October 29, 2019
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Stress linked to inflammatory arthritis among at-risk individuals

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Perceived stress is significantly associated with developing inflammatory arthritis among those who are at risk, according to findings published in Arthritis Care & Research.

“Stress is a part of everyday life, but how we perceive and cope with stressors can have potential impacts on our health,” Kristen J. Polinski, MSPH, of the Colorado School of Public Health, told Healio Rheumatology. “In patients with rheumatoid arthritis, we understand that psychological stress can have negative effects on disease activity, but this relationship is not well established in preclinical populations. Our study adds to the emerging evidence suggesting that perceived distress may affect the future development of rheumatoid arthritis.”

To analyze the association between perceived stress and incident inflammatory arthritis, Polinski and colleagues conducted a prospective, longitudinal study of data from the ongoing Studies of the Etiologies of Rheumatoid Arthritis (SERA), a multisite cohort of 2,037 participants established in 2002. The cohort includes participants without inflammatory arthritis at baseline who were at risk for developing future rheumatoid arthritis, defined as first-degree relatives of RA probands or someone who screened positive for anticyclic citrullinated peptide autoantibody.

For their study, Polinski and colleagues included 448 participants who were without RA or inflammatory arthritis at baseline, and followed for the development of either disease between 2007 and 2018. Participants completed an average of two visits and an average of 4 years of follow-up. Stress levels were assessed through the Perceived Stress Scale14 (PSS) on a scale of 0 to 56. The researchers used the average of the total PSS score, as well as two sub-scores representatives of perceived distress and self-efficacy, across all study visits until the development of inflammatory arthritis or last follow-up.

Image of arthritic hand 
Perceived stress is significantly associated with developing inflammatory arthritis among those who are at risk, according to findings.
Source: Adobe

According to the researchers, the mean total PSS score was 20.4. Polinski and colleagues found that a one-point increase in the perceived distress score was significantly associated with a 10% rise in the risk for inflammatory arthritis (adjusted HR = 1.1; 95% CI, 1.02-1.19). However, total PSS score (adjusted HR = 1.05; 95% CI, 0.99-1.1) and self-efficacy (1.04; 95% CI, 0.91-1.18) were not associated with a risk for inflammatory arthritis.

“Our results suggest that an increase in perceived distress may increase the risk of developing future inflammatory arthritis,” Polinski said. “What this may mean is that when a physician is talking with someone who is at increased risk for developing rheumatoid arthritis, they may want to ask about the stress in that person’s life and target ways to reduce that stress, perhaps through interventions based on cognitive behavioral principals, as a means to try to lower their risk.” – by Jason Laday

Disclosure: The researchers report grant funding from the NIH.