Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis?
Abstract Background Within established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | http://link.springer.com/article/10.1186/s13075-018-1587-y |
| _version_ | 1819069608352546816 |
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| author | Aleid C. Boer Robin M. ten Brinck Andrea W. M. Evers Annette H. M. van der Helm-van Mil |
| author_facet | Aleid C. Boer Robin M. ten Brinck Andrea W. M. Evers Annette H. M. van der Helm-van Mil |
| author_sort | Aleid C. Boer |
| collection | DOAJ |
| description | Abstract Background Within established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We studied whether the psychological stress response was increased in clinically suspect arthralgia (CSA) and if this associated with inflammation at presentation with arthralgia and with progression to clinical arthritis. Methods In 241 CSA patients, psychological stress was measured by the Mental Health Inventory (MHI-5) and the Perceived Stress Scale (PSS-10) at first presentation and during follow-up. Systemic inflammation was measured by C-reactive protein (CRP) and joint inflammation by 1.5 T-MRI of wrist, MCP, and MTP joints. Results At baseline, 12% (24/197) of CSA patients had a high psychological stress response according to the MHI-5. This was not different for patients presenting with or without an elevated CRP, with or without subclinical MRI-detected inflammation and for patients who did or did not develop arthritis. Similar findings were obtained with the PSS-10. When developing clinical arthritis, the percentage of patients with ‘high psychological stress’ increased to 31% (p = 0.025); during the first year of treatment this decreased to 8% (p = 0.020). ‘High psychological stress’ in non-progressors remained infrequent over time (range 7–13%). Stress was associated with fatigue (p = 0.003) and wellbeing (p < 0.001). Conclusions Psychological stress was not increased in the phase of arthralgia, raised at the time of diagnoses and decreased thereafter. The lack of an association with inflammation in arthralgia and this temporal relationship, argue against psychological stress having a significant contribution to progression from CSA to inflammatory arthritis. |
| first_indexed | 2024-12-21T16:52:45Z |
| format | Article |
| id | doaj.art-7df551a7168a4d92b8181dbe51066f2a |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-21T16:52:45Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-7df551a7168a4d92b8181dbe51066f2a2022-12-21T18:56:49ZengBMCArthritis Research & Therapy1478-63622018-05-012011810.1186/s13075-018-1587-yDoes psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis?Aleid C. Boer0Robin M. ten Brinck1Andrea W. M. Evers2Annette H. M. van der Helm-van Mil3Department of Rheumatology, Leiden University Medical CentreDepartment of Rheumatology, Leiden University Medical CentreDepartment of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Science, Leiden University and Department of Psychiatry, Leiden University Medical CentreDepartment of Rheumatology, Leiden University Medical CentreAbstract Background Within established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We studied whether the psychological stress response was increased in clinically suspect arthralgia (CSA) and if this associated with inflammation at presentation with arthralgia and with progression to clinical arthritis. Methods In 241 CSA patients, psychological stress was measured by the Mental Health Inventory (MHI-5) and the Perceived Stress Scale (PSS-10) at first presentation and during follow-up. Systemic inflammation was measured by C-reactive protein (CRP) and joint inflammation by 1.5 T-MRI of wrist, MCP, and MTP joints. Results At baseline, 12% (24/197) of CSA patients had a high psychological stress response according to the MHI-5. This was not different for patients presenting with or without an elevated CRP, with or without subclinical MRI-detected inflammation and for patients who did or did not develop arthritis. Similar findings were obtained with the PSS-10. When developing clinical arthritis, the percentage of patients with ‘high psychological stress’ increased to 31% (p = 0.025); during the first year of treatment this decreased to 8% (p = 0.020). ‘High psychological stress’ in non-progressors remained infrequent over time (range 7–13%). Stress was associated with fatigue (p = 0.003) and wellbeing (p < 0.001). Conclusions Psychological stress was not increased in the phase of arthralgia, raised at the time of diagnoses and decreased thereafter. The lack of an association with inflammation in arthralgia and this temporal relationship, argue against psychological stress having a significant contribution to progression from CSA to inflammatory arthritis.http://link.springer.com/article/10.1186/s13075-018-1587-yInflammationRheumatoid arthritisC-reactive protein (CRP)Magnetic resonance imaging (MRI)Psychological status |
| spellingShingle | Aleid C. Boer Robin M. ten Brinck Andrea W. M. Evers Annette H. M. van der Helm-van Mil Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? Arthritis Research & Therapy Inflammation Rheumatoid arthritis C-reactive protein (CRP) Magnetic resonance imaging (MRI) Psychological status |
| title | Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? |
| title_full | Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? |
| title_fullStr | Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? |
| title_full_unstemmed | Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? |
| title_short | Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis? |
| title_sort | does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis |
| topic | Inflammation Rheumatoid arthritis C-reactive protein (CRP) Magnetic resonance imaging (MRI) Psychological status |
| url | http://link.springer.com/article/10.1186/s13075-018-1587-y |
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