Stress and its Impact on Rheumatic Diseases

Introduction

Individuals diagnosed with rheumatic disease have difficulty accepting the condition and coping with life in general. This psychological disturbance one faces may range from mild to severe and may be related to the diagnosed condition alone or from a general perspective of how life has become limited. How one cope’s with these conditions affects their long-term physical and psychological well-being.

What Is Stress?

Stress is experienced by every individual at some point in their life, but how one responds to stress each time makes the difference in the well-being of a person. Stress is an emotion of worry and tension that an individual feels when in a difficult situation.

An individual may show that one is stressed in different ways, for some it may be as fear, worry, inability to relax, or difficulty concentrating for long, and for some, it may feel more uncomfortable as they experience increased heart rate, difficulty in breathing, disturbance in sleeping patterns and more.

What Is a Rheumatic Disease?

Rheumatic diseases are autoimmune diseases where the immune system attacks one’s own body cells and tissues. Rheumatic diseases include a wide category of diseases that mainly affects the joints, bones, and muscles and subsequently affects other vital organs such as the heart, liver, lungs, and kidneys.

Rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, fibromyalgia, and more are often excruciating. They may limit one’s daily activities which affect the quality of life and mental well-being. The limitations prevent them from socializing with friends and family which adds to the adverse effects on their mental well-being.

Rheumatic disease symptoms may disappear for a while, a phase of no pain and swelling, this is termed ‘remission’ in rheumatic disease conditions. However there are also times when the symptoms worsen suddenly making it all the more difficult for the individual to cope, this is termed as ‘flares’ in rheumatic disease conditions. Rheumatic individuals have noticed that the flares of rheumatic diseases to be as a result of a stressful event in one’s life; studies prove the same.

How Does Stress Affect Rheumatic Diseases?

• When a normal human body experiences stress, one may experience generalized body pain. This is due to the release of the stress hormone called cortisone.

• Furthermore, when stressed, the muscles tense up, which again can cause discomfort and pain for individuals.

• A normal human body can manage these changes that occur without much difficulty but when it occurs multiple times for a prolonged period, it could be unhealthy for healthy individuals as well.

• Studies have shown that stress can worsen the symptoms of rheumatic diseases (flares). Some other studies have shown that individuals experiencing stress at an early age of life are more vulnerable to rheumatic disease.

• One recent study found that individuals who experienced traumatic childhood events were at an increased risk for rheumatic diseases compared with those who did not experience any.

• Studies have shown that how one reacts emotionally to the limitations in one's life directly affects the daily physical activity as well as the activity of the disease. For example, being stressed can bring episodes of flares, and being calm and accepting can bring episodes of remission.

• Studies have shown that stress factors such as excessive worrying and withholding one’s emotions towards the condition can worsen the prognosis of long-term functioning in rheumatoid individuals.

• All the effect on the disease condition is believed to be due to activation of the hypothalamic–pituitary–adrenal (HPA) axis (to release cortisol stress hormone), which interacts with the immune system (responsible for the disease) and interferes with the disease process.

How to Manage Stress in Rheumatoid Diseases?

Rheumatoid individuals at risk of psychological adjustment problems can be identified with a standardized questionnaire used as an assessment tool at an early stage of the disease. The questionnaire gives the therapist, and or doctor, an understanding of the suffering, requirements, priorities, and desires of the individual with respect to the disease condition.

Each individual has a unique stress response and hence the management has to be tailored for each individual. And this can be achieved with:

• Patient Education and Disease Management.

• Cognitive Behavior and Resilience Therapies.

• eHealth- Cognitive Behavioral Treatment.

1. Patient Education and Disease Management-

• Educating rheumatoid individuals about the disease and how one can and should cope with the disease can bring about change in how the individual perceives the disease condition.

• This methodology does not involve a therapist and is usually short-term (4 to 6 sessions) where the individuals are given exercises to do, and homework assignments, and usually involves a team of health professionals from different fields.

• Individuals who follow the instructions seemed to benefit from the therapy and have a better outcome on the psychological and physical aspects of one’s life compared to the individuals who dropped out from therapy.

2. Cognitive Behavior and Resilience Therapies-

• The therapy aims at changing the perspective of the individual towards the disease to a more positive approach and to improve the capability of the individual to manage and cope with the disease condition.

• It is tailored to the individual's needs and priorities, this gives a sense of satisfaction and trust for the individual towards the therapy thereby enabling one to follow the instructions religiously.

• These approaches may be individual or with a group suffering from the same or similar conditions and usually have sessions that last for several weeks (10- 15 sessions).

• Specially trained cognitive-behavioral therapists provide intensive homework assignments and exercises along with sessions to prevent relapse. Several studies have reported the positive effects of these approaches in rheumatic conditions.

3. eHealth- Cognitive Behavioral Treatment-

• eHealth cognitive behavioral treatment is a beneficial strategy for individuals with limited mobility who may find it difficult to attend the therapies in person.

• It aims at improving treatment accessibility for the rheumatoid individual.

• The individuals accept and adhere to treatments much better since it is from the convenience of one’s home, in one’s own time, and in one’s own way.

• eHealth has also helped boost the confidence in individuals as they learn to do most of the tasks without help from trainers as it is done in face-to-face therapy.

Several studies have shown that a combination of exercise therapy along with cognitive behavioral therapy has a positive effect on the physical and psychological well-being of individuals with rheumatic diseases. Cognitive behavior and resilience therapies approach have shown a better positive impact on rheumatoid individuals than mere patient education and disease management.

Conclusion

Rheumatic disease is a chronic disease condition and the disabling nature of the disease does affect the well-being of a rheumatic individual. Stress affects both the mind and the body and worsens conditions of pre-existing diseases. Learning how to cope with stress can help one feel less overwhelmed and prevent the negative impact it leaves on the disease conditions.