Can Rheumatoid Arthritis (RA) be triggered by stress?

From the Guidelines

Yes, stress can potentially trigger or worsen rheumatoid arthritis (RA) symptoms, although it is not a direct cause of the disease. Stress is known to affect the immune system, which plays a central role in RA. While stress alone cannot cause RA, it may contribute to the onset of symptoms in genetically predisposed individuals or exacerbate existing symptoms in those already diagnosed with RA.

Key Points to Consider

• For people with RA, managing stress is an important part of overall disease management.
• Stress reduction techniques such as meditation, deep breathing exercises, regular physical activity, and adequate sleep can help minimize the impact of stress on RA symptoms.
• Additionally, cognitive-behavioral therapy or counseling may be beneficial for developing coping strategies, as supported by the 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis 1.
• It's essential to note that while stress management can be helpful, it should not replace conventional RA treatments prescribed by a rheumatologist, such as disease-modifying antirheumatic drugs (DMARDs) or biologic agents.
• The link between stress and RA is believed to be related to the effects of stress hormones on the immune system, with chronic stress potentially leading to prolonged elevation of cortisol and other stress hormones, contributing to immune dysregulation and increased inflammation, as discussed in the context of healthy lifestyle and stress management in rheumatoid arthritis patients 1.
• More research is needed to fully understand the complex relationship between stress and autoimmune diseases like RA, emphasizing the importance of a multidisciplinary approach to RA management, including psychological interventions and stress management, as highlighted by various studies and guidelines, including those from the European League Against Rheumatism (EULAR) 1.

From the Research

Rheumatoid Arthritis and Stress

• Rheumatoid Arthritis (RA) is a chronic rheumatic disease with unknown aetiology and variable severity, and stress is now recognised as an important risk factor for the onset and modulation of disease activity in RA 2.
• Chronic mild stress, such as family or professional stress, may lead to proinflammatory effects, increasing disease activity, and a positive correlation between the stress level at the onset of RA and radiological progression could be demonstrated 2.
• The onset of RA was associated with moderate stress at work, underlining the possible interactions between the various stress systems and the immune system 2.
• Coping strategies can reduce stress episodes and change stress management with a positive impact on disease activity in RA 2.

Oxidative Stress and Rheumatoid Arthritis

• Oxidative stress (OS) has been shown to be involved in the progression of RA through DNA, lipid and protein damage, resulting in synovial inflammation 3.
• The use of antioxidants represents an integrative treatment for patients with rheumatoid arthritis, given the evidence of the damage caused by oxidative stress in this disease 3.
• Understanding the different factors that contribute to the development and progression of RA, such as OS, will pave the way not only for better pharmacological treatments but also for recommendations for dietary and health behaviours that will benefit patients with this disease 3.

Mechanisms and Therapies

• The pathophysiology of rheumatoid arthritis has been linked to oxidative stress, and the exact mechanism for these potential driving factors contributing to disease inception and perpetuation is yet elusive 4.
• The Nuclear factor erythroid 2-related factor 2 - Kelch ECH associating protein 1 (Nrf2-Keap1) pathway functions as a ubiquitous, evolutionarily conserved intracellular defense mechanism, and administration of antioxidants as an add-on pharmacotherapy along with conventional drugs has been elucidated as a better measure for disease management 4.
• Recent discoveries on the pathogenesis of RA have led to various new kinds of drugs or therapeutic strategies, focusing on the cellular aspects of RA pathogenesis and new therapeutic methods in clinical application 5.