Rheumatoid arthritis causes damage to the lining of your joints. Stress can be a common trigger for flare-ups.
Stress occurs when you perceive a threat and the body reacts by releasing chemicals and hormones. It can interfere with your health in many ways. It’s a risk factor for heart disease and can lead to headaches and problems with sleep. Stress can be especially harmful if you have rheumatoid arthritis (RA). RA is an autoimmune disease, a condition in which the body’s immune system attacks healthy tissue.
For people with RA, the attack on healthy tissue causes damage to the lining of the joints, especially those in the hands and fingers. Symptoms of RA aren’t always present. Instead, they tend to flare up at certain times. Stress is a common trigger for painful RA flare-ups.
Stress as an RA Trigger
Stress can trigger flare-ups of RA, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Flare-ups of RA can also:
- increase your risk of joint damage
- contribute to poorer long-term outcomes
- worsen other complications of RA such as cardiovascular disease
Stress can also make living with RA more difficult and may affect the amount of pain a person with RA feels.
If you experience a flare-up, it’s important to look for treatment.
Learning ways to manage your stress may also help reduce future flare-ups.
RA and Mental Health
Inflammation over time may damage the physiological response to stress, which can result in depression, according to a 2020 narrative review. The authors note that having depression can lead to a worse long-term outcome in people with RA. Depression is twice as common in people with RA compared with the general population.
Having depression before starting a biological disease-modifying antirheumatic drug (DMARD), a treatment for RA, can also reduce the treatment response. This suggests that treating depression may also have a benefit in the management of RA.
Stress and RA Onset
People with RA may experience increased psychological distress when their RA is diagnosed and in the early phases, according to a 2021 study.
The study found that the stress experienced during the year before RA symptoms started was significantly higher in people with RA compared with the control group. While they weren’t able to definitively link stress and the development of RA, the study’s authors found an association between cumulative stress and RA but only in participants who self-identified as female.
Researchers noted that the study relied on self-reported information from the study participants. This may raise some questions about the reliability of the study. However, the researchers concluded that there still appears to be a strong connection between stress and the development of RA.
Talking with a Doctor
Managing stress can play an important role in managing RA. The next time you talk with a doctor or healthcare professional treating your RA, share some of the things in your life that cause you stress. The doctor may have some advice about how to manage anxiety and stress.
A doctor may also be able to refer you to a therapist or mental health professional with experience in helping people living with chronic conditions manage stress.
It can help to be open with a doctor about your symptoms and the stressors in your life. Be specific when describing your symptoms:
- What brings them on?
- How long do they last?
- What helps relieve your symptoms?
- Where do you feel pain?
You should also talk with a doctor about managing other flare-up triggers such as overexertion, poor sleep, or an infection, including the flu.
When to Get Help
If you’re able to manage your RA with medications and lifestyle choices, you may only need to see a doctor for regular checkups. If your symptoms change or if flare-ups are becoming more frequent or more severe, see a doctor soon. Treating and preventing flare-ups may help reduce permanent joint damage.
Keep the doctor treating your RA informed about your health. For example, if you’ve started taking a new medication and suspect it’s interfering with your sleep, tell the doctor. They may be able to recommend changes to your routine or healthcare plan that can have positive impacts on your health and the management of your RA.
Stress Management
Stress is a physical and psychological reaction to stimuli. Everyone experiences some stress at times. The burst of hormones produced when you’re confronted with a threat triggers the “fight-or-flight” response.
A little stress is natural. But too much stress or an inability to handle stress can be harmful. To manage your stress, you’ll need to start by identifying the things that cause you stress and thinking about how they can be avoided or managed. For many people, making certain lifestyle changes can help.
The following tactics may help you manage or lower your stress:
- Avoid stressful situations: This can be as dramatic as leaving a stressful job or ending a bad relationship. It can also mean doing things such as turning off the news if it’s distressing or taking an alternate route to work if the traffic on your usual route causes you stress.
- Get quality sleep: Most people need at least 7 to 8 hours of quality sleep a night. Sleeping in a cool, dark room, and avoiding looking at screens for at least 1 hour before bed may help. If you have trouble falling asleep or staying asleep, tell a doctor or see a sleep specialist.
- Exercise: Exercise every day, if possible. Physical activity may help ease stress and improve your mood. It may also keep your joints mobile and help you sleep better at night.
- Get mental health support: Take a class or talk with a therapist to learn relaxation techniques such as guided imagery, meditation, yoga, or breathing exercises.
Working with a therapist or mental health counselor on strategies to lower stress in your everyday life may help you better manage stressful situations as they arise.
Cognitive behavior therapy (CBT) is a widely used approach to help with stress, anxiety, depression, and other conditions. CBT focuses on changing the way you think about a situation so that your feelings about the situation and your behavior will change. It’s often a short-term approach to specific problems.
Managing RA
RA is a chronic condition. That means managing your symptoms is something you’ll need to do long-term. Your symptoms may temporarily improve, only to flare up again in the future.
A doctor may recommend medication to manage your RA flare-ups.
Medications used to treat RA can include DMARDs. These drugs help slow the progression of RA and reduce damage to your joints. They can help prevent your RA from progressing in severity.
DMARDs commonly used to treat RA include:
- methotrexate (Trexall)
- leflunomide (Arava)
- hydrochloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
If the above DMARDs aren’t enough on their own to treat your RA, a doctor may prescribe biologics, another class of DMARDs. These are injectable drugs. They work by blocking specific inflammatory pathways made by immune cells. This reduces inflammation caused by RA. Doctors prescribe biologics when other DMARDs alone aren’t enough to treat RA symptoms.
Biologics commonly used to treat RA can include:
- tocilizumab (Actemra)
- sarilumab (Kevzara)
- abatacept (Orencia)
- rituximab (Rituxan)
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
Janus kinase inhibitors are targeted synthetic DMARDs that may be used to treat RA. These may include:
- tofacitinib (Xeljanz)
- baricitinib (Olumiant)
- upadacitinib (Rinvoq)
Other tips to manage RA include:
- Rest and exercise: NIAMS suggests that people with RA should rest when their RA symptoms are active, such as during a flare-up, and exercise when they aren’t experiencing active symptoms. Exercise may help strengthen the muscles supporting your joints and help keep your joints mobile, according to the United Kingdom’s National Health Service. Options such as water aerobics or swimming may take the pressure off your joints while you exercise.
- Joint care: Use adaptive devices, such as a zipper pull, as needed. Wearing a splint on an affected joint may help reduce swelling.
- Pain management: Pain-relieving medication and heat and cold therapy may help relax your muscles and numb pain during flare-ups.
- Symptom management: Pay attention to the actions or situations that trigger pain. Understanding your symptoms may help a doctor better treat your flare-ups.
- Caring for your mental health: As stress can affect your RA and may trigger flare-ups, it’s important to take steps to lower and manage your stress. RA may also cause feelings of anxiety, loneliness, or depression. Activities such as joining a support group or talking with friends and family may help. You may also benefit from talking with a therapist or mental health professional.
What’s the Outlook?
If your RA diagnosis is new, starting treatment early can improve your long-term outlook. You may be able to minimize joint damage and prevent disease progression.
A rheumatologist, a doctor who specializes in RA and other conditions that affect the joints, muscles, and ligaments, may help manage your condition.
If you’ve been living with RA for a long time and you suspect stress is making your symptoms worse, talking with a doctor may help you find relief.
Takeaway
While living with RA may bring its own stressors, stress is also a common trigger for RA flare-ups.
Stress and mental health conditions, such as depression, are associated with a worse outlook for people with RA. If you’re experiencing stress that’s hard to manage on your own, get help from a qualified mental health professional such as a therapist.
Managing stress may also help you better manage your RA flare-ups and symptoms.
Sources:
- Chauhan K, et al. (2022). Rheumatoid arthritis.
ncbi.nlm.nih.gov/books/NBK441999/ - Germain V, et al. (2021). Role of stress in the development of rheumatoid arthritis: A case–control study.
academic.oup.com/rheumatology/article/60/2/629/5856832 - Living with: Rheumatoid arthritis. (2019).
nhs.uk/conditions/rheumatoid-arthritis/living-with/ - Lwin MN, et al. (2020). Rheumatoid arthritis: The impact of mental health on disease: A narrative review.
ncbi.nlm.nih.gov/pmc/articles/PMC7410879/ - Rheumatoid arthritis basics. (2019).
niams.nih.gov/health-topics/rheumatoid-arthritis/basics/symptoms-causes - Rheumatoid arthritis: Diagnosis, treatment, and steps to take. (2019).
niams.nih.gov/health-topics/rheumatoid-arthritis/diagnosis-treatment-and-steps-to-take - What triggers an arthritis flare? (n.d.).
arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/what-triggers-an-arthritis-flare
Important Notice: This article was originally published at www.healthline.com by Heather Hobbs where all credits are due. Medically reviewed by Stella Bard, MD
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