Disclosures: The researchers report no relevant financial disclosures.
December 22, 2020
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Chronic stressors 'should be considered risk factors' for arthritis

Disclosures: The researchers report no relevant financial disclosures.
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Emerging research suggests a link between chronic stress and the development of arthritis, including rheumatoid arthritis, according to a review published in Arthritis Care & Research.

“The potential influence of chronic stress-related physiological burden on musculoskeletal health, specifically arthritis development, has received little focus in the literature,” Sarah N. Schwetlik, BPhysio, MMuscsklSportPhysio, of the University of South Australia, and colleagues wrote. “The Boston Puerto Rican Health Study measured [allostatic load (AL)] as an indicator of chronic stress and found increased AL was associated with arthritis; however, the generalizability of these findings to other populations may be limited.”

woman stressed at work
Emerging research suggests a link between chronic stress and the development of arthritis, including RA, according to a review. Source: Adobe Stock

“Telomere length, which is reduced in individuals exposed to chronic stressors, has been linked with pain severity in [osteoarthritis],” they added. “Additionally, a trend of increased prevalence of both OA and RA with increasing degrees of childhood difficulty has been reported. The extent and nature of the field of research investigating chronic stress and arthritis is unclear; no reviews have been identified on this topic. For research to move forward, it is critical to determine the state of the evidence linking chronic stress with arthritis development.”

To analyze the available research examining the relationship between chronic stress and arthritis development in adults, Schwetlik and colleagues conducted a scoping review of the MEDLINE, Embase, Emcare, psycINFO and Scopus databases. Eligibility criteria included English-language qualitative and quantitative peer-reviewed studies of adult populations, with no limitations on publication date. Eligible arthritis outcomes included OA, RA and spondyloarthropathies, as well as the terms “arthritis” and “arthritis or rheumatism.” There were no restrictions on the measurement of arthritis outcomes.

Eligible qualitative studies assessed individuals’ perceived causes of arthritis, while included quantitative studies examined relationships between exposure to a chronic stressor and the presence of arthritis. The researchers identified a total of 1,819 unique studies, of which 54 met the inclusion criteria. Among the included studies, nine used qualitative methods while 45 were quantitative. Two independent reviewers screened all articles, with data narratively synthesized.

According to the researchers, the number of studies that met the inclusion criteria increased chronologically, with half being published after 2010. Chronic stress exposures were heterogenous, with most categorized as adverse life events — a total of 22 — or adverse childhood experiences — 17. Self‐reported arthritis was the most frequent measure of arthritis outcome, at 26 cases, among the quantitative studies. Among the 54 included studies, 41 suggested a relationship between chronic stressors and arthritis development.

“Viewed together with increasing evidence demonstrating the deleterious effects of exposure to chronic stressors and AL on health, a history of potentially stressful experiences and patient-reported stress should be considered risk factors for future adverse health outcomes, which may include arthritis,” Schwetlik and colleagues wrote.

“Providing patients with education about the role stress may play in developing and maintaining clinical symptoms of arthritis, and referring to appropriate management (eg, cognitive-behavioral therapy) is consistent with best-practice biopsychosocial health care for chronic pain,” they added. “We may even find some patients are not surprised by this ‘news,’ already having beliefs and first-hand experience about the negative impact of stress on their health and arthritis.”