for the juvenile chronic arthritis (JCA), chronic stress appear to represent an important factor, for RA psychological stress is perhaps a provoking factor but the data in the literature are ambiguous. Yet, in a comprehensive review of 27 independent studies, the stress of minor life events lasting hours to days was associated with increased disease activity among adult RA patients. Another recent study links chronic daily stress to greater stimulated IL-6 production as well as greater resistance to hydrocortisone inhibition of IL-6 production.
Previous studies have suggested that worrying is associated with negative long-term impacts on disease severity, and experimental stress is known to lead to cortisol elevations and cytokine level alterations.
In the Annals of Rheumatic Diseases study, Andrea Evers and colleagues from the Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands set out to evaluate for a link between real-life stressors and subjective and objective assessments of disease activity, while integrating measurements of cortisol and pro-inflammatory cytokine levels.
Worrying specifically was predictive of more swollen joints and more pain 4 weeks later, while daily stressors, IL-1β and IFN-γ predicted fatigue 4 weeks later. Cortisol levels were not significantly altered in relation to disease activity in this group of patients.
The study characterizes the impact of psychological well-being on rheumatoid arthritis severity in the short term and highlights the importance of assessing and addressing patients’ life stressors and worrying as a critical part of managing this disease.
Source: Ann Rheum Dis, 2013 Jul 9. doi: 10.1136/annrheumdis-2012-203143. [Epub ahead of print]
Read more: Annals of Rheumatic Diseases
Updates
A 2018 review entitled: The role of stress in the mosaic of autoimmunity: An overlooked association, concluded that the relationship between stress and autoimmune diseases appears to be complex and intricate. It appears that recent evidence supports the association and role of stress in influencing various aspects of autoimmune diseases including for instance disease onset and exacerbations.
A 2020 prospective cohort study assessed the association of perceived stress with incident inflammatory arthritis (IA) defined as having at least 1 joint consistent with rheumatoid arthritis (RA)-like synovitis based on examination. Perceived stress was measured using the Perceived Stress Scale-14 (PSS-14), in which scores can range from 0 to 56, and a higher score indicates greater perceived stress. The authors assessed the risk of developing future inflammatory arthritis by using a general measure of psychological stress, rather than assessing stressful life events or PTSD symptoms, in a non-clinical, at-risk population.
In a cohort of individuals at-risk of developing IA, the investigators found that participants with higher perceived distress were at an increased risk of developing IA. We did not find an association between IA and total perceived stress or self-efficacy. Thus, perceived distress is significantly associated with incident inflammatory arthritis in a prospective cohort of at-risk individuals.
This study suggests that IA risk is associated with perceived distress, a subjective stressor defined as how an individual may appraise an objective stressor (e.g. loss of a job), rather than internal self-perceptions such as self-efficacy.
A 2022 a systematic scoping review examined the impact of RA on psychological stress. Among 11.115 potentially relevant studies, 16 studies were included. Remarkably, 13 different instruments to measure stress were reported in these studies. Different types of stress experienced by patients with RA included role stress, social stress, and work stress.
The authors found that stress content was described as either role stress, social stress, or work stress, while a distinction can also be made depending on the severity of the stressor, defined as either major or minor life events. In conclusion, this systematic review suggests that patients with RA tend to experience more work stress and interpersonal stressors than the general population, and that risk factors for the development of stress include more pain, functional disability, higher disease activity, younger age, lower socioeconomic status, certain psychological traits, and insufficient social support.
