Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: October 2023
While stress does not cause psoriatic arthritis, stress can worsen symptoms or trigger a flare of the condition. Stress can increase inflammation in the body, which makes stress management important for people living with psoriatic arthritis. Stress management includes learning why a person feels stress and learning how to develop healthy coping strategies to reduce that stress.1,2
The stress response: Fight or flight
Stress is an automatic psychological and physical reaction of the body to the demands of life. The stress response, also called “fight-or-flight” response, prepares the body to cope with a threat. When faced with a stressor, hormones are released into the body to mobilize energy to fuel a response. Common signs of this state are increased rate of breathing, increased heart rate, anxiety, and a shift of blood flow to the larger muscles in the body. These physiological changes ready the body to fight or flee from a threat. In some cases, the body may also have a “freeze” response to a stressor. In this case, the muscles are tensed and poised for action but are not used.
The stress response begins in the brain, as sensory information is sent to the amygdala, the portion of the brain responsible for emotional processing. The amygdala sounds the alarm when it perceives a threat. However, the amygdala can’t tell the difference between real or perceived stressors, causing the same physical reactions in the body for both. Once the threat is gone, the body is supposed to return to a relaxed state. Unfortunately, with the nonstop pace and rapidly changing environment of modern life, this alarm system rarely shuts off.2,3 Chronic stress that continues for weeks or months can lead to health problems.4
How stress impacts the body
A recent meta-analysis of more than 300 journal articles on stress and its impact on the immune system found that acute stressors, those lasting only a few minutes, and brief stressors, lasting a few days, had limited, temporary impact on the immune system. However, chronic stressors were associated with global suppression of the immune system. Chronic stressors tended to fall into two categories: bereavement and trauma. Bereavement was associated with decreased natural killer cells, those cells in the immune system that attack invaders like viruses and some tumor cells. Trauma was associated with decreased number of T cells, the white blood cells that actively participate in the immune response. The meta-analysis also found that the immunosuppression was greatly impacted by the length of time the chronic stressor persisted. Some chronic stressors are associated with a change in identity or social roles, for example, acquiring the role of caregiver or refugee or losing the role of employee. These persistent chronic stressors cause more severe and constant impact on the immune system.5,6
Tips for relieving stress
Although stress causes a negative impact on the body’s immune response, not everyone experiences the effects of stress the same way. Studies have demonstrated that people’s cardiovascular and endocrine responses to stressful experiences are dependent on their appraisal of the situation and their thoughts about it. Optimism and coping have shown to moderate the effect of stress on the immune system.5
Several techniques can be employed to manage stress:2
- Relaxation response – One of the most effective ways in reducing stress is to use activities or techniques to create the relaxation response in the body. Relaxation approaches include deep abdominal breathing, visualization, prayer, meditation, yoga or tai chi.
- Physical activity – Exercise, such as walking, benefits the body by deepening the breath and by relieving muscle tension. Physical activity that combines movement, deep breathing and mental focus, such as yoga, tai chi, and qi gong, can help induce calm.
- Social support – Receiving emotional support from friends, family and companions can help during times of stress and crisis.3