Is Stress Making Your RA Flare?
Whether it’s been a day or a decade since you were diagnosed with rheumatoid arthritis (RA), we don’t have to tell you that the mere reality of having the disease can be stressful. And you’ve probably also noticed that stress can make your RA issues worse—86% of patients say it’s the most frequent cause of joint symptom flares. This connection has all the makings of a vicious cycle, but it’s fortunately one you can sidestep. We’ve got the information and tools you need to find a sense of calm.
Don't Blame Yourself for Your RA
That stress can actually contribute to the development of RA. Research has found a correlation between, for instance, post-traumatic stress disorder and RA, the association is unclear. “Our understanding of how stress contributes to the development of autoimmune diseases is still relatively crude,” says Anca Askanase, M.D., Director of Rheumatology Clinical Trials at Columbia University Medical Center. “There does seem to be a connection between big life stressors and RA, but not necessarily everyday stressors like having a bad job.” What’s most important to remember: Blaming yourself for your diagnosis is itself stressful—and counterproductive to healing.
Stress Does Cause RA Flares
And in more than one way. “Stress is involved in increasing some of the inflammatory mediators—the big proinflammatory cytokines like IL1, IL6, and TNF—that also exacerbate joint inflammation, pain, and stiffness,” says Dr. Askanase. The autonomic nervous system, which regulates our stress response, also plays a role. “It’s in a state of hypervigilance, and that’s partly responsible for arthritis pain.” Plus, stress affects our perception of pain, and that’s powerful. “Stress exhausts your coping mechanisms, so pain that you may have been able to tune out before may become more relevant,” explains Dr. Askanase.
Stress Is Stress Is Stress
“Anything that puts the body under stress will make rheumatoid arthritis flare up, and it doesn't matter what type of stress—physical stress or emotional stress; good stress or bad stress,” says Howard L. Feinberg, D.O., professor of rheumatology at Touro University California College of Osteopathic Medicine. For instance, a cold or other illness, exercising to the point of exhaustion, enduring an injury, even happy things like planning your wedding—they can all stress your body significantly. Becoming aware of stress’s various forms can help you identify and minimize the triggers.
The Consequences of Stress Go Beyond RA
Experiencing exceptional stress when you have RA may increase the risk for other serious health concerns. For instance, there’s evidence that RA patients with higher levels of stress and anxiety are more likely to have atherosclerosis, a buildup of fatty acids in the arteries and precursor to cardiovascular disease. It’s also likely that stress ups the chance of depression, anxiety, and gastrointestinal conditions among RA patients, says Dr. Askanase. “Obviously, stress is bad for the body in general.” Exactly how stress increases vulnerability—does it lead to the production of more inflammatory molecules?—is still being investigated.
Just Admit It
As with many issues, admitting the problem is the first step. This can be tough with stress, particularly in our go-go-go culture. “Stress is almost glorified in a way,” says Dr. Feinberg. Start the convo in your doctor’s office. While research suggests 45% of PCPs "rarely" or "never" discuss stress management with patients due to factors like time constraints, they're much more likely to offer counseling when patients are dealing with chronic conditions and evident psychological distress. The takeaway: You have to tell your doctor you're struggling. “Sharing that you’re feeling stressed or depressed can help your physician help you manage it,” says Dr. Feinberg.
Give Meditation a Chance
Among its gazillion benefits, meditation can both reduce stress and ease chronic pain. It’s not a quick fix—rheumatoid arthritis patients in one study experienced a 35% reduction in psychological distress after six months of a “Mindfulness Based Stress Reduction” mediation program. However, a long-term solution can be a powerful tool for managing a lifelong chronic illness. There are several styles of meditation, so consider experimenting with different approaches—you could try a few apps or take a workshop—to find one that feels right for you.
Make Your Move
Whether barre class, spin, or whatever gets your heart pumping and won’t compel you to watch the clock, “exercising is an excellent way to decrease stress and relieve some anxiety,” says Dr. Askanase. If you’re concerned that any amount of physical activity may trigger pain, don’t be: “The wisdom is that RA pain gets better with exercise,” assures Dr. Askanase. Just be sure to not push it to the point of exhaustion, which could make your arthritis more active (that cycle again). “If you’re uncomfortable or unsure, working with a physical therapist is the easiest way to get started on a good exercise regimen.”
Stress, sleep, and RA are not good bedfellows. Anxiety about your disease can keep you up, as can rolling over on sore joints, says Dr. Feinberg. But getting a good night’s sleep can go a long way toward lowering stress and easing pain, so it’s important to do what you can to usher in deep Zzz’s. Meditation, exercise, vigilantly powering down your lit screens an hour before bed, and practicing good sleep hygiene can help. Also, be aware that some common RA medications like prednisone and hydroxychloroquine can cause sleeplessness, so try to take them earlier in the day.
Call in the Pros
Not everything can or should be solved on your own. If you’re struggling to get feelings of stress, depression, or anxiety under control, you might need professional support. “Rheumatoid arthritis can take a real emotional toll on patients and their relationships, so individual or family counseling can be beneficial,” says Dr. Feinberg. “And if you have ongoing depression that's lasting months, for instance, it may need to be treated with medication.” What works for one person might not for another, so keep trying until you find your best stress-reduction methods.
Stress and joint symptoms: European Journal of Rheumatology. (2017). “Rheumatoid Arthritis: Are psychological factors effective in disease flare?” ncbi.nlm.nih.gov/pmc/articles/PMC5473448/
The PTSD and RA connection: Arthritis Care & Research. (2015). “Post‐Traumatic Stress Disorder and Risk for Incident Rheumatoid Arthritis.” ncbi.nlm.nih.gov/pmc/articles/PMC6210607/
RA and increased risk of cardiovascular disease: Arthritis Care & Research. (2015). “Differential Association of Psychosocial Comorbidities with Subclinical Atherosclerosis in Rheumatoid Arthritis.” onlinelibrary.wiley.com/doi/full/10.1002/acr.22635
Talking stress with your doctor: Journal of the National Medical Association. (2003). “Health care providers' training, perceptions, and practices regarding stress and health outcomes.” ncbi.nlm.nih.gov/pubmed/14527051
Meditation for stress reduction: Arthritis and Rheumatism. (2007). Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. ncbi.nlm.nih.gov/pubmed/17907231
The importance of sleep: Journal of Clinical Medicine. “Sleep Quality in Patients with Rheumatoid Arthritis and Associations with Pain, Disability, Disease Duration, and Activity.” ncbi.nlm.nih.gov/pmc/articles/PMC6210607/