Autoimmune Disease And Stress: Is There A Link
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
A new study has raised the possibility that stress may cause autoimmune disease, such as lupus or rheumatoid arthritis, because it found a higher incidence of autoimmune diseases among people who were previously diagnosed with stress-related disorders.
I have patients who heard about this research and are saying, “I knew it!”
But before we accept a potential link between stress and autoimmune disease, lets look at some details of the study and consider how we define the terms “autoimmune disease,” “stress,” and “stress-related disorder.”
What Is The Difference Between Osteoarthritis And Inflammatory Arthritis
The major distinction between OA and IA is that:
- Osteoarthritis is caused by physical use wear and tear of a joint over time .
- Inflammatory arthritis is a chronic autoimmune disease in which your immune system misidentifies your own body tissues as harmful germs or pathogens and attacks them. The result is inflammation of the affected tissues in and around joints.
Because OA involves physical wear on joints in the body, it usually appears in people after the age of 50. The older you get, the more likely you are to get osteoarthritis.
Since inflammatory arthritis is a chronic disease, it affects people of all ages, often striking people in their peak working and child-rearing age. IA diseases can often be diagnosed in patients as young as age 20 or 30. Less commonly, kids and teens may be diagnosed with a form of childhood arthritis, such as . IA is more common in females than in males, and it is not understood why.
How Are Autoimmune Diseases Diagnosed
Diagnosing an autoimmune disease usually takes healthcare providers longer than it does to diagnose other diseases. This is because many autoimmune diseases have similar symptoms with each other and with other diseases. You can help your healthcare provider with the diagnosing process by bringing the following to your appointment:
- A detailed list of any symptoms and how long youve had them.
- A record of your familys health history. Note if anyone in your family has an autoimmune disease.
In addition to interviewing you about your symptoms, your healthcare provider may do some blood tests to check for autoimmune diseases, including:
- Antinuclear antibody test .
Specific symptoms combined with specific blood markers may prove that you have an autoimmune disease.
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Why Does The Immune System Attack The Body
Doctors dont know exactly what causes the immune-system misfire. Yet some people are more likely to get an autoimmune disease than others.
According to a 2014 study, women get autoimmune diseases at a rate of about 2 to 1 compared to men 6.4 percent of women vs. 2.7 percent of men. Often the disease starts during a womans childbearing years .
Some autoimmune diseases are more common in certain ethnic groups. For example, lupus affects more African-American and Hispanic people than Caucasians.
Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not every family member will necessarily have the same disease, but they inherit a susceptibility to an autoimmune condition.
Because the incidence of autoimmune diseases is rising, researchers suspect environmental factors like infections and exposure to chemicals or solvents might also be involved.
A Western diet is another suspected risk factor for developing an autoimmune disease. Eating high-fat, high-sugar, and highly processed foods is thought to be linked to inflammation, which might set off an immune response. However, this hasnt been proven.
A 2015 study focused on another theory called the hygiene hypothesis. Because of vaccines and antiseptics, children today arent exposed to as many germs as they were in the past. The lack of exposure could make their immune system prone to overreact to harmless substances.
Types Of Inflammatory Arthritis
In order to make an accurate diagnosis, rheumatologists rely on a persons history of his or her joint and other symptoms, a physical examination, blood tests and, where needed, imaging techniques. Imaging can include X-Rays, ultrasounds of joints or MRI exams if a better understanding of a patients disease is required. If damage is already seen in the joints, this indicates that the type of inflammatory arthritis that is present may be more aggressive with a higher risk for more damage. There are many types of inflammatory arthritis. However, the following conditions are the most common:
: the most common form of inflammatory arthritis, tends to involve the small joints in the hands and feet and most often more than one joint is affected. The focus of inflammation is in the synovium , which can become swollen, warm, painful, and stiff, and eventually becomes damaged when inflammation is prolonged. In 30-60% of patients with RA, blood tests such as rheumatoid factor or anti-cyclic citrullinated peptide antibodies are positive, helping to confirm the diagnosis. RA can be a very destructive and disfiguring form of arthritis. It is important to control the inflammation in the synovium to stop joint destruction. In RA, other organs and systems in the body may also be affected, including the heart, lungs and eyes.
Vitamin D Influence On Immune Response
Vitamin D is known as an immune regulator that assists in the adaptive and innate immune response. A deficiency in Vitamin D, from hereditary or environmental influence, can lead to a more inefficient and weaker immune response and seen as a contributing factor to the development of autoimmune diseases. With Vitamin D present, vitamin D response elements are encoded and expressed via pattern recognition receptors responses and the genes associated with those responses. The specific DNA target sequence expressed is known as 1,25-2D3. The expression of 1,25-2D3 can be induced by Macrophages, Dendritic cells, T-cells, and B-cells. In the presence of 1,25-2D3, the immune system’s production of inflammatory cytokines are suppressed and more tolerogenic regulatory T-cells are expressed. This is due to Vitamin D’s influence on cell maturation, specifically T-cells, and their phenotype expression. Lack of 1,25-2D3 expression can lead to less tolerant regulatory T-cells, larger presentation of antigens to less tolerant T-cells, and increased inflammatory response.
Are People With Autoimmune Diseases At Any Additional Risk When It Comes To Covid
Dr. V. Michael Holers: Initially, we thought that they were not at greater risk if they got COVID-19. However, the thinking on that is evolving. More recent data out of Europe and elsewhere shows that theres a modestly increased risk for severe disease. Youre apparently not at a substantially higher risk of getting COVID itself, but if you do get it, theres an increased risk of severe disease.
The impact of COVID-19 on those with autoimmune diseases is being actively and intensely studied right now. The rarity of these diseases makes that hard to do. You need to be able to put together data from multiple hospitals or multiple health care systems and then try to address all of the comorbidities that are associated with increased risk age, obesity, and so on. Trying to disentangle it all is difficult at times, but with large data sets, you can do it. Thats how this slightly increased risk of severe disease has been identified.
Recognizing The Symptoms Of Rheumatoid Arthritis And Getting Early Treatment Increases The Odds For Putting The Disease Into Remission
The onset of rheumatoid arthritis is higher among adults in their 60s, according to the CDC.
Rheumatoid arthritis is a potentially debilitating form of arthritis that affects more than 1.3 million Americans and 1 percent of the population worldwide. The condition is considered an autoimmune disease because instead of protecting the body by making it immune to outside forces, it attacks healthy tissue for unknown reasons. Heres how the Arthritis Foundation defines it: RA is an autoimmune disease in which the bodys immune systemwhich normally protects its health by attacking foreign substances like bacteria and virusesmistakenly attacks the joints. The process creates inflammation and resulting pain.
Normally, inflammation is the bodys normal response to outside elements such as viruses and bacteria. But with rheumatoid arthritis, the inflammationif not containedcan damage cartilage and bones and spread to other parts of the body.
RA isnt confined to the elderly, although the conditions prevalence increases with age. Nearly 5 percent of women over the age of 55 have rheumatoid arthritis symptoms. RA is chronic and persists for the rest of a persons life, although remission is possible.
Autoimmune Disease And Your Health
Having lupus, rheumatoid arthritis or psoriatic arthritis raises your risk for heart disease. While taking steps to reduce heart disease is always a good idea, it is even more essential if you have one of these conditions. Talk to your doctor about what you can do to keep your heart healthy and strong. For example, keeping your blood pressure and cholesterol levels within healthy ranges, eating a nutritious diet and exercising regularly can be lifesaving.
These steps can also help reduce the symptoms of autoimmune disease. Orbai admits that making time for healthy living can be hard, given womens fast-paced lives, but she insists that finding the balance is key to living with autoimmune disease.
Its something thats going to involve commitment, and sometimes its going to be tough, she says. But learning to listen to your body and being smart about what triggers your disease is important. Its something you do for yourself.
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What Are Newer Rheumatoid Arthritis Medications And Side Effects
Newer “second-line” drugs for the treatment of rheumatoid arthritis include the following:
Each of these medicines can increase the risk for infections, and the development of any infections should be reported to the doctor when taking these newer second-line drugs.
While biologic drugs are often combined with DMARDs in the treatment of RA, they are generally not used with other biologics due to the risk of serious infections. Similarly, JAK inhibitor medication is not used with traditional biologic medicines.
Most Common Autoimmune Diseases
1. Rheumatoid Arthritis Rheumatoid arthritis is a chronic inflammation of the lining of the joints, leading to pain and swelling typically in the hands and feet. It can affect anyone, but is most prevalent in women over 40. Rheumatoid arthritis can sometimes affect other organs as well, such as skin, eyes, lungs and blood vessels. As with all autoimmune disorders, treatment focuses on managing pain and minimizing bone erosion and joint damage.
We have more in-depth information on Rheumatoid Arthritis here.
2. Juvenile Rheumatoid Arthritis Juvenile rheumatoid arthritis is the most common form of arthritis in children under 16. Symptoms usually include pain and swelling in the joints, and can vary from moderate to severe. In some cases, symptoms will subside over time while others can persist well into adulthood.
We have more in-depth information on juvenile rheumatoid arthritis here.
3. Systemic Lupus Erythematosus Lupus can be difficult to diagnose because it shares symptoms with many other disorders. The inflammation resulting from lupus can affect many different areas of the body, from the lungs, heart, joints, skin, kidneys, and brain. Like rheumatoid arthritis, lupus is more prevalent in women and can sometimes be identified by a butterfly-shaped rash on the face, along with photosensitivity, fatigue and fever, joint pain, and other skin lesions that worsen under sun exposure.
We have more in-depth information on lupus here.
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What Triggers Autoimmune Diseases
That’s still not clear. But researchers are making progress.
As with other life-long conditions like heart disease, itâs probably not just one thing that causes these disorders. Many things work together to raise your risk, like your genes, environment, and lifestyle choices, says John A. Peyman, PhD, program officer in the autoimmunity branch of the National Institute of Allergy and Infectious Diseases .
For starters, it seems that you can be more likely to get an autoimmune disease if other members of your family have one. Your parents can pass down genes that make it more likely.
One gene has been linked with most autoimmune diseases, Peyman says. Itâs called human leukocyte antigen .
â200 other genes contribute a tiny bit to the chance of getting RA,â he says.
So what happens if you inherit one of the genes?
You may be more likely than the average person to get an autoimmune disorder. While another person might get an infection and get better, the same infection might trigger the inflammation inside your body that leads to the disease, Peyman says.
For example, researchers are studying super-tiny living things called microbes in your gut, mouth, and on your skin. They may work more closely with the immune system than people thought, Ladd says. If they’re out of balance, it may trigger your immune system and make more inflammation.
Where Can People Get Additional Information On Rheumatoid Arthritis
From the 2015 national meeting of the American College of Rheumatology:
- There are many new biologic treatments for rheumatoid arthritis on the near horizon. Many of these are being studied with and without simultaneous methotrexate. Some block chemical messengers and some block specific cell types of inflammation.
- The significant benefit of treating lipid/cholesterol profiles in patients with rheumatoid arthritis to improve long-term risks of stroke and heart attack was emphasized.
- Diets higher in fish, grains, and vegetables decrease the risk of developing RA. The Western diet, defined as including more processed meats, increases the risk. It is not certain whether this is because of a direct anti-inflammatory effect of the fish, grains, and vegetables or because of changes in the natural bacteria in the gut.
For more information about rheumatoid arthritis as well as living with RA and for support groups, please consider the following:
- National Institute of arthritis https://www.niams.nih.gov/health-topics/rheumatoid-arthritis
- National Arthritis and Musculoskeletal and Skin Diseases Clearinghouse
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Autoimmune Disease Risk Factors
Researchers dont know what causes autoimmune disease, but several theories point to an overactive immune system attacking the body after an infection or injury. We do know that certain risk factors increase the chances of developing autoimmune disorders, including:
- Genetics: Certain disorders such as lupus and multiple sclerosis tend to run in families. Having a relative with autoimmune disease increases your risk, but it doesnt mean you will develop a disease for certain, says Orbai.
- Weight: Being overweight or obese raises your risk of developing rheumatoid arthritis or psoriatic arthritis. This could be because more weight puts greater stress on the joints or because fat tissue makes substances that encourage inflammation.
- Smoking: Research has linked smoking to a number of autoimmune diseases, including lupus, rheumatoid arthritis, hyperthyroidism and MS.
- Certain medications: Certain blood pressure medications or antibiotics can trigger drug-induced lupus, which is often a more benign form of lupus, Orbai says. Our myositis center also discovered that specific medications used to lower cholesterol, called statins, can trigger statin-induced myopathy. Myopathy is a rare autoimmune disease that causes muscle weakness. Before starting or stopping any medications, however, make sure to talk to your doctor.
Is Psoriasis Arthritis An Autoimmune Disease
NYU Langone specialists are experienced in diagnosing and managing psoriatic arthritis, which is considered an autoimmune disease. This means that the immune system mistakenly attacks healthy tissues in the body. In psoriatic arthritis, the immune system attacks the joints, the spine, and the places where tendons attach muscles to bones.
Psoriatic arthritis affects about 30% of people who have psoriasis, an autoimmune condition that affects the skin.
Psoriatic arthritis is a common complication of psoriasis, affecting almost one third of people who have this autoimmune disorder. If you have PsA, your symptoms are more like rheumatoid arthritis which is another autoimmune disorder rather than osteoarthritis , which is a wear-and-tear disease.
Role of interleukin-12 in psoriasis decoded Psoriasis is a chronic inflammatory autoimmune disease.
of chronic inflammatory bowel diseases and psoriatic arthritis,” says Burkhard Becher.
30 aug. 2019.
Psoriasis is an autoimmune skin disorder characterized by red patches covered with thick silvery scales. The most common form of psoriasis is.
PsA is an autoimmune disease, meaning it occurs when the body’s immune system mistakenly attacks healthy tissue, in this case the joints and skin. The faulty.
Enthesitis-related arthritis and a family history of autoimmune disease are key risk factors.
with anti-TNF-alpha and the paradoxical psoriasis in RA treated with anti-TNF-alpha may have.
6 aug. 2021.
22 juli 2021.
3 aug. 2021.
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The Mystery Of Autoimmune Illness Continues
Whether stress or stress-related disorders play an important role remains speculative. Even more important is the question of whether any particular treatment of these stress-induced psychological illnesses can prevent autoimmune disease. I look forward to a clinical trial that examines this fascinating possibility.
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About Rheumatoid Arthritis And Lupus
Rheumatoid arthritis and lupus are relatively common, severe disorders. About 1.5 million people or about 0.6 percent of the U.S. adult population have rheumatoid arthritis. Estimating how many people in the U.S. have lupus is difficult because symptoms vary widely and onset is often hard to pinpoint. Both conditions are autoimmune diseases that occur when the immune system mistakenly attacks parts of the body that it is designed to protect. They represent just two of a larger number of autoimmune disorders, including multiple sclerosis, Crohns disease, ulcerative colitis, type 1 diabetes, and psoriasis. These diseases share common flaws in immune function and regulation, leading to inflammation that destroys tissues. They can last a lifetime, cause severe disability, greatly affect quality of life, and are associated with increased risk of death.
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