Does extreme stress trigger rheumatoid arthritis or make it worse? Some people with RA recall that they were going through exceptional stress when they first noticed their arthritis symptoms. While there’s no proof that stress causes RA, it may make it harder for you to cope with your disease.
Life includes periods of stress that everyone encounters from time to time: work, family tensions, anxiety about money. Just living with a chronic illness like RA can add to your stress levels. You may have days when stress just gets out of control no matter how many positive quotes you recite.
Let’s look at some of the research on stress and your physical health.
Researchers have tried to identify the physiological links between stress and the autoimmune response. In one review of 16 different studies about RA and stress1
, researchers concluded that there is evidence to support the theory that life “stressors,” or experiences that bring on severe stress or anxiety, may alter a person’s immune function. Stress could make it harder for you to manage your autoimmune disease or even make it worse, the study’s authors concluded.
Stressful experiences in your past, even early in your life, may increase your risk of getting an autoimmune disease like RA. One very large study of 15,357 people in a California healthcare databas2
e showed that 64% of people had at least one adverse childhood experience (ACE), or a traumatic event during childhood. They found that a high percentage of both women and men with traumatic experiences were at increased risk of developing an autoimmune disease years later.
Another study published in 2018 looked at more than 100,000 people with stress-related disorders3
, including post-traumatic stress disorder and acute stress reaction. The study’s findings showed that stress-related disorders increased the risk of people developing an autoimmune disease years later compared to their siblings who did not have stress disorders.
Anxiety and depression can make it harder to achieve RA remission. In a 2019 study of 293 people with RA4
, researchers in the Netherlands found that 20% of the patients had either anxiety or depression based on standardized health questionnaires. They found that the people with RA who were depressed or anxious tended to be younger and had more active disease. They were also less likely to achieve RA remission after one year of treatment.
It’s not just in your mind. Stress can have a real effect on your arthritis pain, disease activity and quality of life. What can you do to relieve stress and its negative impact on your health? Mindfulness training may help.
Mindfulness-based stress reduction techniques, such as cognitive-behavioral therapy (CBT), allow you to learn how to have positive, non-judgmental thoughts in reaction to stressful experiences or feelings. You may need to train in how to perform these techniques with the help of a trained therapist, although there are online training courses and books too.
Research shows that CBT-based programs can help you manage RA pain more effectively. Mindfulness-based techniques don’t get rid of your stress. They help you have a healthier response to stress so you can cope with it more effectively. In a study of 144 people with RA published in 20085
, those who received CBT training had greater improvements in their self-reported levels of pain and levels of IL-6, a pro-inflammatory cytokine, compared to people who received health education only. People in the study who had RA and recurrent depression found greater benefit from mindfulness meditation, a similar technique, and they even showed improvements to their joint tenderness scores.
If you don’t want to make a major commitment of time and/or money to therapy or mindfulness training, is there anything else you can do to relieve occasional stress? Yes! Here are three techniques that anyone can do to manage stress even with RA:
- Physical activity. Regular exercise like walking or swimming can help you lower your levels of stress, reduce fatigue, improve your sleep and even manage your pain6
. Even small amounts of activity—as little as a few minutes a day—has a positive effect on anxiety and stress. Pick an activity you enjoy and get moving! Make time for exercise in your schedule if you can. Take a water exercise class. Go cycling with your best friend. Take your dog for a walk in the park.
- Keep a journal. Writing down your thoughts and emotions, also known as journaling, can help you reduce stress and cope with your feelings. Grab a notebook, buy a diary or start a file on your computer and start writing. Keep track of how stress affects your quality of life with RA. You may find that writing down your thoughts helps you put things in perspective7
- Turn on your favorite tunes. Music can relieve stress and even have a positive effect on your body. Some research shows that up-tempo music can lift your mood, while soft, slower music can help calm you down and relax your tense muscles. Music is a natural stress reliever and can even help you wind down at night to get to sleep.
Know Your Vectra® Score. Knowing your Vectra Score can also help you manage your RA. Vectra is an advanced blood test that objectively measures inflammation caused by rheumatoid arthritis. Your Vectra Score is a number between 1-100 that reveals the level of inflammation in your body. Vectra helps evaluate if your current treatment is working and is the best predictor of future joint damage. Your Vectra Score can be a powerful number in helping you and your doctor make the best possible decisions in managing your RA.
- De Brouwer SJ, Kraaimaat FW, Sweep FC, et al. “Experimental stress in inflammatory rheumatic diseases: a review of psychophysiological stress responses.” Arthritis Res Ther. 2010;12(3):R89.
- Dube SR, Fairweather D, Pearson WS, et al. “Cumulative childhood stress and autoimmune diseases in adults.” Psychosom Med. 2009 Feb;71(2):243-50.
- Song H, Fang F, Tomasson G, et al. “Association of stress-related disorders with subsequent autoimmune disease.” JAMA. 2018 Jun 19;319(23):2388-2400.
- Boer AC, Huizinga TWJ and van der Helm-van Mil AH. “Depression and anxiety associate with less remission after 1 year in rheumatoid arthritis.” Ann Rhem Dis. 2019 Jan;78(1):e1.
- Zautra AJ, Davis MC, Reich JW, et al. “Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.” J Consult Clin Psychol. 2008 Jun;76(3):408-421.
- Anxiety and Depression Association of America: “Physical Activity Reduces Stress.”
- Michigan State University: “Journaling to Reduce Stress.”