REVIEW - The impact of stressors on health status and HPA axis and ANS responsiveness in RA

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BASIC AND CLINICAL ASPECTS OF NEUROENDOCRINE IMMUNOLOGY IN RHEUMATIC

DISEASES Volume 1069 published June 2006

Ann. N.Y. Acad. Sci. 1069: 77–97 (2006). doi: 10.1196/annals.1351.007

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The Impact of Stressors on Health Status and

Hypothalamic-Pituitary-Adrenal Axis and Autonomic Nervous System

Responsiveness in Rheumatoid Arthritis

RINIE GEENENa, HENRIËT VAN MIDDENDORPa AND JOHANNES W.J. BIJLSMAb

a Department of Clinical and Health Psychology, Utrecht University,

Utrecht, the Netherlands b Department of Rheumatology and Clinical

Immunology, University Medical Center Utrecht, Utrecht, the

Netherlands

The hypothalamic-pituitary-adrenal (HPA) axis and the autonomic

nervous system (ANS) are critically involved in inflammation and are

activated by stress. This suggests that stressful circumstances may

affect the chronic inflammation of rheumatoid arthritis (RA).

Fifty-six scientific publications of the past 15 years were reviewed

to get insight into the possible impact of stressors (grouped in five

categories) on the health status and HPA axis and ANS functioning of

adult patients with RA. Our findings in this review were: (1) In

response to mental and physical effort and applied physiological

stressors, patients demonstrate ANS hyporesponsiveness and " too

normal " HPA axis responsiveness considering the elevated immune

activity. A premorbid defect, past and current inflammatory activity,

past and current stress, and physical deconditioning may explain

disturbed physiological responses. (2) After brief naturalistic

stressors, self-perceived and clinician's ratings of disease activity

are increased; inflammation parameters have been insufficiently

examined. (3) Major life events do not univocally affect disease

status, but appear able to modify disease activity in a positive or

negative way, depending on the nature, duration, and dose of the

accompanying physiological stress response. (4) Enduring (e.g.,

work-related or interpersonal) stressors are associated with perceived

health. Because this stressor category mingles with personality

variables, the mere observation of a correlation does not prove that

chronic stressors provoke health changes, although this might be the

case. (5) Not one study rigorously examined the prospective hypothesis

that past stressors (e.g., childhood victimization or pre-onset

stressful incidents) may trigger RA or aggravate existing RA, which is

a realistic belief for some patients.

http://www.annalsnyas.org/cgi/content/abstract/1069/1/77

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