The role of stress in rheumatic diseases.
Hassett AL, Clauw DJ.Rheumatology patients frequently note the
occurrence of stressful or traumatic life events prior to the onset of
their illness and/or a relationship between stress and disease flares.
For our patients, identifying causal events could represent an effort
to give meaning to a chronic and often disabling disease, while noting
a link between stress and flares may proffer a sense of control.
Whatever purpose the report of stress as an etiological or maintaining
factor may serve, the science exploring a causal relationship between
stress and autoimmune disease onset and course is expanding. Moreover,
stress can also induce symptoms such as pain via nonimmunological
The authors conclude: In summary, when our patients say that stress
worsens their disease, they may be correct. Although the study of
stress is fraught with problems, there are clearly both immune
mechanisms (that is, psychoneuroimmunology) and nonimmune mechanisms
(for example, mechanisms operative in conditions such as fibromyalgia,
either alone or comorbid with autoimmune disorders) that may be
responsible for increased disease activity and/or symptom expression
during periods of stress.
The above abstract is a comment in response to this published study:
Arthritis Res Ther. 2010;12(3):R89. Epub 2010 May 17.
Experimental stress in inflammatory rheumatic diseases: a review of
psychophysiological stress responses.
de Brouwer SJ, Kraaimaat FW, Sweep FC, Creemers MC, Radstake TR, van
Laarhoven AI, van Riel PL, Evers AW.
Department of Medical Psychology, Radboud University Nijmegen Medical
Centre, P,O, Box 9101, 6500 HB Nijmegen, The Netherlands.
INTRODUCTION: Stressful events are thought to contribute to the
aetiology, maintenance and exacerbation of rheumatic diseases. Given
the growing interest in acute stress responses and disease, this
review investigates the impact of real-life experimental psychosocial,
cognitive, exercise and sensory stressors on autonomic, neuroendocrine
and immune function in patients with inflammatory rheumatic diseases.
METHODS: Databases Medline, PsychINFO, Embase, Cinahl and Pubmed were
screened for studies (1985 to 2009) investigating physiological stress
responses in inflammatory rheumatic diseases. Eighteen articles met
the inclusion criteria.
RESULTS: Results suggest that immune function may be altered in
response to a stressor; such alterations could contribute to the
maintenance or exacerbation of inflammatory rheumatic diseases during
stressful events in daily life.
CONCLUSIONS: This review emphasizes the need for more experimental
research in rheumatic populations with controlled stress paradigms
that include a follow-up with multiple evaluation points, simultaneous
assessment of different physiological stress systems, and studying
factors contributing to specific physiological responses, such as