Flares in Patients with Systemic Lupus erythematosus Are Associated with Daily Psychological Stress

Abstract

Background: The aetiology of systemic lupus erythematosus (SLE) remains unclear. Clinical observations and a small number of studies performed so far suggest an association between psychological stress and self-reported symptoms of SLE patients. This longitudinal study was designed to investigate whether daily psychological stress is associated with flares in SLE patients, measured by clinical and laboratory parameters. Methods: Female SLE patients (n = 41) were followed over a period of six months. Daily stress was monitored by a hand-held PC diary programmed with 44 items based on standardized measures and clinical experience. Once every four weeks patients visited the outpatient clinic for medical evaluation. Disease activity was evaluated using the European Consensus Lupus Activity Measurement (ECLAM), laboratory parameters, and intake of steroids. Results: Classification and regression tree (CART) patient-wise analyses revealed that SLE patients with vs. without flares using complement and ECLAM as activity measures show greater negative self-ratings in mood, and social duties (p < 0.01). In addition, mixed model analysis of variance showed that daily hassles with social relationships were significantly associated with flares in SLE measured by an increase in steroid medication >5mg/d (p < 0.01). Conclusions: These results suggest that psychological stress is associated with flares in SLE. Particularly daily stress with social relationships and social duties may be factors to be related to the course of disease activity in SLE.

Which stressors are responsible for the worsening in the clinical symptomatology of lupus?

“…The results found coincide, on one hand, with those obtained by other researchers [4,6,7], where the psychosocial stressors were related to the worsening in lupus activity. However, we were able to relate different types of stressors with certain specific symptoms of lupus, finding a great effect of the stressors related to work overload and to the perception of the illness itself.…”

“…Specifically, diverse studies have shown that stress is one of the environmental factors that can cause a worsening in lupus [2][3][4][5][6][7][8]. Although the role of stress in this illness appears clear, at first, there was certain controversy about the nature of the stressors, as some authors supported the theory that daily stress (not organizing time well, problems in social relationships...etc.)…”

“…In this way, the authors again showed the modulation of the immune system due to stressful events involving interpersonal relationships, and due to the anticipation of these stressors, in the following 24-36 hours. The latest study carried out with the objective of defining the type of stressor that can affect the worsening of lupus is the one by Pawlak et al [7]. These authors studied the stressors in 41 women with lupus during a six-month period and their physiological correlates (complement activity, anti-dsDNA and ECLAM-European Consensus Lupus Activity Measurement).…”

Activation of Complement System during Ship Voyage and Winter-over Expedition in Antarctica

“…C3 was significantly increased during the ship journey in summer team. Naturalistic stressors have been associated with increases in the levels of C3 and C4 [25][26][27], which are two key components of the complement cascade. Activation of complement in response to acute stress in men who were subjected to repeated simulations of emergency evacuation procedures for seabased oil platforms [28].…”

Influência do estresse psicossocial no lúpus eritematoso sistêmico

“…Existem seis estudos prospectivos sobre esse tema, mais adequados na verificação da correlação estudada, mas que diferem bastante quanto à metodologia empregada (44)(45)(46)(47)(48)(49) . Wekking et al seguiram 13 pacientes com LES durante um ano e mostraram que a freqüência e a intensidade de estressores diários correlacionam-se com depressão e ansiedade e número de atividades sociais, mas não com alguns parâmetros de atividade da doença (alterações laboratoriais, como hemograma e anticorpos, escalas de sintomas ou de interferência em atividades cotidianas).…”