Stress is a very normal, and constant presence in our lives. But for people with a chronic condition, like arthritis, may find they experience stress more often due to subsequent chronic pain, the cost of medical appointments or medication, and the uncertainty of an unpredictable future. Being stressed can worsen stress symptoms (including our experience of pain). While stress and experiencing symptoms can’t always be avoided, the best solution is to try and manage stress before it undermines your disease management and quality of life.
The bi-directional relationship of stress and arthritis:
How stress contributes to arthritis
At a biological level, stress may have several impacts. When your body’s stress response is triggered, a cascade of chemicals and hormones (eg. dopamine, adrenalin, and cortisol) are released to help you deal with the ‘stressor’. These chemicals and hormones increase your heart rate and breathing rate, and your muscles tense in preparation. This is the body engaging in what’s called a process of allostasis, aka the flight or fight response; a dynamic process of adaptation to stress. This normal reaction to stress is ok in the short term, but issues arise when your stress responses are triggered repeatedly over a long period of time. The repeated reaction triggers hormone release, immune response, inflammation, and metabolic activity. The cumulative effect of this ongoing reaction is known as allostatic load; a chemical dysregulation that occurs in response to a sustained stress response. In other words, your body is a constant flight or fight state – which isn’t good long term for many, if not all, body systems.
As mentioned above, stress can set off the immune system’s inflammatory response. Inflammation is a primary cause of joint damage in those with inflammatory arthritis (rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis, and other inflammatory forms of the disease), and can even affect those with osteoarthritis. The longer you’re exposed to stress, that is, the more allostatic load, the more the stress-induced inflammation can damage your joints. Furthermore, stress has been identified as trigger to flare-ups in those with inflammatory arthritis.
How arthritis contributes to stress
Arthritis symptoms contribute to stress. When the pain of your arthritis doesn’t ease, and stops you from doing what you want, gives you trouble falling asleep or wakes you up because of pain, the constant feeling of tiredness and fatigue can create a vicious cycle of stress. The symptoms of arthritis can induce stress responses as the nature of the condition can create great uncertainty for the future – will your symptoms disrupt your ability to work, have a family, travel, stay fit, pay for treatment or specialists etc. Each symptom and subsequent worry can compound the next, making it all the more stressful. So what can we do about it?
Stress management strategies
It’s important to address your stress sooner rather than later. Below are some tips to reduce allostatic load.
- First, talk to someone – a friend, a family member, a peer. It often feels good to share your thoughts with others and to realise that most people in your situation feel the same way, and understand what you’re going through.
- If talking with friends or family about your worries doesn’t help, it’s time to reach out for help. Seek the professional advice of your GP, psychologist or counsellor. These health professionals will help work through the stress and come up with some strategies to cope better. For example, cognitive-behavioural therapy (CBT) can help to reframe the issues that cause you worry, and help you deal with them in a more positive way.
- Learn to meditate. Meditation is a fantastic way of grounding yourself, finding peace and developing a healthy mind set. You may like something a little more active, gentle meditative yoga or Thai Chi.
- Engage in mindfulness and/or relaxation deep breathing. Try to fully absorb yourself in tasks so your thoughts are solely dedicated to the task at hand, and not focused on your worries or pain. These practices have been shown to be extremely powerful at keeping people ‘in the moment’ –which is to say, stopping them from running away with worries of what the future might hold.
- Exercise and socialise often – not only does this help support healthy joint function – exercise and socialisation have been shown to reduce anxiety and stress and serve as powerful means of distraction.
- Ensure you are taking care of your arthritis as best you can. Following the treatment your doctor prescribed will relieve symptoms like pain and stiffness before they can add to your anxiety
- Practice good sleep hygiene. Try to go to bed and wake up at the same time every day. Don’t use blue light screens 1-2 hours before bed (ie. smart phones, iPads, computers etc), and have a to-do list, diary/note book or ‘worry book’ to write down all the things you have to do the next day or what you’re worried about before bed – this may hopefully mitigate any overthinking when trying to go off to sleep.
Author: Kat Keane
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Goldstein, David S. “Adrenal responses to stress.” Cellular and molecular neurobiology vol. 30,8 (2010): 1433-40. doi:10.1007/s10571-010-9606-9
McEwen BS. Stressed or stressed out: what is the difference?. J Psychiatry Neurosci. 2005;30(5):315-318.