Rheumatoid Arthritis, the Stress Response, and Symptoms
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We’ve all heard that chronic stress is bad for our health. And people with rheumatoid arthritis (RA) know all too well that when you’re under stress you’re more likely to have a flare.
But how does psychological stress actually cause physical problems, especially in those with RA? Scientists have been studying stress for years and are coming to a better understanding of how it can wreak havoc on our bodies, especially in people with autoimmune conditions like RA. But there’s still a lot to learn.
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Where Exactly in Our Bodies Do We Respond to Stress?
The amygdala, in the primitive section of the brain, is first to sound the alarm when we come across something that stresses us, whether it’s a near-miss car accident, trouble paying the bills, or losing our job.
This distress signal is received in the hypothalamus, the section of the brain with a direct link to our autonomic nervous system, which controls such involuntary functions as breathing, blood pressure, and heartbeat.
Anybody who’s experienced an acute bout of stress knows what comes next: With the aid of hormones from the adrenal glands (especially adrenaline), the autonomic nervous system immediately makes the heart beat faster, the pulse quicken, the blood pressure increase, the energy level (in the form of available sugar in the bloodstream) rise, and the senses and alertness sharpen.
Hormone Havoc Triggers Symptoms
The hypothalamus also activates a second part of the stress response system, using the hormonal signals of the HPA axis, especially corticotropin-releasing hormone (CRH), which causes the body to increase its level of what we call the stress hormone: cortisol.
Cortisol is the most famous hormone in our bodily response to stress, and with good reason. Cortisol turns on and turns off various reactions in our body, according to the Mayo Clinic. For instance, it tamps down the digestive and reproductive systems while boosting glucose (sugar) in our blood.
Cortisol also alters the response of our immune system, emphasizing substances that repair tissue (to heal wounds) over other immune reactions.
The Fight-or-Flight Energy Rush
All these effects are meant to be helpful, but also temporary — they allow us to survive the famed “running from a tiger” scenario. When stress becomes constant — as it has been for many of us since COVID-19 entered our lexicon — and the hormones and bodily reactions stay on high alert, health problems can ensue.
Research has shown that the chronic effects of stress increase the risk of depression and heart disease. Another study has linked it to digestive diseases. In the short term, the impact of stress may disrupt sleep and worsen fatigue and other RA symptoms.
While the natural energy boost from cortisol is intended to fuel muscles so we can run or physically fight a threat, chronic high blood sugar can result in insulin resistance and type 2 diabetes.
RELATED: Cortisol: Everything You Need to Know About the ‘Stress’ Hormone
The Stress and Chronic Inflammation Link
Anyone with RA knows that stress plays a role in making people feel worse. “We see it in patients all the time. Somebody loses a job or they have a fire in their house and suddenly they have a big flare,” says Daniel Muller, MD, a rheumatologist at UCHealth in Ft. Collins, Colorado, and a coauthor of Integrative Rheumatology.
But how exactly does this happen? Experts don’t have all the answers, but science has provided some clues.
One study looked at mice and blood samples from low-income (and therefore, it was surmised, chronically stressed) people. Researchers found that stress alters some genes in the bone marrow, which in turn produces immune cells in our blood that are more pro-inflammatory. You can see how pro-inflammatory cells would be valuable in a stressful moment in which the body needs to fight the bruises or potential infection resulting from battle with an enemy. But this dynamic can lead to chronic inflammation if the stress never lets up.
Another study documented how chronic stress in early life alters the expression of genes. By examining the blood of 2,000 Europeans who came from disadvantaged childhoods, they found that changes in the identity and function of certain genes could explain the connection between this early stress and later levels of inflammation in adulthood.
And in other research, scientists at Carnegie Mellon University described how a body under constant stress isn’t properly able to wind down the levels of pro-inflammatory cytokines, the chemical messengers that trigger inflammation. They also believe an overstressed body loses its ability to properly discard cortisol, so too much of that steroid hormone stays circulating; cortisol also plays a role in inflammation.
The Importance of Staying Calm — and How to Do It
If you find yourself frequently feeling stressed, try some proven stress-reducing techniques.
- One of the most effective is mindfulness. Taking even a few minutes to breathe and focus in the present moment can blunt your reaction to stress, Dr. Muller says. Meditation, as part of practicing mindfulness, can even cause physical changes in the stress centers of the brain. To meditate, you can simply sit and watch your breath, or sign up for the eight-week mindfulness-based stress reduction (MBSR) program available online.
- Getting out in nature is another way to keep stress at bay.
- Exercise can also reduce stress and may have other benefits for people with RA.
- Consider joining a support group or keeping a gratitude journal to keep your problems in perspective, or see a therapist if you need professional assistance to accept or deal with the challenges in your life, including your disease.
It’s also crucial to think about ways to build your resilience in the face of life’s inevitable stressful events. Muller encourages bringing your body into an overall state of balance, known as homeostasis.
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“The idea is if you don’t have a good homeostasis, you don’t have the resilience to deal with the stress. Someone who is resilient can take a lot more stress without bad things happening to their body,” he says. Some important ways of maintaining homeostasis: Eat healthy foods, exercise, and get enough sleep, he says.
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