Leonard H. Calabrese
SCOTTSDALE, Ariz. — Among the most important research in rheumatology over the past two decades has been the role of stress in the onset and course of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus — an interaction that requires more study for therapeutic implications, according to a presentation here.
Speaking before the Seventh Annual Basic and Clinical Immunology for the Busy Clinician symposium, Leonard H. Calabrese, DO, vice chairman of rheumatic and immunologic disease at the Cleveland Clinic and chief medical editor of Healio Rheumatology, highlighted chronic stress and its relation to autoimmune disease as part of his “immunology boot camp for non-immunologists.”
“More intriguing to me is data from the past 2 decades in the area of psychoneuroimmunology,” Calabrese said. “There is not a person in this room that doesn’t recognize, based on your own reason and the robust body of literature, that unbridled stress is bad for the immune system.”
The role of stress in the onset and course of autoimmune disorders such as RA and SLE has been among the most important research in rheumatology over the past two decades, according to a presentation.
Calabrese cited recent data demonstrating the widespread impact of chronic stress in accelerating cardiovascular disease and compromising surveillance against pathogens.
“We can understand a pathogenic microbe and we can understand having to fend off the crystallization of uric acid, but what about stress?” he said.
In contrast to acute stress, which is triggered by immediate, physiologic dangers — “like our ancestors encountering a saber-toothed tiger” — chronic stress can be activated by PTSD, major depression episodes, and even the stress of caregivers in caring for loved ones with cancer and dementia.
“Perhaps one of the reasons for the increase in autoimmune diseases over the past 8 decades may be because of ‘modern stress’ and stressors that were not present before,” Calabrese said.
Emerging data have begun to identify the impact of unchecked stress on a variety of chronic conditions, especially within the field of autoimmune disease, with preliminary research working to countereffect chronic stressors in patients.
“There are therapies now designed to dampen this stress response through parasympathetic stimulation and through vagal nerve stimulation that are now in phase 2 trials to treat everything from fibromyalgia to rheumatoid arthritis,” Calabrese said. – by Bob Stott
Calabrese LH. 30,000 Foot View of the Integrated Immune Response. Presented at: Seventh Annual Basic and Clinical Immunology for the Busy Clinician; February 15-16, 2019; Scottsdale, Ariz.
Disclosure: Calabrese reports he is a consultant for Abbvie, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Jansen, Pfizer and Sanofi; and is on the speakers bureau for Abbvie, Bristol-Myers Squibb, Crescendo Bioscience and Genentech.