Stress can do more than leave you feeling overwhelmed. For people living with autoimmune diseases such as lupus and rheumatoid arthritis, periods of significant stress can contribute to worsening symptoms and disease flares.
Understanding the connection between stress and the immune system can help patients and their doctors identify triggers and develop strategies to manage symptoms.
“There is a great deal of data about the effect of stress on the body,” said Raai Mahmood, MD, a rheumatologist at The University of Texas Medical Branch (UTMB Health).
“Many times, a patient will report that they became ill after a traumatic event,” she said. “Slowly, science has learned that our nervous system also regulates our immune system.”
The relationship between the brain, nervous system, and immune system is complex. During periods of acute stress, the body releases hormones such as cortisol and adrenaline that help prepare it to respond to a perceived threat.
That response can be useful in the short term. But when stress becomes chronic, prolonged activation of the body’s stress response can affect immune regulation.
When stress becomes a trigger
The immune system normally works to protect the body while keeping its response under control. In autoimmune disease, that regulation is disrupted, causing the immune system to attack the body’s own tissues.
For people who already have an autoimmune disease, chronic stress can be one factor that contributes to a flare, Mahmood said.
“That’s what happens when a patient is experiencing a ‘flare-up’ of their disease,” she said. “Many times, symptoms come in waves. We can stabilize a patient, and then it flares up, then dips again. This is the nature of autoimmune diseases.”
Symptoms can include pain, fatigue, and other problems that can make it difficult to manage work, family responsibilities, and everyday activities.
Stress can also be difficult for others to understand. A situation that seems manageable to one person may have a very different physical impact on someone living with an autoimmune condition.
But stress is only one piece of the picture. Genetics, smoking, environmental exposures, and other factors can contribute to the development and progression of autoimmune disease, and triggers vary from person to person.
Managing stress is part of managing health
Because triggers are different for every patient, Mahmood said treatment plans should be individualized.
“When stress is the trigger, we gear treatment plans to the patient,” she said. “Identifying the stress and channeling it in a healthy way, rather than letting it affect the body, is what we are looking for.”
In addition to prescribed treatment, regular physical activity and stress-management strategies may help. Mahmood recommends activities such as walking, swimming, or yoga, as well as talking with others and finding healthy ways to manage emotional stress.
“Physical activity seems to calm the mind, and the body will follow,” she said.
For some patients, the relationship between symptoms and disease activity can be complicated. A person may have certain antibodies associated with an autoimmune disease without experiencing significant symptoms, and symptoms and laboratory results do not always change at the same time.
“All the disease symptoms and blood work have to align,” Mahmood said. “You can have the markers and be completely fine, and then it could flip, either for no apparent reason or due to a major stressful event in life.”
That uncertainty can make it especially important for patients and physicians to look at the whole picture rather than relying on a single symptom or test result.
A proactive approach
Mahmood encourages patients to take an active role in managing their health. Depending on the disease and the individual, that may include maintaining a healthy diet, exercising, quitting smoking, managing stress, and working with a physician to determine an appropriate treatment plan.
Some patients may be interested in complementary approaches alongside conventional medical treatment. Mahmood said those decisions should be individualized and discussed with a clinician.
Patients also sometimes ask whether they can manage an autoimmune disease without medication.
“If you are doing your part, and you don’t feel that the meds are helping, then we can certainly taper off or reduce the dose,” she said. “We can try.”
Mahmood cautioned that changes to medication should never be made without guidance from the treating physician.
Living with an autoimmune disease can mean learning to recognize patterns and understand what makes symptoms better or worse. Stress may be one of those factors, but recognizing it is not about blaming patients for their disease.
Instead, understanding the stress-immune connection gives patients another opportunity to intervene.
Managing stress, staying physically active, making healthy choices, and working closely with a healthcare team can all be part of the larger picture. The goal isn’t to eliminate every source of stress, which isn't realistic. It is to give patients more tools to manage their health when life becomes stressful and symptoms begin to change.