Question: Can Stress Trigger Rheumatoid Arthritis?
Patients often report that episodes of stress or trauma preceded the onset of their rheumatoid arthritis. While stress is nearly impossible to measure, some researchers have suggested that stressful life events, such as divorce, job loss, death of a loved one or accidents, are more common in people with rheumatoid arthritis during the six-month period before disease onset compared with the general population.
Is there concrete evidence that stress is a trigger of rheumatoid arthritis and related conditions? Is stress a factor in disease activity for those conditions?
If you have rheumatoid arthritis, it's both interesting and important to know if stress triggers the disease or if stress worsens the symptoms. Either way, it is to your benefit to eliminate as much stress from your life as possible. With stress that cannot be eliminated, it must be well-managed. For the perspective of a rheumatologist, we asked Scott Zashin, MD, about the effect of stress on rheumatoid arthritis.
Dr. Zashin on Stress and Arthritis
Dr. Zashin says, "There is no question that being afflicted with a chronic disease, such as rheumatoid arthritis, can cause increased stress, but can stress be a trigger for developing rheumatoid arthritis or another rheumatic disease -- and can stress increase the likelihood of exacerbation of these conditions?"
"According to Laurence Bradley, PhD, and Nancy McKendree-Smith, PhD, in the Primer of Rheumatic Diseases," Dr. Zashin continues, "major-life events are actually associated with short-term decreases in the symptoms of rheumatoid arthritis (perhaps because the patient is distracted and is not focusing on their symptoms). Yet, a major stress will tend to increase the likelihood of what they describe as "daily hassles" -- negative events associated with an alteration of the immune system and exacerbation of symptoms."
"In other words, scientific evidence appears to confirm that stress can lead to flare-ups in patients with rheumatic diseases," Dr. Zashin says. "The role of stress as a cause of these rheumatic conditions is unclear at this time. While stress may be related to the development of rheumatoid arthritis, research in this area is not definitive."
Rheumatoid Arthritis Symptoms and Diagnosis. Up-to-Date. Maini RN et al. July 10, 2007.
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.