How Stress Affects Your RA and Tips for Managing Both

Understanding the relationship between stress and rheumatoid arthritis can help you manage symptoms of both.

Stress is simply a part of life. This unavoidable stress can affect your immune system. If you have rheumatoid arthritis (RA), you probably already know this.

Stress and health can often go hand in hand. Stress can put you at a higher risk for heart disease, stroke, anxiety, and insomnia. According to a 2020 study, stress can promote cancer development. Stress can even make chronic health conditions worse, according to the Centers for Disease Control and Prevention (CDC). This is especially true if you have RA.

RA is an autoimmune, inflammatory condition where the immune system mistakenly attacks healthy joints and tissues. Although many people experience remission, the condition often waxes and wanes in the form of flares.

Can stress cause inflammation and RA flares? Anyone with RA knows this answer firsthand: YES! But why? How does the stress response affect the immune system?

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What is stress?

A stressor is a perceived threat. When you encounter a threat, such as being chased by a bear, your hypothalamus, the small portion at the base of your brain, tells your body to prepare to fight. These messages go to other organs in your body in the form of hormones.

These messengers specifically target the adrenal glands that sit on top of your kidneys. These glands then release adrenaline and cortisol. Adrenaline increases your blood pressure and heart rate to increase your energy and focus. It also increases your breathing and tightens your muscles, which allows you the ability to run or fight better.

Cortisol is most commonly known as the stress hormone. When released, this increases glucose levels in your bloodstream to improve energy and focus. Cortisol also increases the availability of substances that repair tissues, which is often necessary for life threatening situations.

Simultaneously, cortisol “turns off” nonessential functions. It tells your digestive system to slow down, your reproductive system to turn off, and brings growth signals to a halt. It also alters your personality by improving mood, increasing motivation, and providing the sensation of bravery.

Usually, this response is self-limiting. This means that, when the threat is gone, the body returns to normal. Hormone levels normalize, and heart rate, blood pressure, and breathing slow down. Your digestion and reproductive system resume normal functioning.

How does stress affect your immune system?

Cortisol can affect your immune system by altering the immune response. The immune response is how your body recognizes and defends itself against bacteria, viruses, and foreign substances.

The immune system protects the body by recognizing and responding to antigens. Antigens are substances, usually proteins, that are found on the surface of cells, viruses, fungi, or bacteria. Nonliving substances, such as toxins, chemicals, drugs, and foreign particles (like a splinter), can act as antigens.

Your immune system recognizes tries to destroy substances that contain nonself antigens by attacking them with T lymphocytes — a part of the immune system that works to protect the body from infection. The T-lymphocytes then release chemicals known as inflammatory cytokines. These inflammatory cytokines promote bodily inflammation. This is how the stress response directly impacts inflammatory conditions, like RA.

Usually, cortisol is anti-inflammatory. However, chronic elevations can lead to the immune system becoming resistant to this hormone. Your immune system may even increase the production of these inflammatory cytokines in response to overexposure to cortisol.

Your body has self-antigens that are specific to you. Your immune system recognizes those and typically does not react to them.

This is not the case when you have RA. When you have an autoimmune condition, like RA, you often have a dysregulated immune system that has trouble distinguishing self from nonself. This means your body is sending T-cells, which are releasing more inflammatory cytokines and attacking your healthy tissues.

This further complicates the stress and inflammation cycle. This overproduction of inflammatory cytokines is sometimes seen in bloodwork as increased inflammatory markers, like C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (ESR).

Attacking big projects at work, raising a family, and managing a chronic condition, like RA, can trigger this stress response and the inflammatory cascade. This can worsen inflammation and overall health.

No, there’s not a bear chasing you, but your body doesn’t know the difference at the hormone level. The same hormones are sent out with messages to prepare to fight — regardless of the actual threat.

What happens in the long term?

When stressors are constant, true threats or not, and your body constantly feels under attack, the fight-flight-freeze response signals never turn off.

This becomes a long-term response and causes overexposure to adrenaline and cortisol. In time, this will worsen your overall health, potentially affecting:

• anxiety
• depression
• insomnia
• chronic pain
• daily headaches
• memory and cognition

Why does your body react the way it does?

There can be a genetic component. Life experiences can also contribute to this. Abuse and neglect can trigger higher stress responses. Stress over finances, home, and work can also contribute.

People who work around trauma can also react differently, such as:

• military personnel
• police officers
• firefighters
• first responders
• medical professionals

Having chronic pain can alter your ability to cope with stress. The chronic pain itself causes a perceived threat. There’s also the constant worry of whether the pain will be there tomorrow, ruin your plans, or if you’ll feel good enough to get your whole to-do list done.

Stress management tips

Many people with RA agree that stress makes their symptoms worse. There are ways to manage this stress to help better manage your RA.

Consider these tips:

• Make changes if something is causing high stress.
• Learn to set limits.
• Take care of your body.
• Avoid toxic people and substance misuse.
• Seek counseling.
• Stay active, and move as much as possible.
• Try deep breathing and meditation throughout the day.
• Do yoga and gentle stretching.
• Prioritize self-care.
• Get enough sleep.
• Connect with others at a support group or other social event.
• Unplug from the news and social media.
• Take frequent breaks, especially when working on hard things or long hours.
• Accept that you can only control what you can control.

Stress is part of life, but too much is not good for your RA. Do your best to manage your stress to better manage your RA.