Stress is real and simply a part of life. This unavoidable stress of life 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 high risk for heart disease, stroke, anxiety and insomnia. Stress can promote cancer development, according to this study. Stress can even make your chronic health conditions worse according to the CDC. This is especially true if you have Rheumatoid Arthritis (RA).

Rheumatoid arthritis (RA) is an auto-immune, inflammatory disease where one’s immune system mistakenly attacks healthy joints and tissues. Although many people experience remission, this disease often waxes and wanes in the form of flares. Can stress cause inflammation and Rheumatoid Arthritis (RA) flares? Anyone with RA knows this answer first hand– YES! But why? How does the stress response affect the immune system?

What is a stressor? 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! Messages go to other organs in your body in the form of hormones. One of the targets is the kidney. 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 for better oxygenation and tightens your muscles so you have 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 continue to improve energy and focus. Cortisol also increases the availability of substances that repair tissues, which is often necessary in life-threatening situations. Cortisol also turns off non-essential functions. It tells your digestive system to slow down, your reproductive system to turn off, and your growth signals to halt. It also alters your personality by improving mood, motivation, and providing instant bravery.

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

Cortisol can impact your immune system by altering the immune response. The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that are foreign. 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. Non-living substances such as toxins, chemicals, drugs, and foreign particles (I.e. a splinter) can also be antigens. Your immune system recognizes and destroys, or tries to destroy, substances that contain antigens by attacking them with T lymphocytes. The T-lymphocytes then release chemicals known as inflammatory cytokines. These inflammatory cytokines promote inflammation. This is how the stress response directly impacts inflammatory diseases, 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 production of these inflammatory cytokines in response to over exposure to cortisol.

Your body has 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 auto-immune disease, like RA, you often have a dysregulated immune system that cannot distinguish self from non-self. This means that your body is sending T-cell, which are releasing more inflammatory cytokines, and attacking your healthy tissues, too.

This further complicates this vicious stress and inflammation cycle. This over production of inflammatory cytokines is sometimes demonstrated in bloodwork as increased inflammatory markers, i.e. C-reactive Protein (CRP) and elevated Erythrocyte Sedimentation Rate (ESR).

Attacking big projects at work, raising a family, and managing a chronic illness, like RA, can trigger this stress response and the inflammatory cascade. This can worsen inflammation and overall health. No, there is 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 whenever triggered, regardless of the actual threat.

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

This becomes a long term response and causes over-exposure to adrenaline and cortisol. In time, this will worsen your overall health. Anxiety, depression, insomnia, chronic pain, daily headaches, memory and cognition will all be affected.

Why do you react the way you do? There can be a genetic component. Life experiences can also contribute to this. Abuse and neglect can trigger higher stress responses. People who work around trauma can also react differently. I.e. military, police, fire, first responders, medical professionals, or victims of violent crimes.

Having chronic pain can alter our ability to cope with stress. The chronic pain itself causes a perceived threat. There is also the constant anxiety of whether or not the pain will be there tomorrow, ruin your plans, or if you’ll feel good enough tomorrow to get your whole to-do list done.

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

Managing stress will help to better manage RA symptoms and avoid unnecessary flares. It’s important to manage and cope with stress in healthy ways to avoid this over exposure.

Here are some ways to cope and better manage your stress:

• Make changes if something is causing high stress
• Learn to set limits and say no sometimes
• Take care of you body
• Avoid toxic substances (Smoking, Alcohol, Drugs)
• 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 Rheumatoid Arthritis! Do your best to manage your stress to better manage your RA.