Stress and Worrying Affect Short-Term Fluctuations in Rheumatoid Arthritis Symptoms

rheumatic diseases

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