STRESS AND RHEUMATIC DISEASES
Section snippets
Measurement of Stress
Before illustrating the different diseases in greater detail, some general methodologic problems of research dealing with psychologic parameters should be mentioned. In most studies, measuring stress and other psychologic parameters and their significance for the affected person is based on information provided by the patient. The assessed person fills out a questionnaire or the physician does it, making use of the information given by the patient in an interview. As a result, the results are
STRESS AND SYSTEMIC LUPUS ERYTHEMATOSUS
Much less literature is available concerning stress and SLE or other rheumatic diseases. Most of the studies that were found were retrospective. A summary is provided in Table 4.
Only two articles indicate that emotional stress acts as a precipitating factor in SLE. Otto and Mackay94 compared 20 hospitalized SLE patients with other hospitalized seriously ill controls. The SLE group had significantly more stress before onset of the disease. All SLE patients believed that stress had provoked their
STRESS AND THE FIBROMYALGIA SYNDROME
FS is characterized by fatigue, stiffness, disturbed sleep, musculoskeletal aching, and multiple points of tenderness. Unlike the aforementioned inflammatory disorders, there are no histologic signs of inflammation in the affected tissue. Interestingly, 10% to 30% of patients with RA and SLE also fulfill the diagnostic criteria for FS.100, 138
With FS, numerous authors have focused on the relation between psychologic characteristics and disease (summarized in Table 5). Some of them looked for
RHEUMATIC DISEASES: THE MOST IMPORTANT PERCEIVED STRESSORS AND COPING STRATEGIES
Coping strategies are important for the daily routine and the psychologic well-being of persons with a chronic disease like RA. They enable the afflicted persons to adapt to the problems and stressors arising from the disease. The predominant perceived stressor in individuals with RA is pain, followed by limitation in mobility, difficulties in the activities of daily living, helplessness, dependency on others, threat to self-esteem, interference with social activities, problems in family
INTERACTION BETWEEN THE DISEASE AND PSYCHOSOCIAL FUNCTIONING
The relation between stress and rheumatic diseases is not unidirectional (stress influences the diseases) but rather bidirectional. Rheumatic diseases and their consequences cause a number of different stressors, which probably have effects on the psychologic and social functions of the afflicted individual.
Andrew11 estimates that organic psychiatric diseases occur in 22% to 29% of the patients with SLE and RA and that functional disorders occur in 18% to 35%. The most common mental change in
NEW STRATEGIES IN THERAPY
There is strong evidence that stress and psychologic factors play a role in the onset and course of rheumatic diseases. The common therapeutic regimens are mainly pharmacologic and combined with physiotherapeutic treatment. If one takes into account the role of stress as a provoking and modulating factor, psychologically orientated methods could also be of benefit and could possibly reduce the need for strong drugs.
Achterberg et al4 demonstrated the effectiveness of relaxation techniques and
SUMMARY: MAJOR AND MINOR STRESS INFLUENCES RHEUMATIC DISEASES
Despite difficulties in assessing the influence of minor or major stress on the onset or course of the chronic rheumatic diseases, it is likely that stress has an impact on the disease. Major life events and chronic minor stress seem to be important factors in JCA and are significantly associated with the onset and course of this disease (Fig. 1). With respect to RA and FS, stress may be a provoking factor, but the data in the literature are equivocal. During the course of the disease, minor
THE PSYCHE AND THE NEUROENDOCRINE-IMMUNE SYSTEM IN RHEUMATIC DISEASES
With the emergence of interdisciplinary research areas such as psychoneuroimmunology, new insights into the concept of stress as a stereotyped and relatively unspecific response (e.g., alarm, resistance, exhaustion) to aversive or noxious stimuli were obtained.6 Stress involves an array of regulatory mechanisms, including corticotropin-releasing hormone, adrenocorticotropic hormone, cortisol and other adrenal hormones, neurotransmitters of the sympathetic nervous system (e.g., norepinephrine,
ACKNOWLEDGMENT
We thank Niklas Beyersdorf, Kathrin Beyersdorf, and Dr Bunesh Agrawal for critical comments and manuscript corrections.
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Address reprint requests to Rainer H. Straub, MD, Department of Internal Medicine I, University Medical Center, D-93042 Regensburg, Germany, [email protected]
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Department of Internal Medicine, University Medical Center, Regensburg, Regensburg, Bavaria, Germany