Rheumatoid arthritis and stress

The Link Between Stress and Rheumatoid Arthritis

9 Ways to Relieve RA-Related Stress

Sometimes the stress and pain connection can work in reverse, and your worsening RA symptoms are causing the extra stress. “Stress or secondary depression can go along with an illness that isn’t being adequately treated,” Roseff says. “But with new treatments we can stop the progression of the disease and control symptoms — treatments that weren’t available as recently as 10 to 12 years ago. There are few people with uncontrolled disease.”

Talk to your doctor if you feel that your symptoms aren’t responding to your current RA treatment plan because there might be other options to try. Here are more ways you can relieve stress and mitigate rheumatoid arthritis symptoms:

Practice yoga or mindfulness meditation. Yoga “can be very good in terms of stretching, spirituality, and relaxation,” Roseff says. “Patients who go this route do well.” And practicing mindfulness meditation, which teaches how to focus on the present moment, reduces stress and fatigue in people with RA, according to a study published in November 2014 in Annals of Rheumatic Diseases.

Consider tai chi. The Arthritis Foundation recommends tai chi, and offers videos on its website with sample moves you can do. They include shoulder exercises, spine stretches, and neck stretches.

Exercise. “Exercise benefits you emotionally and physically. It strengthens the joints and structures surrounding the joints,” says Roseff. “It helps you sleep better and provides stress relief.”

Try swimming. One of the best ways to exercise if you have RA is to get in the pool, says Stephen Soloway, MD, president and founder of Arthritis & Rheumatology Associates of South Jersey, in Vineland, New Jersey. “Start with lessons, if you need them, so you know the proper way to kick,” he suggests. “Get some equipment like a kick board so you can stretch your fingers wide on the surface. Try to swim once a day, every three days to start. Consistency is the key, no matter what exercise you choose.”

Maintain a balanced diet. The processed sugars and sodium in packaged foods aren’t good for anyone, says Dr. Soloway. Choosing a balanced diet with foods that include a combination of complex carbohydrates, lean proteins, and omega-3-rich fats like salmon and avocado will help your overall well-being.

Go to physical therapy. “Working with a good, caring physical therapist can have a marked improvement on symptoms,” Roseff says.

Quit smoking. For anyone who thinks of lighting up as a stress-reliever, your smoking could very well have the opposite effect. “If you smoke, you are more likely to develop ,” Roseff says. “For those who already have RA, smoking it worse.” Research presented at a 2014 meeting of the American College of Rheumatology found that RA patients who participated in smoking cessation programs also reduced their pain.

Limit alcohol. The occasional recreational drink is fine, Soloway says, but people with RA should pay attention to potential drug interactions, as well as the sodium and carbohydrates in alcohol.

Find a doctor with whom you feel comfortable. Stress levels increase when you’re unable to communicate your concerns and symptoms to your physician, so be sure you’re happy with your relationship with your doctor, Soloway says. “When a patient doesn’t have open conversations with their doctor, they may not convey their questions and problems, and then they may not get the treatment they need.”

—Additional reporting by Liza N. Burby

Rheumatoid Arthritis and Stress

Question: I’m 58, and I have a very demanding, high-stress job. I’ve also had rheumatoid arthritis (RA) for a few years. It seems like the more stressed I am, the worse my RA gets. Is there really a connection between stress levels and RA? If so, how can I reduce my stress?
— Cape Cod, MA

The stress from everyday living can increase rheumatoid arthritis related pain. It can be burdensome like carrying the weight of the world on your back.

Answer: It’s not just your mind playing tricks on you: There’s a strong connection between stress and rheumatoid arthritis (RA), and it’s a vicious cycle. You have chronic pain caused by rheumatoid arthritis, and you’re physically and emotionally stressed, which can lead to an increased perception of pain in the joints involved with RA.

Feeling stressed and depressed when you have RA is normal, but these feelings may make it more difficult for you to successfully manage your RA. Routine tasks may be more difficult or take longer to complete. Learning stress-management skills is important to reduce stress, but you must understand your disease and know what to expect.

To help you understand the link between stress and RA, you need to know what happens to your body physically when you’re stressed.

  • A typical stress response involves a rapid heart rate, quick breathing, and a spike in your blood pressure as a result of stress hormones flooding your body. It’s normal for your body to respond this way on occasion (eg, slamming on your brakes to avoid hitting the car in front of you), but when you experience this stress response daily, it can definitely aggravate your RA.
  • With your demanding job, it sounds like your body is constantly battling the effects of stress. Ongoing stress weakens your body. It affects your immune system, which can promote inflammation, and your central nervous system, which can lead to even more stress.
  • Stress can also affect your perception of pain—the more tense you are, the more intense your pain may feel. Too much stress also means that you’re more susceptible to other RA symptoms, such as fatigue and weakness.

While a completely, stress-free life isn’t realistic, reducing stressful triggers and incorporating healthier behaviors can help you regain a sense of well-being. Fortunately, there are several things you can do manage your stress and control your rheumatoid arthritis symptoms.

You should start with your job. If you can, try to cut back at work—ask for help with assignments or talk to your boss about adjusting the number of hours you work per week. Try not to overdo things: Pace yourself and the activities you do to avoid becoming fatigued. Yes, work is important, but doing other things you enjoy—perhaps curling up with a good book—is just as essential.

Here are other ways to reduce stress and rheumatoid arthritis symptoms.

  • Breathe correctly: Most of us take short, shallow breaths, which can actually contribute to tension. Try to do deep belly breathing—your breath should be slow, smooth, and steady. This helps calm the nervous system.
  • Develop strong, personal relationships: Develop a network of friends and/or family members who understand and support you. Meet with them to laugh and to vent stress that may have built up. If your schedule allows, join a book club to get your mind off your stressors and to seek out new friendships.
  • Exercise: Making exercise a priority can boost your mood and increase levels of endorphins—your body’s natural painkiller. Consistency is key here, so pencil in regular workouts. Moderate physical activity on a regular basis helps decrease fatigue, strengthen your muscles and joints, and improve your sense of well-being. Low-impact exercises, such as walking or riding your bicycle are generally good, safe options. Also, aerobic water exercise is good for your joints because it doesn’t put a lot of stress on them, and it helps increase your stamina and strength.
  • Get a massage: Massage can literally help rub away your pain and tension. Schedule regular massages for maximum benefits.
  • Join a rheumatoid arthritis support group: Check out the Arthritis Foundation to find an Arthritis Foundation Self-Help Program in your community. Programs are also offered online.
  • Meditate: Taking a few minutes each day to meditate can help counteract the effects of stress and create a feeling of inner peace.
  • Sleep: Ideally, you should shoot for 8 hours of sleep each night, but go to bed and wake up at the same time every day. This helps your body regulate a healthy sleep-wake cycle.
  • Take a warm bath: The heat helps decrease secretion of stress hormones, signaling your body to relax.

Incorporating just a few of the stress management techniques mentioned above into your daily routine can help soothe your stress and ultimately ease your rheumatoid arthritis symptoms.

Continue reading … Rheumatoid Arthritis Resource Center

Can Stress Make Rheumatoid Arthritis Worse?


Paige Greenfield

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In short, yes. However, the reality is a little more complex. That’s because while stress can worsen the disease, rheumatoid arthritis (RA) can create stress for you.

Stress is especially tough on people with autoimmune diseases such as RA. Some of the pathways involved in your body’s stress response are the same ones involved in autoimmune disease. For people with RA, stress releases chemicals that can trigger flare-ups, along with inflammation and pain.

RA as Internal Stressor

In addition, RA can affect your body’s production of the stress-related chemical cortisol. In other words, RA is a type of internal stressor. With time, stress chemicals like cortisol may increase your risk for serious health conditions such as heart disease, obesity, and depression. These problems can lead to even more stress.

As you likely already know, you may feel stressed because of your RA symptoms. No one likes moving slowly, and stiff joints can make it difficult to move around and get places on time. It can be stressful when daily activities or hobbies you love to do feel difficult or painful—or even seem impossible.

Get the Best of Stress

Just because you have RA doesn’t mean you have to feel stressed all the time. There’s plenty you can do to control the stress in your life and reduce its impact on your well-being. Here are five ways

1. Exercise. It can help with depression, anxiety, and sleep. Physical activity can even increase levels of chemicals in your body that improve your mood.

2. Breathe deeply. To promote relaxation, practice deep breathing, in through the nose and out through your mouth. Feel your belly rise and fall as you breathe.

3. Talk it out. Telling someone about negative emotions you’re experiencing can help relieve stress. If you don’t feel comfortable talking about these things, write them down in a journal.

4. Embrace the outdoors. Spending time in nature can boost your mood and quell stress. Take a hike or scenic drive. Enjoy a picnic. Plant a garden.

5. Get organized. At the end of each workday, create a to-do list for the following day. This can help you leave work behind so you can enjoy the rest of your day.

Key Takeaways

  • For people with RA, stress releases chemicals that can trigger flare-ups, along with inflammation and pain.

  • In addition, RA can affect your body’s production of the stress-related chemical cortisol, increasing your risk for serious health conditions such as heart disease.

  • There’s plenty you can do to control the stress in your life, including exercise, deep breathing, and spending time outdoors.

Stress and Arthritis

People with arthritis like everyone else can benefit from learning to cope with stress in a positive way.

What is stress?

Stress is a term used to describe the body and mind’s reaction to everyday tensions and pressures. Too much stress can increase pain and can make a person more prone to illnesses such as heart disease or mental problems.

Stress and arthritis

Too much stress can also make it harder for people with arthritis to face the extra problems imposed by their disease. These problems may include medical expenses, changes in lifestyle, side effects from drugs and concern about the future. By learning to cope with stress in a positive way you can reduce your pain feel healthier and deal better with the extra demands of your disease. It is for these reasons that stress management is an important part of taking care of your arthritis. Learning stress management or how to cope with stress in a positive way is a skill. Like any skill it needs to be practiced.

This information first explains how the body and mind react to stressful events. Then it describes a program for managing stress. For more help ask your doctor or see a counselor or psychologist.

Reactions to stress

Typical stressors
Stress is a normal part of life. Many things in life can be stressful such as a move to a new town a change in jobs marriage or divorce the birth of a child or the death of someone close to you. Trying to meet such basic needs as having food to eat and a roof over your head can be stressful too.

Stress and chronic disease

People with arthritis experience the same kinds of stress as everyone else. However sometimes having a chronic disease as well can add special problems. People with arthritis may become more dependent on family members and health care professionals. They may also have to adapt to changes in their job status hobbies energy level or body image. None of these adjustments are easy–and all can be upsetting.

Reacting to stress

When you are under stress your muscles become tense. This muscle tension can increase your pain. A vicious cycle of stress pain and depression may develop. However if you learn how to manage stress you can help break that cycle.

Some of the body’s reactions to stress are easy to predict. At stressful times the body quickly releases chemicals into the blood. This sets into motion a series of physical changes. These include a faster heartbeat and breathing rate higher blood pressure and increased muscle tension.

Break the vicious cycle
Click to enlarge

Break the vicious cycle

These physical changes give the body added strength and energy. They prepare the body for dealing with stressful events such as giving a speech aiding an accident victim or fighting or fleeing from an attack. When stress is dealt with in a positive way, the body restores itself and repairs any damage caused by the stress. However most of the time people don’t deal with stress in a positive way. Thus stress-related tension builds up and with no outlet takes its toll on the body.

The mind’s reaction to stress is harder to predict. These mental reactions vary according to the situation and the person. They may include feelings of anger fear anxiety annoyance or frustration. A small amount of stress can help people perform their best–during an exam an athletic event or on stage. With too much stress people may become accident-prone make a lot of mistakes and may not be able to function. Stress can be compared to a violin string. If the string is too loose (not enough stress) it won’t produce music. If the string is too tight (too much stress) it will break. Some degree of stress is necessary to function properly.

Realize that people respond in different ways to events and situations. Some people like to be busy with lots of activity. Other people may prefer a slower pace with less activity. What one person finds relaxing may be stressful to another.

Manage stress

Signs and symptoms of stress

Managing stress begins with learning the signs and symptoms of stress.

  • Tiredness/exhaustion
  • Muscle tension
  • Anxiety
  • Indigestion
  • Nervousness/trembling
  • Sleeplessness
  • Cold sweaty hands
  • Loss of or increased appetite
  • Grinding teeth/clenching jaws
  • General body complaints such as weakness dizziness headache stomachache or pain in the back or muscles.

It’s possible that some of these symptoms may be caused by problems other than stress such as the flu. Ask your doctor about symptoms that last for more than a week. If your doctor decides that stress is the problem you can work together to understand and relieve it.

Make stress work for you

The key to managing stress is to get stress to work for you instead of against you. A complete program for managing stress has three parts:

  1. Learn how to reduce stress.
  2. Learn how to accept what you can’t change.
  3. Learn how to overcome the harmful effects of stress.

Suggestions for following these guidelines are described in the following pages.

Reduce stress

Ways to reduce stress

Identify causes of stress

What causes you the most worry and concern? What situations make you feel anxious nervous or afraid? Once you know what the stressful aspects of your life are decide whether or not you can change them.

Keep a “stress diary” to record the events in your life that cause stress. Record any physical symptoms you have. Try some of the ways to manage stress suggested in this program noting if they helped you. Soon you will learn what upsets you the most and which ways help you cope the best. Then try to prevent those situations from occurring. For example if important family events usually make you anxious plan to get extra rest ahead of time so you are better able to cope.

Share your thoughts and feelings

It’s usually helpful to talk to someone about your concerns. Perhaps a family member friend co-worker or member of the clergy can help you see your problems in a different way.

Learn to tell people when you can’t do certain things. Saying “no” to people is important and you shouldn’t feel guilty when you do. You may find that turning down extra duties–even for a short period of time–reduces your stress.

Respect your limits of energy pain and time. If you don’t you can become so worn out that you can’t be the kind of friend lover or parent you want to be.

Realize that you have the right to decide if you want to discuss your arthritis. If having arthritis limits your activity that may be a good reason to mention it. Otherwise your arthritis is a private matter.

Learn to express anger and other negative emotions without hurting others. It’s all right to be angry! However try to say “I’m feeling angry ” instead of “you are making me angry. ” This lets you express your feelings without blaming someone else. “Striking” someone with words will only make that person feel under attack. This can make the conflict harder to resolve. Learning to express your feelings will enable you to improve relationships with the people who are important to you.

Try to avoid depression

A condition such as arthritis can bring about feelings of depression. You may feel sad or “blue ” or have more serious thoughts of hopelessness and despair. Depression can make you feel miserable and also increase your pain.

You may wonder “why me?” or “why are other people able to do things I can’t do?” You may be angry or feel sorry for yourself. It might help to know that these are common feelings of people who have arthritis.

Usually feeling depressed depends on how you deal with events in your life whether they are real or imagined. If you believe you’re a helpless victim of depression, you probably won’t do anything to overcome it. Here are some tips to help you manage depression:

  • Realize that you are responsible for how you feel. If you are aware that your state of mind is up to you then you are more likely to take an active approach to improving your mood.
  • Take care of yourself. You’re special–so pamper yourself. Try something good to eat take a leisurely bath or buy something nice for yourself.
  • Be a “doer.” When you’re sad or lonely, go to an event. Get involved in neighborhood or volunteer organizations. Don’t forget the joy of giving.
  • Find new activities to replace old ones so you can continue to grow and develop. Discover new creative outlets such as hobbies skills or interests.
  • Remember that it’s all right to cry. A good cry can be a healthy way to relieve tension.
  • Keep in touch with family and friends by phone if you can’t get out. Don’t let your arthritis set you apart from others.
  • Try to discover what set off your depression and learn to avoid those events in the future.
  • Be alert for signs of depression that last for more than two weeks. If you continue to have signs such as eating or sleeping too much or too little, or feeling hopeless, forgetful, restless or more tired than usual tell your doctor. Sometimes this type of depression is caused by a change or an imbalance in the body’s chemistry. Often certain drugs can correct such an imbalance.

Simplify your life

Look at your activities. Decide which ones are most valuable and omit those that aren’t. Many tasks or chores may seem necessary. But are they? They may be important only in your mind. Your family and friends enjoy you more when you’re rested and healthy. Therefore don’t get worn out trying to do too much. Instead do a few things well.

In addition ask for help when you need it and accept it gratefully. You may also use aids and devices to make your everyday tasks easier.

Manage time and conserve energy

When you usually have pain and limited energy, it’s natural to work harder on days you feel well. Instead of getting worn out trying to do everything, organize each day the night before or in the morning. Plan to do the most stressful or hardest task early in the day. Schedule rest periods and remember to take them before you get worn out. Pace your activities by doing a heavy task and then light ones. Don’t try to do too many heavy chores in one day.

Set goals

Goals give you something to work for and they give you satisfaction once you achieve them. Set short-term achievable goals, taking one day at a time. Remember to include hobbies and friends. Because of the uncertainty of your arthritis, be flexible about the time needed to complete a goal. Take some time to think about your long-term goals. How has your life changed since you last thought about your goals? Has your arthritis affected them? What is most important to you now? What do you want to achieve?

Avoid drugs and alcohol

Realize that drugs and alcohol don’t solve life’s problems. When people who smoke are under stress they tend to smoke more. Some people use alcohol marijuana or other drugs in an attempt to solve or to escape from life’s problems. These substances can only add to your health problems. They don’t help you manage stress. In fact in the long run they can increase your stress. Instead see a mental health counselor or ask your community health service or hospital about programs offered in stress management.

Seek support and education

Most Arthritis Foundation chapters have clubs and support groups. Many chapters offer educational programs such as the Arthritis Self Help Course which meets for two hours each week for six weeks. The course emphasizes many topics including stress and pain management. These groups can allow you to discuss problems or concerns with people who have similar ones. Sharing will help you realize that you are not alone.

Try to stay healthy

Remember that having arthritis is only one part of your total health picture. Sometimes people feel so overwhelmed trying to manage their arthritis that they forget about the rest of their health. You control your diet weight exercise and attitude for example. By becoming as physically and mentally fit as possible you can improve your energy state of mind and your level of stress.

Make time for humor and fun

Schedule time for play and become involved in activities that make you laugh. There is almost a magical quality about laughter. No matter how sad your mood, laughing can make the world look brighter. Laughter dissolves tension–you can’t be “uptight” and laugh at the same time! Joke with friends or see a funny movie. You know yourself–do what is fun for you.

Seek help if you need it

Get help to cope with constant hard-to-solve problems. For instance a mental health counselor or therapist may be able to help you work through a serious marital problem or severe depression. He or she might be able to help you find positive ways to express anger if that has become a major concern.

Accept what you can’t change

Change yourself not others

Realize that you can change only yourself not other people.

Many people spend too much time and energy trying to reform their spouses, children or doctors. They want to make them different or to have them act in a certain way. When these changes don’t happen, people tend to feel frustrated, tense and upset. No one has the power to change another person. When people change, it’s generally because they wanted to do so.

Accept imperfection

Have the courage to be imperfect. Stop trying to be the ideal parent, spouse, child, patient, employee or boss. No one is perfect! Trying to be perfect is admirable but doing so takes its toll on your time, energy and the way you feel about yourself.

Realize that life isn’t always fair. Drugs have side effects, doctors may sometimes be grouchy, and families don’t always understand.

Try to “roll with the punches.” Being flexible helps you keep a positive attitude despite hardships.


What is relaxation?

Learning how to relax is one of the most important ways to cope with stress in a positive way.

Relaxation is more than just sitting back and being quiet. Relaxation is an active process involving methods that calm your body and mind. Learning how to relax takes practice, just as learning how to ride a bicycle takes practice. Once you know how it becomes “second nature.”

Keep in mind that there’s no right way to become relaxed. Whatever works for you is what’s important. Listed below are a few suggestions. Try out different methods until you find one or two that you like best. If you need help see a mental health counselor or contact your local Arthritis Foundation chapter.

Relaxation techniques

  • To begin with try to set aside time in a quiet place away from people TV radio and other distractions.
  • Close your eyes. Slowly tense and then relax muscles that feel tense. Begin with your feet and work up to your neck.
  • Sit in a comfortable chair with your feet on the floor and your arms at your sides. Close your eyes. Breathe in saying to yourself “I am . . . then breathe out saying . . . relaxed.” Continue breathing slowly silently repeating to yourself something such as: “My hands are . . . warm; my feet . . . are warm; my forehead . . . is cool; my breathing . . . is deep and smooth; my heartbeat is . . . calm and steady; I am . . . happy; I feel calm . . . and at peace.”
  • Light a candle and focus your attention on the flame a few minutes. Then close your eyes and watch the image of the flame for a minute or two.
  • Imagine a white cloud floating toward you. It wraps itself around your pain and stress. Then a breeze comes. It blows away the cloud taking your pain and stress with it.
  • Think about a place you have been where you once felt pleasure or comfort. Imagine it in as much detail as possible how it looks smells sounds and feels. Recapture the positive feelings you had then and keep them in your mind. Don’t make any room for negative thoughts stress or pain.
  • Imagine that you’ve put all your concerns worries and pain in a helium filled balloon. Now let go of the balloon and watch it float away.

Sometimes simply letting your mind wander or “go on vacation” will help reduce your stress. Here are a few suggestions. Invent your own!

  • Watch a sunset.
  • Take your shoes off and walk in the grass.
  • Sit in a park on a warm sunny day and listen to the birds.
  • Sit in front of a fire in the fireplace.
  • Gaze at fish in an aquarium.

Overcoming barriers to relaxation

To overcome barriers to relaxation you must really want to learn to relax. Some common “stumbling blocks” to relaxation include these:

  • Feelings of guilt for taking time from your busy schedule
  • Being made fun of by others
  • Not being able to stop and take time
  • Fear of “loss of control.”

Remember that relaxation will help you gain better control of the demands made on you. If you devote time to relaxation later you’ll be able to do more and enjoy yourself more.

From time to time, it may seem impossible to stop and relax. You may find yourself in a rut–tense because you’re so busy and too busy to relax. If this happens start wherever and whenever you can. If you’re waiting in traffic, take a few deep breaths and let the air out slowly. If you’re at work, take a short break in the rest room lounge or snack bar. Close your eyes breathe deeply and try to forget about everything except your breathing. Notice which muscles are tense–perhaps your neck forehead or shoulders–and relax them.

You may think that a high level of body tension means that you’re “in control” and that feeling relaxed seems like a loss of control. Realize that muscle tension drains your energy and can increase your pain. Relaxation actually helps you gain control over your stress and pain.

It takes time and effort to learn a new skill. Therefore, don’t give up before you have a chance to reap the benefits! Knowing how to relax can become part of your life. Remember, like any habit, learning to relax takes time to become automatic.

More relaxation tips

  • Practice every day even for just 15 minutes. A new habit must be repeated often until it begins to feel as though it’s a part of you.
  • Choose your favorite methods. Be creative. Remember there is no one best way to relax.
  • Work in short relaxation breaks during your day whenever you can. Try using very simple methods such as deep breathing for even a minute or two.


Make stress work for you

Managing stress can help you have less pain and feel healthier. It can also help you cope with the extra demands made on you by your disease. By following these suggestions you may be able to get stress to work for you instead of against you.

Learn to identify those situations you can do something about and those you can’t. Work at reducing the cause of your stress by communicating better and respecting your limits of energy and pain. Simplify your life “look on the bright side and develop and keep a sense of humor. Prepare for stressful events by getting extra rest.

Remember that you can’t change others. Keep in mind that no one is perfect. Seek professional help for serious problems.

Practice relaxation methods to overcome the effects of stress that you can’t avoid. Engage in hobbies and simple pleasures that give you joy.

Finally, remember that managing stress is your job. With stress under control, it’ll be easier to keep your arthritis under control.


Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Beth Ziebell PhD. This material is protected by copyright.

If you have arthritis, you already know about swollen joints and painful movement. But what may surprise you is that arthritis can get to your head and cause mental distress too — leading to stress and anxiety for a third of people in the U.S who have this condition.

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Finding ways to cope with stress can go a long way toward limiting your pain and improving your quality of life. Let’s look at how that can work.

The stress-arthritis cycle

It’s often unsettling for patients to hear the initial diagnosis, says rheumatologist Alla Model, MD. “There is worry about the prognosis and the future,” she says.

As arthritis symptoms progress, you may grow frustrated. You may struggle to put on socks, chop vegetables or do other things that were once routine. Worry can rob you of sleep, cause indigestion, and you may notice other side effects that boost your stress levels.

“Being uncomfortable and in pain makes people more emotional and increases stress,” Dr. Model says. And because stress can lower your threshold for pain, the stress just makes the physical pain worse.

3 tips to handling stress

1. Stay as active as you can

Exercise and physical activity such as walking and swimming help:

  • Reduce the stiffness that comes with arthritis
  • Control weight, which reduces stress on joints
  • Release the “feel-good” endorphin hormones, which can both improve your mood and block pain.

Dr. Model offers the example of one of her patients: Diagnosed with psoriatic arthritis, she was active in a hiking club, often spending three to five hours at a time out on the trail. “She got braces, learned how to cope and it hasn’t stopped her — she’s doing great,” Dr. Model says.

She also recommends yoga, Pilates and hot-water therapy to foster relaxation and help cope with the stress of arthritis.

Some people are more motivated to follow an exercise program at home, while others may need the support of a class instructor, personal trainer or physical therapist. “Whatever it takes to get them moving,” she says.

2. Keep pain in check

Talk to your doctor about drugs to help reduce the pain. There is no medicine to cure arthritis, but nonsteroidal anti-inflammatory drugs (NSAIDs) can help control your pain. And, as mentioned above, keeping your pain in check can help reduce stress levels and vice versa.

What type, how much and how often you should take an NSAID will vary depending on what type of arthritis you have (there are more than 100 types) and your symptoms.

For instance, your doctor may prescribe higher doses of NSAIDs if you have rheumatoid arthritis, while lower doses are often enough for osteoarthritis that affects only one joint.

3. Eat right to fight inflammation

Eating healthy, especially foods shown to improve arthritis symptoms, can help reduce stress and pain.

Three types of anti-inflammatory foods to include in your diet are:

  • Wild salmon, olive oil and other sources of omega-3 fatty acids
  • Broccoli, cauliflower and other fresh or frozen cruciferous vegetables
  • Cherries, blueberries and strawberries

Limit foods containing omega-6 fatty acids, which boost rather than reduce inflammation. Omega-6 fats are common in red meat and vegetable oils such as corn and sunflower oil.

As patients learn how to cope with arthritis, they often report a reduction in stress, Dr. Model says. “If they believe in a healthy lifestyle, are mentally strong and able to stay active every day, they will do so much better,” she says.


In the present issue of Arthritis Research & Therapy, de Brouwer and colleagues review the literature pertaining to experimental studies targeting acute-phase reactivity in the stress-response systems of patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) . The authors included only studies employing experimental stressors (psychosocial, cognitive, exercise, and sensory/pain induction) to evaluate physiological responses at three levels – the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and the immune system – in patients with RA and SLE.

Sixteen studies were identified . The authors found inconsistent results regarding experimentally induced stress and the ANS and HPA axis baseline levels and reactivity, but found some evidence for alterations in immune functioning in patients compared with controls. They noted that the most consistent finding in response to experimentally induced stress was an increase in the number of natural killer cells, but this may not be surprising because natural killer cell trafficking is very sensitive to stress hormones such as catecholamines. The authors note, however, that many of the studies possessed methodological problems of their own. Most studies were underpowered (that is, small sample sizes) and some failed to control for potential confounders such as medication use, age, sex, psychiatric comorbidity, stress coping/appraisal and abuse history. In patients with rheumatologic illness, the presence of depression and a history of abuse are relatively common and have been associated with alterations in the stress-response and immune systems .

The results from the present review of the effects of stress in RA and SLE suggest that the findings in these disorders are congruent with a broader literature including both animal models and clinical studies of other rheumatic disorders. A number of different types of stress have been shown to induce arthritis in animal models ; however, such a relationship in humans is more tenuous.

Most studies are limited by the use of cross-sectional designs and the pitfalls associated with self-report retrospective data, but their findings are still of interest. For example, a study of Vietnam combat veterans with current post-traumatic stress disorder (n = 2,490) found that they were at increased risk for autoimmune diseases (16.7%, 95% confidence interval = 7.9 to 29.3%) compared with those without post-traumatic stress disorder (6.1%, P < 0.05) . In that study, the combination of several stress-related conditions seemed to further increase this risk, with 8.1% of these male veterans with both posttraumatic stress disorder and comorbid depression, anxiety or other significant psychopathology reporting a diagnosis of RA .

Other studies have contemplated a role for early life stressors in increasing vulnerability to autoimmune disease. One recent study found that individuals reporting two or more traumatic childhood events were at a 100% increased risk for rheumatic diseases compared with those reporting no childhood trauma . Further, a multitude of studies have described relationships between psychological stress and poor outcomes in both RA and SLE including disease flares. The mechanisms presumed to underlie these associations include stress-related changes in functioning of the autonomic, neuroendocrine and/or immune systems.

Work performed to examine how stress modulates symptoms, especially pain, in other nonautoimmune rheumatic conditions such as fibromyalgia might also be instructive in elucidating the role of stress in symptom expression. From a vast array of experimental studies it is reasonable to conclude that a variety of stressors may cause pain, that pain may cause stress, and, more importantly, that a simple unidirectional relationship between changes in stress-response function and pain and other symptoms probably does not exist. Imaging studies of pain processing in fibromyalgia indicate that psychological stress (that is, depression, anxiety) and pain are processed somewhat independently in the central nervous system . Supporting this conclusion are the clinical data indicating that drugs acting as both antidepressants and analgesics (for example, tricyclics or serotonin-norepinephrine reuptake inhibitors) are equally effective analgesics in chronic pain conditions in patients with and without depression . The lack of direct overlap in the central processing of stress and pain suggests that the degree to which stress influences pain, and vice versa, may be moderated by individual factors such as cognitions, coping/appraisal and social support .

In fibromyalgia, as well as in autoimmune disorders, symptom expression is likely determined to a similar extent by genetic and environmental factors. Although there have been efforts to link pain and subtle abnormalities in ANS and HPA system functioning seen in individuals with fibromyalgia and other chronic pain syndromes, newer data suggest much more complex interrelationships between these systems. Observable changes in the ANS or HPA axis tone in some individuals may represent a baseline diathesis or risk factor for the subsequent development of chronic pain, or the changes may be due to pain itself or to the indirect effects of pain such as deconditioning secondary to decreased exercise.

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.

Life is full of stressful situations. You may feel stress over meeting a deadline, managing finances, or even something as simple as getting the kids out the door in the mornings (ok, maybe NOT so simple).

According to the Anxiety and Depression Association of America, “Seven out of ten adults in the United States say they experience stress or anxiety daily, and most say it interferes at least moderately with their lives.”

Stress has become such a part of daily life that many people don’t realize it’s a problem until symptoms become unbearable, and sometimes, irreversible.

How Does the Body Respond to Stress?

When faced with danger, a chemical reaction occurs in your body which allows you to act quickly. This reaction, also known as the “fight-or-flight” or “stress response”, is your body’s way of keeping you safe from harm. Unfortunately—the body can’t always discern between a legitimate threat and the pressure of daily life.

Any stressful situation—from narrowly avoiding a head-on collision to being stuck in a traffic jam—can trigger this response causing the heart rate to increase, blood pressure to rise, and muscles to tighten.

Chronic Stress and Long-term Joint Health

Aches and pains are common symptoms of stress, however, ongoing pain or stiffness may be a sign of a more serious problem.

A 2018 study published by PubMed revealed “Stress-related disorders were significantly associated with risk of subsequent autoimmune disease.”

Autoimmune diseases cause your immune system to produce antibodies which attack and damage the body’s healthy tissue instead of fighting infection. In certain conditions, such as rheumatoid arthritis and lupus, the antibodies attach to connective tissue within the joints leading to pain, stiffness, swelling, and—without treatment—potentially permanent joint damage.

Autoimmune diseases are often incurable; however, early intervention and treatment can help prevent further damage and joint deterioration.

Symptoms of Stress and Anxiety

Stress can wreak havoc on your mind and body. In small doses, the stress response can improve alertness and sharpen senses; however, chronic stress can lead to serious problems such as cardiovascular disease, gastrointestinal problems, and autoimmune disease. Be sure to talk to your doctor if you experience any of the following symptoms on an ongoing basis.

Mental/Emotional Symptoms:

  • Moodiness
  • Distraction
  • Forgetfulness
  • Low self-esteem
  • Depression

Physical Symptoms:

  • Aches, pains, and tension
  • Insomnia
  • Headaches
  • Chest pain
  • Nervousness
  • Digestive problems
  • Low energy levels
  • Frequent colds or infections

How to Reduce Stress-Related Joint Pain

We can’t exactly remove stress from our lives, but there are ways to ease symptoms.

  • Identify triggers: Write in a journal and look for patterns. Once you’ve identified them, try to find ways around them.
  • Eat well: Not only is a healthy diet essential in maintaining a healthy weight, certain foods can also help decrease pain and inflammation.
  • Ask for help: You’re not alone. If you feel overwhelmed, ask for help.
  • Stay active: Exercise plays an important role in both mental and physical health. Incorporate walking, yoga, or other activities into your daily routine. **Depending on medical conditions and fitness levels, there may be activities you should avoid. Talk to your doctor to determine a routine that’s right for your body.
  • Limit alcohol and caffeine: Alcohol and caffeine can intensify anxiety and joint pain. Stick to water when you can.
  • Stay positive: Try to look at the bright side of things. It’s not always easy, but your body will thank you.

The Joint Preservation Center at Towson Orthopaedic Associates offers an innovative, personalized approach to long-term joint health. Utilizing early diagnosis, intervention, and the latest techniques, our orthopaedic surgeons can restore and preserve the joint’s natural ability, which makes it possible to avoid more invasive surgeries and prolonged rehabilitation. Are you suffering from persistent joint pain or stiffness? Call 410-337-7900 to schedule an evaluation or .

10 Unlikely Things That Cause Joint Pain

When you think of causes of joint pain, most people go immediately to age, too much exercise, injury and arthritis. However, did you know that these ten things can cause or increase your joint pain?

1. Anxiety. While there are many types, anxiety disorders share a general feature of excessive fear and as a result cause behavioral and functional disturbances. What you may not know is that joint pain is a complex symptom of anxiety. There are many reasons that people who have anxiety feel increased joint pain. Stress inflammation is one of the most common issues inside the body. Pro-inflammatory cytokines are molecules that can be released by many things, one being stress. When you have anxiety you experience long-term stress, and as a result your body continually produces these cytokine molecules. Inflammation caused by these molecules cause your joints to swell and ultimately leads to more pain in your movements.

2. Weather. If you suffer from chronic pain conditions, like arthritis, you may notice that when the pressure in the air changes you feel it in your joints in the form of stiffness or tightness. As the atmospheric pressure drops, tissues in the body may expand and cause more pressure on nerves that control pain signals. Atmospheric pressure drops when a storm system develops. This is why people often claim to be able to tell when a storm is coming because they feel pain in their joints. Another reason that weather affects your joints is that temperature changes can cause fluctuations in fluid levels, which can lessen the lubrication of the joints, therefore causing increased inflammation and pain. Lastly, when the weather gets warmer, you are more likely to become dehydrated. The joint cartilage in our bodies has a high water content so when your body loses fluid and is not replenished, dehydration can occur. Without that fluid in your joints, you are more susceptible to degeneration and damage of your joints.

3. Lack of Exercise. Staying active is one of the most important things you can do to combat joint pain and arthritis. I know it may sound counterintuitive, since moving often makes your joints hurt, why would you do it? Limiting your movements will weaken your muscles. So, by exercising you strengthen the muscles near your joints and increase your range of motion and flexibility.

4. Vitamin D Deficiency. A simple vitamin deficiency may be causing your joint pain. It can be difficult to reach your recommended vitamin D intake, especially if you don’t make an active effort to get outside or eat a balanced diet. Researchers say that the longer you are deficient in vitamin D, the worse your joint pain will get. Eventually, you can develop arthritis or bone problems. Just 10-20 minutes of natural sunlight may give you the Vitamin D you need. However, if you can’t get outside, other sources of vitamin D are foods such as salmon, mushrooms, tuna, and egg yolks. Supplements are also a great way to get your daily vitamin D intake.

5. Food Allergies. While food allergies are quite common in children and often inherited, in some cases you can develop allergic reactions toward a certain food later in life. Allergic reactions occur when your immune system overreacts towards a particular food. One of the symptoms of an allergic reaction is inflammation, which ultimately causes your joints to hurt.

6. Seasonal Allergies. Joint pain is unavoidable when allergies cause inflammation. During allergy season some people suffer from inflammation because your body is working hard to flush out the foreign allergens (pollen, dust, nuts, mold and bee venom). As a result, this inflammation causes pain in your joints. Your body is very fatigued from trying to fight off the allergens and this may cause your joint pain to feel worse. Coughing, sneezing, and wheezing may also cause you to suffer from muscle, joint and neck pain. to learn about how to manage your seasonal allergies to avoid joint pain.

7. Smoking Cigarettes. By now, you know that smoking cigarettes causes many negative health benefits. Add joint pain to that list! Smoking is addictive because nicotine causes the body to release dopamine, which makes you feel good. It tricks the body into feeling less pain at first however, when that feeling wears off the pain is often worse. Cigarettes also affect the body’s circulatory system and inhibit nutrients from flowing to the muscles and joints. Since your muscles help to protect your joints, when they are not receiving the proper nutrients your joints are more susceptible to pain. Back pain and neck pain are also common in smokers because of the coughing symptom that many smokers experience.

8. Obesity. Obesity means that a person’s body weight is 20% higher than it should be, and they have a body mass index (BMI) over 30. Added weight puts more pressure on your joints. Each pound of weight that you gain adds 4 pounds of pressure to your knee joints. This is why obesity is such a major risk factor for the development of osteoarthritis and joint pain.

9. Alcohol. Alcohol forces your body to lose water and therefore dehydrates your ligament and tissues. Since your joints rely heavily on having sufficient fluids to move smoothly and function properly, insufficient fluids in your joints can cause agonizing pain. Drink in moderation to minimize dehydration and to allow your joints to function normally!

10. Depression. Depression is defined as sadness, not being interested in daily activities, weight loss or gain, insomnia or excessive sleeping, low energy levels, inability to concentrate, thoughts of worthlessness or excessive guilt, and recurrent ideas of death or suicide. Studies show that depression lowers your pain tolerance level and weakens a person’s ability to deal and cope with pain. Since people with depression are unable to deal with their joint pain, they are less likely to stick to their treatment regimens and maintain a healthy lifestyle. A 2016 study measured the CRP levels (a blood test marker for inflammation) of 10,036 people. Of those people who showed symptoms of depression, CRP levels were 31% higher than those with no depressive symptoms. So, there is a developing theory that inflammation may also be directly linked to depression.


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RA Causes: What are the Top Causes of Rheumatoid Arthritis?

Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Oct 27, 2018 8 min read

What Causes Rheumatoid Arthritis?

The specific causes of rheumatoid arthritis (RA as it’s often shortened to in the medical community) have yet to be identified. This is true despite decades of medical research.

However, while we don’t know specifically what brings about RA and the symptoms it is known to create — such as joint pain, stiffness, fatigue, and low-grade fever — we do know that it is the result of an autoimmune disorder which ultimately affects the joints.

In fact, oftentimes the pain in the joints is so severe that the people suffering from RA are advised to take a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, or naproxen or some other type of anti-rheumatic drug to help ease the pain in the joints created by RA.

What’s the connection between RA and the joints? Specifically, how does this disease impact the joints in the human body, creating pain as a primary symptom?

RA and the Joints

The answer to this question begins first with understanding that RA is an autoimmune disorder. This means that this particular disorder occurs when immune cells begin to attack the normal cells of the body. In the case of RA specifically, the body attacks its own healthy joint tissue called the synovial membrane, or synovium.

If you’re unfamiliar with the synovium, don’t worry. You’re not alone. The synovium is the lining of the joint which produces a clear liquid substance known as synovial fluid. This fluid has two roles. First, it is responsible for lubricating healthy joints. Second, it gives cartilage and bones the nourishment required to remain effective and mobile.

Once RA has been triggered, antibodies are produced and they go into attack mode. These antibodies release chemicals that cause inflammation to the synovium, inhibiting its ability to produce the synovial fluid.

As less and less fluid is produced, the joints become more stiff and immobile. This is generally where NSAIDs often come in, to help treat the pain that results.

As the synovium becomes thicker without the benefit of the fluid’s normal, healthy lubrication, the joint’s cartilage can also become destroyed, causing inflammation. Over time, this can weaken and eventually destroy the connective tissue between the bones.

Once the cartilage is destroyed, the ligaments that connect to the bone also begin to weaken. The tendons that connect the bone to muscle are negatively impacted as well. As the ligaments and tendons weaken, they can no longer hold joints in proper position; they’ve essentially been stretched out, which can cause such a severe loss of configuration that the joint can eventually be totally destroyed.

This entire process is what leads to the chronic RA symptoms which people with this disease suffer from. It’s also why anti-inflammatory medications on several levels are effective RA treatment.

RA as a Cause

If the RA is chronic in nature, which means that it is a severe inflammation and goes on for quite some time, one could also develop rheumatoid vasculitis. Rheumatoid vasculitis is an inflammation of the blood vessels. Fortunately, this condition only afflicts about one percent of RA patients as a whole. It is thought to be brought on by a compromised immune system, ultimately making it more able to attack the blood vessels in addition to the joints.

Another somewhat rare form of RA is called palindromic rheumatism. In the case of palindromic rheumatism, instead of the pain and stiffness in the joints being constant, it is more flippant in nature. In other words, between attacks, the joints go back to normal with no permanent damage.

While the symptoms may be less problematic than with other forms of arthritis, palindromic rheumatism can lead into the development of RA. That makes finding a quick treatment option extremely preferable so that this type of come-and-go inflammatory arthritis doesn’t result in joint damage that is more permanent in nature.

Medical professionals can often get a decent read on how severe a patient’s current RA flare-up is by testing his or her level of c-reactive protein (CRP). CRP is a protein in your blood which rises in response to inflammation and infection, making it a solid indicator of how much inflammation is currently present in the body. A simple blood test is all it takes to see where a patient’s levels are.

RA Risk Factors

Even though the exact causes of RA are unknown, researchers have identified that it is the result of an autoimmune disorder which creates joint inflammation, pain, stiffness, and other common RA symptoms. Today, researchers continue to study what triggers the disorder and its symptoms as well as the different factors that induce RA.

It is suspected that autoimmune diseases like RA are caused by a multitude of variables. These can generally be broken down into four basic categories: genetics, hormonal changes, lifestyle choices, and environmental factors. Sometimes it is a combination of them all as, while they each have the ability to impact the health of your joints, put them together, and they can really wreak havoc.


While having a specific history of RA in your family can increase the chances of your own development of the disease, this does not always guarantee that you will develop this type of inflammation. The degree of risk as it relates to genes, that are passed down from one generation to the next, can vary quite greatly when it comes to determining what role family history plays in developing the disease. What does this mean in easy-to-understand terms?

Put simply, people who possess a genetic background of RA may never develop this disease and thus require treatment. Conversely, some people develop RA without any known family history, causing them to wonder where all of the pain and stiffness is coming from and, perhaps more importantly, how to treat it as quickly and effectively as possible.

Juvenile rheumatoid arthritis (JRA), also commonly referred to as juvenile idiopathic arthritis (JIA), is a good example of how genetics can play a role in the development of a disease such as this. Those from European ancestry are most at risk of inflammation associated with JRA or JIA, while African Americans also tend to test positive for rheumatoid factor more often than some of the other racial groups. Rheumatoid factor is an antibody which, in higher levels, can indicate that someone is at a higher risk of the development of a rheumatoid nodule or other rheumatoid disease which results in joint damage.

It has also been determined that there isn’t one individual gene that causes the joint pain and inflammation associated with RA. Rather, researchers feel that there is a combination of genes interacting with each other that potentially lead to development of the disease. This genetic combination can cause the development of RA early on in life, as in the case of JRA, as opposed to some of the potential environmental causes that may lead to its development as a person advances in years.

Another way that genetics may potentially play a role in the potential development of RA is when a person has another genetic condition that weakens his or her immune system. If you have been genetically predisposed to conditions like Epstein-barr virus or Sjogren’s syndrome for instance, you could be more susceptible to viral or bacterial infections. Furthermore, it’s possible that this susceptibility could trigger the development of other autoimmune diseases such as RA.

Thus, treatment of those conditions can potentially help reduce one’s risk of RA. It does this by making your immune system stronger and more capable of preventing other autoimmune diseases. If there’s a question about whether genetics is an issue for you, a blood test may help provide the answer.


Research has shown that there are a greater number of women who develop RA in their joints, with three times as many patients being female versus male. This leads researchers to believe that female hormones could contribute to the triggering of this disease, making them a risk factor worth considering.

Women who develop RA typically do so somewhere between the ages of 30 and 60 years old. That puts this age range specifically at risk for developing the symptoms associated with RA, the pain and the stiffness in the joints, leading them in search of effective treatment methods in higher numbers than other segments of the population.

Because of this, it appears that maintaining healthy levels of the reproductive hormones, estrogen and progesterone, can reduce the risk of triggering RA inflammation. That makes doing blood tests and addressing these levels a prospective treatment option for patients with RA as joint symptoms are reduced during pregnancy as well as during a woman’s postovulatory stage of the menstrual cycle, when reproductive hormone levels tend to be higher.

These types of hormonal changes also put a woman at risk as she ages, when her levels of reproductive hormones naturally decrease. Once she has reached and passed the age of menopause, hormone levels aren’t nearly at the same as they were at an earlier age. It is possible that this lowered hormone level is what causes the onset of this type of arthritis in the joints, and is why this segment of the population experiences this disease more than any others.


As for non-genetic risk factors, researchers consider the possibility that obesity, smoking, and poor health in general could be potential contributing factors in developing the pain and stiffness commonly felt by patients with RA. This only makes sense as all of these lifestyle factors are known to compromise an otherwise healthy immune system, making it easier for joint-related conditions like RA to take hold.

Case in point: Research has shown that many patients suffering from RA are diagnosed with obesity prior to developing the disease. This link could be explained by the fact that fat cells store cytokines, which are inflammatory chemicals. The more fat cells you have, the more inflammatory chemicals your body stores.

Smoking, like obesity, also puts you at greater risk for many health conditions, with RA being one. Smoking cigarettes can have serious adverse effects on the ability of your immune system to function properly. The damage that inhaling all of these carcinogens does to the body, combined with other genetic factors, could increase your risk of developing RA.

Although no evidence can directly link RA to obesity, smoking, and overall bad health, these are still prominent risk factors and should be controlled as preventative measures when it comes to achieving and maintaining healthy joints. The best thing about them is that they’re all controllable on a personal level, making them an affordable and simple-to-implement treatment option that doesn’t require going to a health professional or taking time off work.

Making positive lifestyle choices can also reduce RA symptoms. Thus, if you’ve already been diagnosed with this disease, losing weight, quitting smoking, and improving your health can potentially make treatment easier and more effective.


Outside of the lifestyle factors of smoking, obesity, and poor health, there are also environmental factors to consider. These include exposure to chemicals and pollutants which could heighten your risk of RA.

Found in the form of air pollution, food and product chemicals, second-hand smoke, and insecticides, these toxic substances are all parts of our external environment that are known to have a negative impact on our body. This makes them prime candidates for creating the painful joints suffered by RA patients.

Depending on the type and severity of the exposure, it’s possible that these can all be contributing factors to developing autoimmune diseases like RA. As managing your weight and quitting smoking are recommended to lower your RA risk, avoiding exposure to toxins is another way of controlling and preventing the disease.

If your environmental exposures are many and you’ve already been diagnosed with RA, successful treatment may involve removing these toxins from your space as much as possible. For instance, if your job entails working around chemicals that could be contributing to your RA, then perhaps a career change is a suitable treatment option. Or, if you live with someone who smokes, making them go outside or ending the relationship may help reduce your RA symptoms.

Environmental issues also include any past emotional or physical traumas that alter how the body reacts. These types of issues are also thought to perhaps contribute to the eventual development of RA because emotional stress is shown to activate or trigger an immune response, which in turn worsens the disease and its symptoms.

In this case then, certain individuals who have experienced a high level of stress or a trauma and who have a genetic predisposition to RA are at higher risk. Both of these factors individually or in unison could trigger the onset of this disease.

Ongoing research continues to further identify the causes of RA in patients, the risk factors, the symptoms — such as severe pain in the joints — that this condition creates, as well as effective treatment options. The goal is the eventual prevention of this painful and debilitating disease and the creation of a better life for people with RA.

Job Stress Linked To Rheumatoid Arthritis

Researchers have found new links between stress at work and risk of rheumatoid arthritis. It seems that low levels of job-related control may increase the risk, but high demands may actually be protective.

A team led by Dr. Camilla Bengtsson at the Karolinska Institute in Sweden used figures on 1,221 rheumatoid arthritis patients aged 18 to 65 years, and 1,454 similar healthy people.

Psychological job demands and job “decision latitude,” or personal control, were measured by questionnaire. Participants facing high demands with low control were defined as experiencing “job strain” as opposed to relaxed working conditions.

Earlier work has linked job strain with an increased risk of several diseases, including heart disease, because of a possible association with inflammation. But it has not previously been studied in relation to rheumatoid arthritis.

The team explains, “Data on environmental factors that may cause rheumatoid arthritis is scarce.” Results of their new study appear in the journal Psychotherapy and Psychosomatics.

Low decision latitude was linked to a 60 percent increase in risk of rheumatoid arthritis, but surprisingly, high psychological job demands were linked to a 20 percent lower risk. Job strain, a combination of the two, was linked with a 30 percent higher risk, compared with relaxed working conditions.

The team concludes, “The main new finding of this study was that low decision latitude was associated with an increased risk of developing rheumatoid arthritis. Furthermore, some evidence that those with high psychological job demands had a decreased risk of rheumatoid arthritis was found.”

Dr. Maurizio Cutolo of the University of Genoa, Italy, has looked into this link. He writes, “Stress is now recognized as an important risk factor in the pathogenesis of rheumatoid arthritis.”

He believes the mechanism can be explained by brain activity. “Activation of the stress response system influences the relationships between the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system and the immune system,” he writes.

“The stress response results in the release of neurotransmitters (norepinephrine), hormones (cortisol) and immune cells. Major life events lead to an intense release of stress mediators, whereas in minor life events, only short-lived surges of neurotransmitters and hormones are expected.”

Long-lasting stress may lead to proinflammatory effects, because no adequate long-term anti-inflammatory responses are available, he states.

The Swedish team also investigated the possible influence of formal education and occupational class on risk of rheumatoid arthritis. Using figures on 930 rheumatoid arthritis patients and 1,126 similar healthy people, they calculated the risk of developing rheumatoid arthritis for different levels of formal education and occupational classes.

Those without a university degree had a 40 percent increased risk, compared with those with a university degree. Manual employees, and assistant and intermediate non-manual employees had a 20 percent higher risk than higher-ranking non-manual employees.

The researchers say that these increased risks were mainly confined to women, who constitute three times as many sufferers as men. They suggest that “as yet unexplained environmental or lifestyle factors, or both, influence the risk of rheumatoid arthritis, even in the relatively egalitarian Swedish society.”

In contrast to osteoarthritis, the more common form of arthritis caused by trauma or infection of a joint, rheumatoid arthritis is an autoimmune disease in which the body attacks itself.

Dr. Bengtsson believes that environmental factors are important, as the shared risk among identical twins is low, at only 12 to 15 percent. Evidence of the role of social class is crucial for understanding its causes, she writes. A limited formal education has been found to raise the risk of rheumatoid arthritis, but results are “somewhat inconsistent.” She thinks this inconsistency may be due to low participant numbers or the inclusion of other types of arthritis.

Because Sweden provides universal access to medical care, Dr. Bengtsson says it is unlikely that the links she found can be due to variation in treatment.

“Taking these considerations into account, the results from our study add to the likelihood that socioeconomic status indeed influences the risk of developing this disease even today, and even in Western Europe, including the highly egalitarian societies in Scandinavia,” she says.

“The lower risk in individuals with high education and less manual work may reflect fundamental factors that may have changed the overall pattern of rheumatoid arthritis in many Western societies toward a lower overall rate and a higher age of diagnosis,” she suggests.

Bengtsson, C. et al. Psychosocial Stress at Work and the Risk of Developing Rheumatoid Arthritis: Results from the Swedish EIRA Study. Psychotherapy and Psychosomatics, Vol. 78, April 2009, pp. 193-94.

Bengtsson, C. et al. Socioeconomic status and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Annals of the Rheumatic Diseases, Vol. 64, November 2005, pp. 1588-94.

Job Stress Linked To Rheumatoid Arthritis

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