Skip to main content
Home
Latest news
Browse topics
Lupus Rheumatoid arthritis Spondyloarthropathies COVID-19 Browse all topics
In focus
Bimekizumab: Dual IL-17A/IL-17F inhibition in SpA Anifrolumab for the treatment of SLE JAK inhibitor safety: Weighing up the data and understanding the risks Rituximab and rheumatology practice in the COVID-19 era Safety snapshot: Upadacitinib in patients with PsA Repurposing rheumatology drugs for COVID-19 Telemedicine in rheumatology: COVID-19 and beyond Managing PsA in resource-limited settings
Conferences
ACR Convergence 2022 EULAR 2022 Congress
About us
Medicine Matters Rheumatology
EXTENDED SEARCH
Top

03-05-2018 | Rheumatoid arthritis | Article

Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis?

Journal: Arthritis Research & Therapy

Authors: Aleid C. Boer, Robin M. ten Brinck, Andrea W. M. Evers, Annette H. M. van der Helm-van Mil

Publisher: BioMed Central

Login to get access

Abstract

Background

Within established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We studied whether the psychological stress response was increased in clinically suspect arthralgia (CSA) and if this associated with inflammation at presentation with arthralgia and with progression to clinical arthritis.

Methods

In 241 CSA patients, psychological stress was measured by the Mental Health Inventory (MHI-5) and the Perceived Stress Scale (PSS-10) at first presentation and during follow-up. Systemic inflammation was measured by C-reactive protein (CRP) and joint inflammation by 1.5 T-MRI of wrist, MCP, and MTP joints.

Results

At baseline, 12% (24/197) of CSA patients had a high psychological stress response according to the MHI-5. This was not different for patients presenting with or without an elevated CRP, with or without subclinical MRI-detected inflammation and for patients who did or did not develop arthritis. Similar findings were obtained with the PSS-10. When developing clinical arthritis, the percentage of patients with ‘high psychological stress’ increased to 31% (p = 0.025); during the first year of treatment this decreased to 8% (p = 0.020). ‘High psychological stress’ in non-progressors remained infrequent over time (range 7–13%). Stress was associated with fatigue (p = 0.003) and wellbeing (p < 0.001).

Conclusions

Psychological stress was not increased in the phase of arthralgia, raised at the time of diagnoses and decreased thereafter. The lack of an association with inflammation in arthralgia and this temporal relationship, argue against psychological stress having a significant contribution to progression from CSA to inflammatory arthritis.
Literature
1.
Straub RH. Rheumatoid arthritis: Stress in RA: a trigger of proinflammatory pathways? Nat Rev Rheumatol. 2014;10(9):516–8.CrossRefPubMed
2.
Finan PH, Zautra AJ. Rheumatoid arthritis: stress affects rheumatoid arthritis, but via what mechanisms? Nat Rev Rheumatol. 2013;9(10):569–70.CrossRefPubMedPubMedCentral
3.
Cutolo M, Straub RH. Stress as a risk factor in the pathogenesis of rheumatoid arthritis. Neuroimmunomodulation. 2006;13(5–6):277–82.CrossRefPubMed
4.
Evers AW, Zautra A, Thieme K. Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nat Rev Rheumatol. 2011;7(7):409–15.CrossRefPubMed
5.
Wesley A, Bengtsson C, Skillgate E, Saevarsdottir S, Theorell T, Holmqvist M, et al. Association Between Life Events and Rheumatoid Arthritis: Results From a Population-Based Case–Control Study. Arthritis Care Res. 2014;66(6):844–51.CrossRef
6.
Evers AW, Kraaimaat FW, Geenen R, Jacobs JW, Bijlsma JW. Stress-vulnerability factors as long-term predictors of disease activity in early rheumatoid arthritis. J Psychosom Res. 2003;55(4):293–302.CrossRefPubMed
7.
Evers AW, Verhoeven EW, van Middendorp H, Sweep FC, Kraaimaat FW, Donders AR, et al. Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis. Ann Rheum Dis. 2014;73(9):1683–8.CrossRefPubMed
8.
Bugajska J, Brzosko M, Jedryka-Goral A, Gluszko P, Zolnierczyk-Zreda D, Sagan A, et al. Psychological stress in rheumatoid arthritis patients: a comparative Polish-German study: summary of the current conceptualization of the role of stress in rheumatoid arthritis. Autoimmun Rev. 2010;9(4):211–5.CrossRefPubMed
9.
Davis MC, Zautra AJ, Younger J, Motivala SJ, Attrep J, Irwin MR. Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: implications for fatigue. Brain Behav Immun. 2008;22(1):24–32.CrossRefPubMed
10.
de Brouwer SJ, van Middendorp H, Kraaimaat FW, Radstake TR, Joosten I, Donders AR, et al. Immune responses to stress after stress management training in patients with rheumatoid arthritis. Arthritis Res Ther. 2013;15(6):R200.CrossRefPubMedPubMedCentral
11.
de Brouwer SJ, van Middendorp H, Stormink C, Kraaimaat FW, Joosten I, Radstake TR, et al. Immune responses to stress in rheumatoid arthritis and psoriasis. Rheumatology (Oxford). 2014;53(10):1844–8.CrossRef
12.
Veldhuijzen van Zanten JJ, Ring C, Carroll D, Kitas GD. Kitas, Increased C reactive protein in response to acute stress in patients with rheumatoid arthritis. Ann Rheum Dis. 2005;64(9):1299–304.CrossRefPubMed
13.
Strating MM, Suurmeijer TP, van Schuur WH. Disability, social support, and distress in rheumatoid arthritis: results from a thirteen-year prospective study. Arthritis Rheum. 2006;55(5):736–44.CrossRefPubMed
14.
Odegard S, Finset A, Mowinckel P, Kvien TK, Uhlig T. Pain and psychological health status over a 10-year period in patients with recent onset rheumatoid arthritis. Ann Rheum Dis. 2007;66(9):1195–201.CrossRefPubMedPubMedCentral
15.
Gerlag DM, Raza K, van Baarsen LG, Brouwer E, Buckley CD, Burmester GR, et al. EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis. Ann Rheum Dis. 2012;71(5):638–41.CrossRefPubMedPubMedCentral
16.
van Steenbergen HW, Mangnus L, Reijnierse M, Huizinga TW, van der Helm-van Mil AH. Clinical factors, anticitrullinated peptide antibodies and MRI-detected subclinical inflammation in relation to progression from clinically suspect arthralgia to arthritis. Ann Rheum Dis. 2016;75(10):1824–30.CrossRefPubMed
17.
van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJ, Brouwer E, Codreanu C, Combe B, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017;76(3):491–6.CrossRefPubMed
18.
van Steenbergen HW, van Nies JA, Huizinga TW, Bloem JL, Reijnierse M, van der Helm-van Mil AH. Characterising arthralgia in the preclinical phase of rheumatoid arthritis using MRI. Ann Rheum Dis. 2015;74(6):1225–32.CrossRefPubMed
19.
Leplege A, Ecosse E, Verdier A, Perneger TV. The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol. 1998;51(11):1013–23.CrossRefPubMed
20.
Thorsen SV, Rugulies R, Hjarsbech PU, Bjorner JB. The predictive value of mental health for long-term sickness absence: the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5) compared. BMC Med Res Methodol. 2013;13:115.CrossRefPubMedPubMedCentral
21.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.CrossRefPubMed
22.
de Rooy DP, van der Linden MP, Knevel R, Huizinga TW, van der Helm-van Mil AH. Predicting arthritis outcomes--what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford). 2011;50(1):93–100.CrossRef
23.
Boer AC, Burgers LE, Mangnus L, ten Brinck RM, Nieuwenhuis WP, van Steenbergen HW, et al. Using a reference when defining an abnormal MRI reduces false-positive MRI results-a longitudinal study in two cohorts at risk for rheumatoid arthritis. Rheumatology. 2017;56(10):1700–6.CrossRefPubMed
24.
Bacconnier L, Rincheval N, Flipo RM, Goupille P, Daures JP, Boulenger JP, et al. Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort. Rheumatology (Oxford). 2015;54(3):520–7.CrossRef
25.
Holmes WC. A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Med Care. 1998;36(2):237–43.CrossRefPubMed
26.
Rumpf HJ, Meyer C, Hapke U, John U. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res. 2001;105(3):243–53.CrossRefPubMed
27.
Rabe-Jablonska J. A new draft of the mental disorders classification prepared by the American Psychiatric Association: diagnostic and statistical manual of mental disorders-IV, Options Book. Psychiatr Pol. 1993;27(2):109–19.PubMed
28.
Friedman B, Heisel M, Delavan R. Validity of the SF-36 five-item Mental Health Index for major depression in functionally impaired, community-dwelling elderly patients. J Am Geriatr Soc. 2005;53(11):1978–85.CrossRefPubMed
29.
Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The Claremont Symposium on Applied Social Psychology. The social psychology of health. Thousand Oaks: Sage; 1988. p. 31–67.
30.
Wooden M, Bubonya M, Cobb-Clark D. Sickness absence and mental health: evidence from a nationally representative longitudinal survey. Scand J Work Environ Health. 2016;42(3):201–8.PubMed
31.
Hyphantis TN, Bai M, Siafaka V, Georgiadis AN, Voulgari PV, Mavreas V, et al. Psychological distress and personality traits in early rheumatoid arthritis: A preliminary survey. Rheumatol Int. 2006;26(9):828–36.CrossRefPubMed
32.
Ten Brinck RM, van Steenbergen HW, Mangnus L, Burgers LE, Reijnierse M, Huizinga TW, et al. Functional limitations in the phase of clinically suspect arthralgia are as serious as in early clinical arthritis; a longitudinal study. RMD Open. 2017;3(1):e000419.CrossRefPubMedPubMedCentral
33.
Ramjeet J, Koutantji M, Barrett EM, Scott DG. Coping and psychological adjustment in recent-onset inflammatory polyarthritis: the role of gender and age. Rheumatology (Oxford). 2005;44(9):1166–8.CrossRef
34.
Michelsen B, Kristianslund EK, Sexton J, Hammer HB, Fagerli KM, Lie E, et al. Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis. 2017;76(11):1906–10.CrossRefPubMed
35.
Burgers LE, Siljehult F, ten Brinck RM, van Steenbergen HW, Landewe RBM, Rantapaa-Dahlqvist S, van der Helm-van Mil AHM. Validation of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Rheumatol. 2017;56(12):2123–8.
36.
van Tuyl LHD, van der Heijde D, Knol DL, Boers M. Chronological reading of radiographs in rheumatoid arthritis increases efficiency and does not lead to bias. Ann Rheum Dis. 2014;73(2):391–5.CrossRefPubMed
Image Credits