RESEARCH - Abnormal stress responses suspected of worsening RA

[Guest guest]

Abnormal stress responses suspected of worsening RA

Rheumawire

Jan 19, 2005

Janis

Regensburg, Germany - Stress that is minor and brief normally enhances

immune response, while sustained major stress leads eventually to immune

suppression. Some patients with inflammatory rheumatoid diseases may lack

the adaptive response that cools things down when stress turns chronic. Dr

Rainer H Straub (University Hospital, Regensburg, Germany) and colleagues

report in the January 2005 issue of Arthritis & Rheumatism that rheumatoid

arthritis (RA) patients have abnormal hormonal and sympathetic nervous

system responses, causing a functional loss of sympathetic nerve fibers in

inflamed synovial tissue and uncoupling the cortisol and norepinephrine

branches of the stress axes [1].

Straub tells rheumawire that RA and juvenile idiopathic arthritis (JIA)

patients appear to have abnormalities in the stress axes, as a result of

which sustained stress may increase inflammatory responses rather than

decreasing them, perhaps because the stress axes are not able to generate

the normal long-term responses.

" Stress axes that are chronically stimulated do not work anymore, " Straub

says.

Straub reviewed several cross-sectional studies on stress and immune

responses in RA and JIA. Minor stress was defined as acute minor stress over

a few hours ( " daily hassles " ). Major stress was defined as lasting over days

or weeks, such as caring for a handicapped family member.

The reviewers found that:

Cortisol has both immunostimulatory and immunosuppressant activity,

and effective treatment with glucocorticoids mimics the levels reached

during sustained major stress.

In chronic inflammation, RA patients had inadequate cortisol

secretion, increased sympathetic tone at rest, but inadequate response

during stress.

Responsiveness of the hypothalamo-pituitary axis (HPA) in RA patients

is diminished in relation to ongoing inflammation.

In RA and JIA patients, norepinephrine does not have its normal

immunosuppressive effects on macrophages, neutrophils, and natural killer

(NK) cells and in fact has a proinflammatory effect.

RA and JIA patients have increased baseline sympathetic tone and local

loss of sympathetic nerve fibers, both of which increase inflammatory

responses.

The authors hypothesize that sustained stress may increase inflammation in

these patients because their stress axes are unable to generate adequate

long-term responses.

If so, this suggests several therapeutic approaches. " First, " Straub says,

" disease activity must be reduced to normalize responses. "

Straub would like to see carefully controlled studies of mild exercise

training that does not hurt the joints (eg, swimming, bicycling) to see how

the stress axes change under mild exercise.

Source

Straub RH, Dhabhar FS, Bijlsma JWJ et al. How

psychological stress via hormones and nerve fibers may exacerbate rheumatoid

arthritis. Arthritis Rheum 2005; 52:16-26.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org