Stress factors, emotional stress and rheumatoid arthritis disease activity

Abstract

The purpose of this study was to determine the relationship between stress factors, emotional stress and rheumatoid arthritis (RA) disease activity. Subjects (n = 101) confirmed to have RA completed the Daily Hassles Scale (DHS) to identify daily stress factors and the State/Trait Anxiety Inventory (STAI) as well as a visual analogue (VA) to measure emotional stress levels. The investigator evaluated RA disease activity (RADA) and erythrocyte sedimentation rate (ESR). Pearson product-moment correlation was used for statistical evaluation. A statistically significant, positive correlation was found between RADA and both measures of emotional stress; STAI r2 = 0.16, VA r2 = 0.25, P less than 0.01. Utilizing a psychophysiological feedback loop model, it was hypothesized that emotional stress levels and RA disease activity each served as a driving force and a consequence, i.e. as emotional stress levels increased, RA symptoms intensified and, likewise, as RA symptoms intensified, emotional stress levels increased. Nursing interventions were identified which possibly would reduce emotional stress levels, and thus, perhaps, decrease the incidence and/or severity of RA disease activity.

Impairment of quality of life: rheumatoid arthritis versus sarcoidosis

“…constant lack of energy [27]. Furthermore, in another study she demonstrated a correlation of pain, fragfound, that patients with RA have to cope simulmented sleep, and functional ability with fatigue in taneously with pain, limitations and dependence and RA patients [28].…”

Factors which contribute to fatigue associated with rheumatoid arthritis

“…Another important difference that should be kept in mmd is the difference between fahgue which is chronic in nature versus the chronic fahgue syndrome (CFS) The CFS is charactenzed by debilitating fatigue that has lasted for at least 6 months To qualify for the diagnosis of CFS, the person must not have any other medical or psychiatric condihons that produce similar symptoms This does not preclude an overlapping of CSF with other well-established illnesses such as RA, lupus and fibromyalgia However, investigators believe that CFS is a separate disease entity that may follow mfechon by one or more retroviruses (Schluederberg 1990) The ongin of fatigue associated with RA is just as mystenous as the ongm of fahgue m CFS Perhaps the basis is again viral Or there may be a composite of factors which leads to the sensahon of fatigue Until the physiological basis has been discovered, it would seem prudent to identify other factors which may contnbute to the sensation of fahgue v«thin this populahon The value of such research would be the ldentificahon of points for intervention designed to reduce the level of fatigue The purpose of this research was to identify the factors which RA subjects believed contnbuted to their fatigue A second purpose was to examine the relationships among the idenhfied factors and the sensation of fatigue BACKGROUND Fatigue was first studied by investigators mterested m skilled performance (Drew 1940, Davis 1948) and produchvity (Chambers 1961) Yoshitake (1971, a pioneer in the field, focused much of his research on acute fatigue associated with employment He defined fahgue as a 'feeling of overall unpleasantness' and reported that specific factors, such as non-shmulahng work, led to boredom or decreased abihty to concentrate Over time, these factors culminated m the actual sensation of fahgue Cameron (1973), another pioneer m the lnveshgahon of fatigue, attempted to develop a theory of fatigue He cntically evaluated pnor research efforts directed toward either measunng or defining the sensation and concluded that 'fatigue has its ongm m the personal state of the mdividual' The author stressed that fatigue was multidimensional yet situahon specific and should be mveshgated m a like manner While both Cameron (1973) and Yoshitake (1971) were pnmanly interested m acute fatigue assoaated with employment, their careful attenhon to identifymg the mihatmg factors has provided direction for much of the current research In addihon, the point that fahgue is highly subjechve and should only be charactenzed m terms of what the person is expenenang, should always be kept m mind Clearly, the basis for the sensation may be totally different, populahon to populahon Interest m the sensation of fahgue has expanded to include not only evaluatmg healthy people expenenang acute fatigue assoaated with work-related situahons but also studymg ill individuals expenencmg chronic fatigue associated with altered physical responses Chronic fahgue has been reported to be a troublesome clinical manifestation associated with viral infechons (Schluederberg 1990), end-stage renal disease (Snvastava 1989), as well as rheumatoid arthnhs (Crosby 1988, Tack 1990 In addihon, treatment regimes such as radiation therapy …”

“…addihon, a recent study highlighted the prevalence and impact of fatigue 52% of 101 people with RA stated that A great deal of hme has been spent descnbmg and/or they consistently lacked energy and 32% indicated they measunng fatigue and far too httle hme has been spent on were too tired to work for more than 4 hours without discovenng the basis of fatigue assoaated with rheumatoid restmg (Crosby 1988) arthnhs (RA) The fact that fahgue is a dmical feature of RA But again, what is the basis of fatigue? Unhl that quesls not disputed Fahgue has been listed, for a number of hon is answered, httle will have been accomplished by years, m the Pnmer on the Rheumattc Diseases as a present-contmuously measunng the sensahon, using a mulhtude of ing symptom of the disease process (Bennett 1988) In different mstruments, most of which were developed and tested with healthy people expenenang acute fahgue versus ill people expenencmg chronic fahgue Acute fahgue is usually of short durahon and relieved by rest, sleep or a change in situation Chronic fatigue is persistent, cumulative and not eliminated by rest In other words, acute fahgue IS episodic and usually associated with temporal situahons whereas chronic fahgue is persistent and usually associated with an illness situation Thus, the basis of fatigue may be totally different, acute versus chronic, and should be evaluated and measured with those differences m mmd…”

Chronic strain, daily work stress and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse?

“…Although we demonstrated a possible moderating effect for control and demands in paid work on the event-mood relationship within a day, we have used a widely-tested model that views undesirable events as stressors that lead to outcomes such as changes in mood and pain (Affleck et al, 1990Crosby, 1988;Mason et al, 1990;Parker et al, 1988;Zautra et al, 1994). However, we cannot rule out the fact that negative mood states at midday might have enhanced the recall of the morning's negative events (Blaney, 1986;Bower, 1981).…”

“…A growing body of evidence indicates that such stressful daily circumstances are associated with daily mood (Affleck, Tennen, Urrows, & Higgins, 1990;Armeli, Tennen, Affleck, & Kranzler, 2000;Bolger, DeLongis, Kessler, & Schilling, 1989), and illness symptoms (DeLongis, Folkman, & Lazarus, 1988;Repetti, 1993;Stone, Reed, & Neale, 1987). Studies show an association between minor stressful events and the course of RA as well, including symptoms such as pain (Affleck et al, 1990Crosby, 1988;Parker et al, 1988), emotional well-being (Zautra, Burleson, Matt, Roth, & Burrows, 1994), daily mood (Affleck et al, 1990) and indicators of disease activity (Mason, Anderson, Meenan, Weaver, & Haralson, 1990;. Few studies have examined the role of work events at the daily (cf.…”