Research suggests emotional distress may trigger or worsen PsA, but many questions remain.

Can trauma or stress trigger the onset of psoriatic arthritis (PsA)? Can worrying make the disease worse?

Research examining the role of trauma and emotional distress in rheumatic diseases suggests the answers to both questions may be yes.

For example, a 2013 study found that people with PsA reported higher amounts of traumatic childhood events – including physical, emotional, or sexual abuse -- than those who reported no childhood trauma.

Psychological Stress May Affect Disease Outcomes

Research has indicated that psychological stress is linked to poor outcomes, including diseases flares in inflammatory arthritis. For example, in one study, researchers investigated a link between post-traumatic stress disorder (PTSD) and autoimmune diseases among US soldiers. The study found soldiers who had PTSD and arthritis a had higher rates of self-reported pain, physical impairment and tender joint count, than those who had arthritis but no PTSD.

Stress May Worsen Symptoms

Researchers have found a correlation between stress, PsA symptoms and disease activity.

When you feel stressed, your body triggers the release of chemicals that cause physiological changes, such as your breathing to quicken, your heart rate to increase and your muscles to tense. If you feel stressed regularly the increased tension in your muscles can increase inflammation. Increased inflammation can worsen your arthritis symptoms, such as pain, psoriasis and joint damage. Worsening symptoms can fuel stress and anxiety, creating a vicious cycle. This can affect your sleep and ability to exercise which can further contribute to inflammation and pain.  

Understanding the Role of Emotions

Researchers say such findings point to the need for more studies about exactly how stress and worrying impacts the disease process. One presumption is that stress leads to changes in the functioning of the immune system. Another possible explanation is because worrying affects emotional well-being and behaviour, it could lead to less treatment adherence.

Despite the growing evidence that emotional stress can affect the immune system, explaining the effect can be difficult. This is because stress effects people differently and people have different responses to stressors.

While the medical community continues to search for answers, patients with the tendency to worry extensively can be helped with psychological interventions like cognitive-behavioural therapy.

It is not uncommon for people to feel stressed time-to-time, but dealing with a condition like inflammatory arthritis stress levels can be heightened.  Best stress relievers for PsA provides some helpful tips on how to deal with stress.