Is Stress a Trigger for Rheumatoid Arthritis?

Stressed older woman using laptop
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People often report that episodes of stress or trauma preceded the onset of their rheumatoid arthritis. While stress is nearly impossible to measure, some researchers have suggested that stressful life events, such as divorce, job loss, death of a loved one, or accidents are more common in people with rheumatoid arthritis before disease onset compared with the general population.

If you have rheumatoid arthritis, it's both interesting and important to know if stress triggers the disease or if stress worsens the symptoms. Either way, it is to your benefit to eliminate as much stress from your life as possible. With stress that cannot be eliminated, it must be well-managed.

Stressful Life Events and the Onset of Rheumatoid Arthritis

People with rheumatoid arthritis often connect a stressful event to the onset of their condition. A 2010 paper notes this can be a way to give meaning and a sense of control rather than solid evidence a cause-and-effect relationship.

There are some epidemiologic studies that show an association between stressful life events and an increased risk for rheumatic diseases. One study from 2009 found 100 percent increased risk for people who had two or more traumatic events in childhood, as compared with those who had no such events.

A study of veterans with rheumatoid arthritis found that those who were also diagnosed with post-traumatic stress disorder (PTSD) had more symptoms and impairment as compared with veterans who weren't diagnosed with PTSD.

While not definitive, these are clues that there may be an association between major stress and autoimmune diseases. "There is no question that a chronic disease such as rheumatoid arthritis can cause increased stress," says rheumatologist Scott Zashin. "The role of stress as a cause of these rheumatic conditions is unclear at this time.

While stress may be related to the development of rheumatoid arthritis, research in this area is not definitive."

Stress and Flare-ups of Rheumatoid Arthritis

Zashin says, "Scientific evidence appears to confirm that stress can lead to flare-ups in patients with rheumatic diseases." However, he notes that major life events could also lead to short-term decreases in rheumatoid arthritis symptoms, perhaps because the person is distracted and not focused on the symptoms.

Ascribing flare-ups to stressful life events can be a way for a patient to feel he can have some control over them. But it is also true, the 2010 paper notes, that stress can lead to symptoms such as pain, even if it doesn't spur an immunological reaction.

One study that followed 80 rheumatoid arthritis patients for six months and assessed their daily stressors, levels of worry, and symptoms found that those who worried more had slightly more disease activity, swollen joints, and pain.

A Word From Verywell

Taking steps to reduce stress can help you cope with having a chronic disease. Your emotional reactions can have a significant effect on how you experience symptoms, whether or not there is a cause-and-effect relationship.

Sources:

Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative Childhood Stress and Autoimmune Diseases in Adults. Psychosomatic Medicine. 2009;71(2):243-250. doi:10.1097/psy.0b013e3181907888.

Evers AWM, Verhoeven EWM, Middendorp HV, et al. Does Stress Affect the Joints? Daily Stressors, Stress Vulnerability, Immune and HPA Axis Activity, and Short-Term Disease and Symptom Fluctuations in Rheumatoid Arthritis. Annals of the Rheumatic Diseases. 2013;73(9):1683-1688. doi:10.1136/annrheumdis-2012-203143.

Hassett AL, Clauw DJ. The Role of Stress in Rheumatic Diseases. Arthritis Research & Therapy. 2010;12(3):123. doi:10.1186/ar3024.

Mikuls TR, Padala PR, Sayles HR, et al. Prospective Study of Posttraumatic Stress Disorder and Disease Activity Outcomes in US Veterans With Rheumatoid Arthritis. Arthritis Care & Research. 2013;65(2):227-234. doi:10.1002/acr.21778.

Zashin, Scott J. Interview. May, 2008.