From the Guidelines
There is no direct evidence from recent high-quality studies to convincingly link hardship as a cause of autoimmune disease. The relationship between hardship and autoimmune diseases is complex and multifactorial, involving genetic, environmental, and infectious components 1. While chronic stress from hardships such as poverty, trauma, abuse, and discrimination can dysregulate the immune system, potentially leading to autoimmune conditions, the current evidence does not strongly support hardship as a direct cause of autoimmune disease.
Key factors to consider include:
- The role of stress hormones like cortisol in initially suppressing immune function but potentially leading to immune dysregulation with chronic exposure.
- The activation of inflammatory pathways by psychological distress.
- The potential for early life adversity to permanently alter immune development. However, these factors are part of a broader spectrum of influences on autoimmune disease development, including genetics, environmental exposures, and infections 1.
In terms of management and prevention, techniques aimed at reducing stress, such as mindfulness, exercise, adequate sleep, and social support, may be beneficial in reducing the risk or managing symptoms of autoimmune diseases, but they should be used in conjunction with, not in place of, conventional medical treatments 1. Given the complexity of autoimmune diseases and the current state of evidence, a comprehensive approach that addresses both the psychological and physiological aspects of health is crucial for individuals experiencing hardship and autoimmune diseases.
From the Research
Hardship and Autoimmune Disease
- There is evidence to suggest that stress, a form of hardship, may play a role in the onset and exacerbation of autoimmune diseases 2.
- The relationship between stress and autoimmune diseases is intricate, with stress associated with disease onset and exacerbations in conditions such as rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis 2.
- Psychological stress can trigger a fight-or-flight response, altering the immune system and potentially leading to autoimmune diseases 3.
Mechanisms of Stress and Autoimmune Disease
- During the stress response, catecholamines and glucocorticoids are released, exerting control over immune cells and altering the cytokine profile released 2.
- Stress can lead to an imbalance in the immune system, promoting T-helper 2 (Th2) cell differentiation and reducing T-helper 1 (Th1) cells 2.
- Meditation and stress management techniques may help regulate the stress response, reducing chronic inflammation and maintaining a healthy gut-barrier function 3.
Clinical Evidence and Recommendations
- Clinical practice guidelines often rely on evidence-based recommendations, but in areas where evidence is lacking, guidelines may be based on expert opinion 4.
- The quality of evidence plays a significant role in making strong recommendations, with higher quality evidence increasing the probability of making a strong recommendation 5.
- Cognitive-behavioral therapy (CBT) has been shown to be effective in managing mental health and stress-related disorders, including autoimmune diseases 6.