Human beings experience stress as a response to change. While everyone experiences stress, people with a chronic illness like rheumatoid arthritis (RA) often have more stress than healthy people do. Chronic illnesses may require people to make significant changes in many, or perhaps most, areas of their lives.

RA has the potential to create stress in some or all of these ways:

1. The illness itself is a fixed, lifelong stress. RA is also aggravated by other stresses. This creates a cycle: having the disease is stressful. Life stresses can worsen symptoms, creating even more stress.

2. Financial stress may result from the expenses connected with the illness. Medications, assistive devices, in-home care etc. can drain finances while simultaneously affecting the ability to earn wages.

3. If the body is altered as the disease progresses, self-esteem can be affected, creating emotional stress.

4. Any pain or discomfort that accompanies RA can cause stress. Studies also seem to show that stress increases the amount of pain the patient experiences.

5. Physical limitations or loss of physical control may create dependency, which many people find stressful.

6. One's vocation or education may be limited by this chronic illness. In some cases, the disease leads to job loss. Education and employment-related stresses can impact one's sense of being productive and able to contribute to the support of self or family.

7. Any chronic illness can cause social stress. Sufferers may be excluded, avoided or even teased. They may not be able to participate in some activities, or to keep pace with friends or family. This can create a sense of isolation and/or a sense of being "different."

8. RA patients may experience fatigue and depression. Depression may result from medications used to treat the disease, or from the changes that have affected self-image. Being too tired to do things can also be stressful for the person with the disease. Healthy people may not understand that depression and fatigue are related to the disease. This can cause relationship stress.

9. Fear is stressful. Patients may fear the course of their disease. They may fear pain, loss of physical abilities or various other things.

10. RA can put tremendous stress on marriages or intimate relationships. An illness can cause roles to change. The well partner may have to be the wage earner, children's caregiver and take care of the home too. He or she may feel overburdened. The partner with the illness may feel guilty, angry or less important. RA may affect sexual intimacy, physically and/or emotionally. Support groups and counselors can help.

Many RA patients have learned that exacerbations of their disease follow physically or emotionally stressful experiences. Some RA patients believe they can also link the start of their disease with a major stressful event such as a car accident or the death of a loved one.

Raynaud's phenomenon is a disorder that often accompanies RA. Raynaud's phenomenon causes spasms in the small blood vessels of the extremities. The blood vessels constrict, temporarily reducing the flow of blood to the affected areas. The fingers, toes, ear lobes, nose, lips or tongue can be affected. Attacks are triggered by cold temperatures or emotional stress. Some people are more likely to be affected by cold when they are already under stress. In other people, stress alone can trigger an Raynaud's phenomenon attack.

Mastering stress is very important for people with RA. Experts say that the key to managing stress is how we think about the things that cause us stress. Patients are encouraged to distinguish between things that can and cannot be changed. When things can't be changed, the patient's thinking must change. Many people have learned to combat stress by mastering relaxation methods. Books and tapes, support groups, counseling, exercise, prayer, humor, breathing techniques and sometimes medication can help. In addition, patients can make choices that help reduce some of life's routine stresses. This starts by identifying stressors and then taking steps to reduce as much stress as possible.

References

First published July 15, 2003
Last updated December 16, 2002
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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