Does Stress Affect Lupus?

Many symptoms have been associated with stress in normal persons as well as those with lupus. These symptoms include:

• poor or inadequate sleep (insomnia),
• anxiety,
• depression,
• panic attacks,
• headaches,
• poor concentration,
• muscle aches,
• skin inflammation (eczema),
• inflammation of the joints (arthritis),
• irritable bowel syndrome (spastic colitis),
• constipation and
• diarrhea,
• high blood pressure (hypertension),
• certain types of stomach ulcers,
• asthma attacks,
• decreased sex drive, and
• even some cancer.

Any of these symptoms, or any combination of them, can affect a person who is suffering from stress.

First of all, in some lupus patients (as in people without lupus), stress may cause no direct or indirect effects. Stress, however, may affect a person with lupus in one of three ways.

• Stress may cause the same reactions that can occur in any person who does not have lupus.
• Stress can be associated with (precipitate or initiate) the first appearance of their lupus.
• Stress may be associated with a flare-up of their already existing disease.

The exact cause(s) of lupus is (are) unknown. Isolating the cause of lupus and other immune (defense system) disorders is a very active area of research around the world. To date, there is some evidence that supports a number of possible factors that lead to the development of lupus. For one thing, the genes that are inherited from parents to children clearly play a role in increasing the tendency toward developing lupus or other so-called autoimmune diseases, such as rheumatoid arthritis and immune thyroid disorders. Thus, other autoimmune diseases are more common among relatives of patients with lupus than in the general population.

Environmental factors also seem to play some role. For example, symptoms of lupus might first occur after exposure to ultraviolet light from the sun. Further, some scientists hypothesize that the immune system in patients with lupus is more easily activated by (is more sensitive to) external factors, such as viruses and ultraviolet light. What's more, a variety of drugs (particularly certain medications for blood pressure, abnormal heart rhythms, and seizures) has been reported to trigger lupus. Finally, the sex hormones are also believed to be factors in predisposing a person to lupus. For example, women are affected with lupus far more often than are men.

Stress has also been associated with the onset of lupus. How stress can initiate (precipitate) lupus is unclear. It may be that certain genetically and hormonally susceptible persons, who have been exposed to just the right amount of environmental factors, are "ripe" for stresses to trigger the onset of the illness. We don't yet know, however, how each factor relates to the activation of this autoimmune condition. Nevertheless, as practicing doctors, we do see patients come (present) to us with lupus for the first time after significant life stresses.

Speaking on behalf of my fellow rheumatologists (lupus experts), the answer is undeniably "Yes." Again, stress may not cause any problems for any individual patient. However, it is believed that stress not only can cause fatigue and a general lack of well-being, but it can also cause a flare up (reactivation) of the lupus. This typically means that features of the lupus, including fatigue, muscle and joint aching and stiffness, fevers, and blood test abnormalities can worsen. Stress can also have indirect effects on lupus disease. For example, it is known that women with systemic lupus not infrequently experience a worsening of symptoms prior to their menstrual periods. (This phenomenon, together with the female predominance among those with the disease, again suggests that female hormones play an integral role in the clinical characteristics or expression of systemic lupus.)

Moreover, at the 2001 Annual Scientific Meeting Of The American College Of Rheumatology, it was reported by researchers that stress reduction improved certain measures of lupus disease activity. As a matter of fact, based on their experience with a variety of patients, doctors who treat lupus have long accepted this concept of a relationship between stress and lupus.

Finally, here are a few words about stress, exercise (one way of managing stress), and lupus. It was also reported at the 2001 Annual Scientific Meeting Of The American College Of Rheumatology that supervised aerobic exercise did not seem to worsen disease activity in lupus patients. Furthermore, another report even demonstrated that aerobic exercise actually decreased fatigue and increased an overall sense of well-being in lupus patients. This benefit of exercise is encouraging news. As doctors, we always wonder about the effects of over-exercising patients with lupus. It seems that a balance can be reached that can allow patients with lupus to pursue physical exercise.

The bottom line is that stress can be unhealthy for anyone. However, stress is often, but not always, something that we can control to some extent. We certainly can learn to control portions of our reactions to stress. In persons afflicted with lupus, stress can have direct consequences, not only on their overall health, but also on their disease.