Research suggests emotional distress may trigger or worsen RA, but many questions remain.

Can trauma or stress trigger the onset of rheumatoid arthritis? Can worrying make the disease worse?

Research examining the role of trauma and emotional distress in rheumatic diseases suggests the answers to both questions may be yes.

For example, a 2009 study found that people who reported two or more traumatic childhood events – including physical, emotional, or sexual abuse -- had twice the risk of rheumatic disease compared with those who reported no childhood trauma.

Psychological Stress May Affect Disease Outcomes

Further, many studies have described relationships between psychological stress and poor outcomes in RA, including disease flares.

In one of those studies, researchers analysed the records of 1,522 U.S. veterans with RA. They found that those who also had a diagnosis of post-traumatic stress disorder (PTSD) had higher scores of self-reported pain, physical impairment and tender joint count, and worse global well-being than those with RA but no PTSD. 

Worry May Worsen Symptoms

In a Dutch study, researchers found a correlation between worry, RA symptoms and disease activity.

Trying to understand how daily stressors and worrying impact symptoms and disease activity in RA, researchers gathered data from 80 RA patients once a month for six months. Patients answered questions about daily stressors (for example, long appointment wait times or losing something valuable); level of worry; and symptoms of pain, fatigue and disease activity.

Researchers also took blood samples to measure levels of the stress hormone cortisol as well as inflammatory cytokines (chemical messengers) -- including TNF-alpha and interleukin-1 beta (IL-1β) -- believed to play a key role in RA severity. 

Their findings showed that patients who have a tendency for more worrying reported slightly more disease activity, more swollen joints and more pain one month later.

Understanding the Role of Emotions

Researchers say such findings point to the need for more studies about exactly how stress and worrying impacts the disease process. One presumption is that stress leads to changes in the functioning of the autonomic, neuroendocrine and/or immune systems. Another possible explanation is because worrying affects emotional well-being and behaviour, it could lead to less treatment adherence.

Despite the growing evidence that emotional stress can affect the immune system, explaining the effect can be difficult due to the subjectivity of stress and people’s response to different stressors.

While the medical community continues to search for answers, there is no question patients with the tendency to worry extensively can be helped with psychological interventions like cognitive-behavioural therapy.

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