Does Stress Affect Lupus?

Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Leslie J. Schoenfield, MD, PhD

Let's start by discussing what is meant by stress. Stress means different things to different people based on their backgrounds and their current emotional and physical condition. For some people, milk spilling on the table causes a major emotional reaction. To others, a tank rolling through the living room might be viewed as just another life experience!

For the purpose of this topic, I will define stress as human reactions to forces that tend to disturb our normal functional (physiologic) balance (equilibrium). Stress, in this general sense, refers to any adverse condition or state that affects our normal well-being. Such stress can be imposed on us by, for example, work, a spouse, other people, ourselves, or by setting our daily schedule too rigorously.

For nearly all of us, our first real stress was being engulfed by cold air when we slipped from the warm comfort of our mother's womb. (I don't know about you, but I cried like a baby!)

In what ways may stress affect the patient with lupus?

First of all, in some lupus patients (as in people without lupus), stress may cause no direct or indirect effects. Stress, however, may affect a person with lupus in one of three ways.

• Stress may cause the same reactions that can occur in any person who does not have lupus.
• Stress can be associated with (precipitate or initiate) the first appearance of their lupus.
• Stress may be associated with a flare-up of their already existing disease.

What reactions can stress cause in a person with lupus that are the same as in a healthy individual?

Many symptoms have been associated with stress in normal persons as well as those with lupus. These symptoms include poor or inadequate sleep (insomnia), anxiety, depression, panic attacks, headaches, poor concentration, muscle aches, skin inflammation (eczema), inflammation of the joints (arthritis), irritable bowel syndrome (spastic colitis), constipation and diarrhea, high blood pressure (hypertension), certain types of stomach ulcers, asthma attacks, decreased sex drive, and even some cancer. Any of these symptoms, or any combination of them, can affect a person who is suffering from stress.

What about the relationship between stress and the onset of lupus?

The exact cause(s) of lupus is (are) unknown. Isolating the cause of lupus and other immune (defense system) disorders is a very active area of research around the world. To date, there is some evidence that supports a number of possible factors that lead to the development of lupus. For one thing, the genes that are inherited from parents to children clearly play a role in increasing the tendency toward developing lupus or other so-called autoimmune diseases, such as rheumatoid arthritis and immune thyroid disorders. Thus, other autoimmune diseases are more common among relatives of patients with lupus than in the general population.

Environmental factors also seem to play some role. For example, symptoms of lupus might first occur after exposure to ultraviolet light from the sun. Further, some scientists hypothesize that the immune system in patients with lupus is more easily activated by (is more sensitive to) external factors, such as viruses and ultraviolet light. What's more, a variety of drugs (particularly certain medications for blood pressure, abnormal heart rhythms, and seizures) has been reported to trigger lupus. Finally, the sex hormones are also believed to be factors in predisposing a person to lupus. For example, women are affected with lupus far more often than are men.

Stress has also been associated with the onset of lupus. How stress can initiate (precipitate) lupus is unclear. It may be that certain genetically and hormonally susceptible persons, who have been exposed to just the right amount of environmental factors, are "ripe" for stresses to trigger the onset of the illness. We don't yet know, however, how each factor relates to the activation of this autoimmune condition. Nevertheless, as practicing doctors, we do see patients come (present) to us with lupus for the first time after significant life stresses.