a This work is supported by grants from the National Institute of Arthritis and Muscular-Skeletal and Skin Diseases (5 R01 AR41687-05; A.J.Z., Principal Investigator) and The Arthritis Foundation (A.J.Z., PI). The authors wish to acknowledge Kathleen Matt, Ph.D., and David Yocum, M.D., for their many contributions to this research.
ABSTRACT: We review empirical evidence from two field studies for the role of stressful life events in disease flare-ups among patients with rheumatoid arthritis (RA). RA patients were expected to be more vulnerable psychologically, and physiologically, to stressful events in their everyday lives than other arthritis patients without an autoimmune disease. Findings from two studies are reviewed both for their substantive contribution, but also to provide guidance on measurement issues in future field research of this kind. One study included 41 patients with RA, who were interviewed weekly and called to a clinic for blood work and joint examinations when their levels of interpersonal stress increased significantly. A second study used a similar design but included comparison samples of patients with osteoarthritis (OA) and healthy controls of similar age and the same gender as the RA sample. The findings provided support for the proposition that interpersonal stressors are predictive of increases in disease activity. Not all RA patients, however, showed these relationships, and there was evidence that some participants with OA who were depressed also showed higher disease activity following interpersonal stressors. Significant individual differences in the stress-disease relationship were uncovered that deserve greater attention in future studies. Important improvements in the assessment of stressful events and refinements in panel study design are also presented as guides to research on the role of stress in disease processes.
Bradley T. Thomason1, Phillip J. Brantley1, 2 VIEW IMAGE, Glenn N. Jones2, Herbert R. Dyer2 and Jed L. Morris2
Accepted: 12 May 1991
Key words stress - rheumatoid arthritis - inflammation