Perceived Stress and Inflammatory Arthritis: A Prospective Investigation in the Studies of the Etiologies of Rheumatoid Arthritis Cohort
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Objective: The aim of this study was to determine the association of perceived stress with incident inflammatory arthritis (IA) defined as having at least 1 joint consistent with rheumatoid arthritis (RA)–like synovitis based on examination. Methods: We conducted a prospective cohort study in the Studies of the Etiologies of Rheumatoid Arthritis cohort. Participants without IA were recruited if they were a first‐degree relative of an RA proband or screened positive for anti–citrullinated protein antibody. Perceived stress was measured using the Perceived Stress Scale–14 (PSS‐14), in which scores can range from 0 to 56, and a higher score indicates greater perceived stress. The total PSS‐14 score, as well as 2 subscores indicative of perceived distress and self‐efficacy, were averaged across all study visits until development of IA or the last follow‐up. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of IA associated with average PSS‐14 scores were obtained using Cox proportional hazards models. Results: The mean total PSS‐14 score was 20.4. We found that a 1‐point increase in the perceived distress score was significantly associated with a 10‐percent increase in the risk of IA (adjusted HR 1.10 [95% CI 1.02–1.19]). Total PSS‐14 and self‐efficacy were not associated with IA risk (adjusted HR 1.05 [95% CI 0.99–1.10] and 1.04 [95% CI 0.91–1.18], respectively). Conclusion: An association between perceived distress and incident IA was observed in this at‐risk cohort. Replication of this finding in other preclinical and at‐risk RA populations is needed.
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Stress is associated with an increased risk of rheumatoid arthritis, cardiovascular disease, cancer, and autoimmune diseases such as systemic lupus erythematosus, type 1 diabetes, and multiple sclerosis.
“Studies have found that stress was associated with an increased risk of rheumatoid arthritis [29], cardiovascular disease [30], cancer [31], and autoimmune diseases such as systemic lupus erythematosus, type 1 diabetes, and multiple sclerosis [32].”
From Efficacy of a web application for stress management among Iranian college students during COVID-19 outbreak: a study protocol for randomized controlled trials (2020) · cites this paper as [29]
Citation [29] is attached to rheumatoid arthritis, not the other diseases in the sentence. The Results and Discussion (pages unavailable) report that higher perceived distress was associated with incident RA-like inflammatory arthritis in an at-risk cohort. They do not establish an increased risk of diagnosed rheumatoid arthritis, and the adjusted association for the total perceived-stress score was not statistically significant. (LLM, conf=0.88)
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Associations between childhood trauma, depression, anxiety disorders and early arthritis presence
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Balancing inflammation under stress: glucocorticoid regulation of innate immune pathways
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- Authors
- Polinski, K. J., Bemis, E. A., Feser, M., Seifert, J., Demoruelle, M. K., Striebich, C. C., Brake, S., O’Dell, J. R., Mikuls, T. R., Weisman, M. H., Gregersen, P. K., Keating, R. M., Buckner, J., Nicassio, P., Holers, V. M., Deane, K. D., & Norris, J. M.
- Affiliations
- Colorado School of Public Health (US)
- University of Colorado Anschutz (US)
- Nine Health Services Denver Colorado
- University of Nebraska Medical Center (US)
- Cedars-Sinai Medical Center (US)
- Northwell Health (US)
- University of Chicago (US)
- Benaroya Research Institute (US)
- University of California, Los Angeles (US)
- Corresponding author
- Norris, Jill M.
- ORCID
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2020-11-06
- Volume
- 72
- Issue
- 12
- Pages
- 1766-1771
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC7145743
- OpenAlex
- W2979863178
- Cited by
- 42
- References
- 51
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 3 · 2020: 6 · 2018: 1
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32AR007534)
- National Institutes of Health (K23 AR051461, R01AR051394, U01 AI101981)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Keywords
- perceived stress, inflammatory arthritis, rheumatoid arthritis, perceived distress, self-efficacy, anti-citrullinated protein antibodies, preclinical arthritis, synovitis
- MeSH terms
- Adult, Aged, Arthritis, Rheumatoid, Colorado, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Stress, Psychological, Incidence, Risk Assessment
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