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Patients with rheumatoid arthritis tend to have stress and worry regarding their disease. However, stress and worrying can actually worsen the disease. This article outlines the relationship between stress, worry and rheumatoid arthritis.

Arthritis is an inflammatory condition that affects various joints of the body. It is not known exactly why arthritis develops, though it is known that some forms of arthritis, including rheumatoid arthritis, are autoimmune diseases. An autoimmune disease is a condition that develops when our immune system, which is designed to protect us from foreign pathogens, goes haywire and starts to attack our own body. Thus, in the case of rheumatoid arthritis, the immune system starts to attack our own joints.

The reason why autoimmune disease develops is not entirely clear, but it is speculated that external factors, including trauma or stress, can trigger the development of these diseases. One study reported that people who suffered two or more traumatic childhood events (i.e. physical or sexual abuse) were twice as likely to develop rheumatoid arthritis compared to people who had not experienced any childhood trauma. Thus, trauma or long-term stress can lead to the develop of rheumatoid arthritis.

Additionally, researchers noted that psychological stress is actually associated with worse outcomes in rheumatoid arthritis, including a higher rate of disease flares. In one particular study that was focused on analysis of records of 1,522 US veterans with rheumatoid arthritis, results indicated that patients who received a diagnosis of of post-traumatic stress disorder (PTSD) had higher levels of pain, physical impairment, tender joint count and worse overall well-being compared to patients with rheumatoid arthritis but no PTSD.

Furthermore, worrying can also worsen symptoms in patients with rheumatoid arthritis. In fact, one study found that there was a significant correlation between worrying, symptoms or severity of rheumatoid arthritis, and disease activity. In order to better understand how daily stresses and worrying can impact the severity of symptoms and disease activity in patients with rheumatoid arthritis, researchers examined data from 80 patients that answered questions about the stressors they faced in daily life, the level of their worries, and their rheumatoid symptoms.

Additionally, researchers gathered blood samples to look at the blood profile of patients for indicators of stress (a hormone called cortisol) and inflammation (such as TNF-alpha and interleukin-1 beta). The results of this study indicated that people who worried more also had more intense disease activity, increased inflammation and swelling of joints, and more severe pain.

So, how do stress and worrying affect disease activity?

Stress leads to changes in disease activity, though it is not known exactly how it works. Stress changes the way in which our autonomic, neuroendocrine (hormonal) and immune systems work. Thus, stress actually causes changes in the way the body works, and therefore, contributes to the development of rheumatoid arthritis.

Another reason why researchers postulate that stress leads to more disease activity is because worrying affects our emotional well-being and when we are emotionally unwell, we are more likely to be less adherent to our treatment schedule. Thus, worrying can indirectly cause a worsening of disease activity.

Unfortunately, despite the mounting evidence that emotional stress can affect the immune system, it is hard to quantify or determine the exact effect due to how subjective the feelings of stress and worry are from person to person. Thus, while the medical community continues to research and determine the cause and effect of worrying and arthritis, these are the things you can do to keep your worrying and stress at bay.

1. Exercise

The most well-known technique for getting over stress and worry is doing some form of physical exercise. This can include going for a walk, going for a bike ride or swimming. While it can be hard to work out and exercise when you have achy joints, it is important to keep in mind that being physically active is also beneficial for your arthritis. Exercise has been shown to effectively improve mood, reduce stress and improve range of motion of your joints.

2. Meditation

Research into meditation has shown that it benefits significantly and helps improve mood, reduces distress and eases pain. It doesn’t have to be difficult and you don’t have to attend any classes if you don’t want, though group meditation has been shown to be beneficial. You can simply focus on your breathing and practice deep breathing. If you find that your mind wanders, that’s okay. Just make sure to re-focus. Joining a yoga class can be a good way to help meditate.

3. Lifestyle changes

There are several ways to make your life easier when you have arthritis. These are products or strategies that can help you work around your functional limitations. For example, instead of typing using your hands if you have arthritis of the hand, use your voice recognition to work. Find utensils that are easier to grip if you have trouble doing so. There are lots of little techniques that can help make your life easier and ease the worry.

4. Go see a therapist

If you have severe levels of anxiety and stress, seeing a doctor can help as they can prescribe anti-anxiety medication. Seeing a therapist can help talk through some of the causes of your worry and also help you.

  • Evers, Andrea WM, et al. "Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis." Annals of the rheumatic diseases 73.9 (2014): 1683-1688.
  • Finan, Patrick H., and Alex J. Zautra. "Rheumatoid arthritis: Stress affects rheumatoid arthritis, but via what mechanisms?." Nature Reviews Rheumatology 9.10 (2013): 569.
  • Robinson, C. E. G. "Emotional factors and rheumatoid arthritis." Canadian Medical Association Journal 77.4 (1957): 344.
  • Photo courtesy of SteadyHealth

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