A link between stress andrheumatoid arthritis (RA)is commonly acknowledged. However, scientists continue to explore the connection between the nervous and immune systems and the effect on RA onset and progression. People with RA commonly report experiencing physical or emotional stress when first diagnosed with an autoimmune disorder like RA. However in a 2010 editorial inArthritis Research & Therapy, Daniel Clauw, MD, a professor of anesthesiology at the University of Michigan (who has expertise in rheumatology and pain), commented on a review of 16 studies on the stress-arthritis link. In his editorial, Dr. Clauw highlighted the verified link in animal models and the difficulty in proving a similar linear relationship in humans.
克劳博士解释说:“之所以困难，是因为很难测量压力，我们知道，并不是所有类型的压力都能以同样的方式影响不同的个体。”
但是，研究人员仍在关注这种联系的证据。在同一篇社论中，克劳博士引用了一项研究，该研究发现患有创伤后应激障碍(PTSD)的越战老兵患自身免疫性疾病的风险比没有创伤后应激障碍的老兵高出近17%。A 2009 study inPsychosomatic Medicineshowed that people with two or more traumatic events in their childhood had a 100 percent higher risk for rheumatic diseases compared with people who didn’t suffer childhood trauma.
How Stress Affects the Immune System
Showing a correlation between stress and the inflammatory chemicals associated with RA has been complicated. “We know that stress affects the sympathetic nerve system and cortisol levels, explains Theodore R. Fields MD, an attending physician in rheumatology at New York’s Hospital for Special Surgery. “But in terms of being able to show how that’s related to specific inflammatory chemicals of RA, we need more data.”
It’s believed that stress reduces the immune system’s ability to function properly. Researchers are trying to better understand the role of proinflammatory cytokines like interleukin-6 (IL-6) released during times of stress. Alex Zautra, a professor in the Department of Psychology at Arizona State University, co-authored a commentary published in the October 2013 issue ofNature Reviews Rheumatologyabout a July 2013 Dutch study on the effect of stress on joints. In the study, researchers measured levels of cortisol and inflammatory markers like IL-6, IL-8, interferon and tumor necrosis factor.
他们发现，日常压力(例如，漫长的预约等待时间或失去一些有价值的东西)预示着下个月患者的疲劳增加，而担忧预示着下个月患者报告的疼痛、关节肿胀和疾病活动量增加。但炎症标志物和皮质醇水平似乎并没有因为压力而发生变化。
“Different biopsychosocial pathways of disease progression need to be charted,” Zautra and his co-author wrote.
Zautra does believe there’s a link between RA and stress. A 2008 study he co-authored, which was published inBrain, Behavior, and Immunity, showed that higher chronic interpersonal stress did predict increased levels of IL-6 and inhibit the ability ofcorticosteroidsto stop IL-6 production. “There is evidence that it might speed up the immune dysfunction or delay recovery. That’s all possible,” he explains.
Zautra的研究还表明，对于类风湿性关节炎患者来说，在压力时期缺乏良好的关系与病情恶化密切相关，而拥有较好的配偶关系的女性在人际关系压力发作后并不会看到疾病活动的增加。“他人的基本价值在于社会联系。不要孤单是关键。分享喜悦和心痛，关系的这些方面才是最重要的，”祖特拉解释道。
Can Stress Relievers Alleviate RA Symptoms?
Researchers are also working to understand how modifying stress affects RA on a biological level.
In a review published online on Sep. 10, 2013, in theJournal of Evidence-Based Complementary & Alternative Medicine, author Manoj Sharma PhD, a professor at the University of Cincinnati foundyogato be a promising modality for arthritis. Of nine studies done between 2010 and June 2013, six showed positive changes in psychological and physiological outcomes related to arthritis, including pain. “It relieves stress because your mind is not dwelling on things that are causing you anxiety and stress,” Sharma explains, adding that this form of low-impact exercise also strengthens muscles and adds to the flexibility of joints.
Zautra’s research has also shown that mindfulness meditation, which focuses on acceptance and cognitive behavioral therapy, which works to combat negative thought patterns, can help people manage their RA pain. ”The mind is in the brain and the brain is in the body, so, if we change the way we think about something, it will have a physiological effect,” Zautra says.
Related Resources:
- Stress and Worry Affect RA
- Depression and RA
- Why Do Some People With Rheumatoid Arthritis Experience “Brain Fog”?