Chronic Stress: How Arthritis Can Flare Up

For most of us, our daily lives are filled with lots of activities, deadlines, emotional ups and downs, and pressures to "perform" in one way or another. Every time we take on one of these challenges, our bodies pump out the adrenal "stress hormone" cortisol, to provide us with the energy for the job. Depending on the number of challenges facing us, as well as our individual responses to those challenges, more or less of this stress hormone is recruited. It is a sign of a healthy body to be able to secrete this "fight or flight" hormone in times of need. Our bodies, however, were not designed to sustain a high production of cortisol over a long period of time. With continuous stress, the adrenal glands grow tired, and levels of cortisol become too low. DHEA is another adrenal hormone that helps to balance many of the effects of cortisol and enhances our health in many ways. When cortisol drops, DHEA tends to drop, as well.

If you have been living a stressful lifestyle, and are having a harder time dealing with stress than you once did, your levels of adrenal stress hormones may be low as a result. Low levels, in turn, can aggravate your arthritis symptoms. One of cortisol's many actions in the body is to keep inflammation in check, partly by suppressing the amount of inflammatory compounds in the body called "cytokines." Scientific studies have shown that individuals with some forms of arthritis have excess amounts of these "inflammatory" cytokines, and low production of cortisol. Other studies have suggested that low cortisol may allow certain bacteria, e.g. mycoplasma, to contribute to inflammatory arthritis.

Do you tend to experience a worsening of joint symptoms during the night or early morning? If your cortisol level has dropped below where it should be, then you will be more susceptible to pain and inflammation at this time of the day, when cortisol is always at its lowest and cytokines are at their peak. As far back as 25 years ago, clinicians found that the administration of very small doses of cortisol improved symptoms.

Deficiencies of DHEA, have also been found in both pre- and post-menopausal women. A low level of DHEA appears to also contribute to the bone breakdown that accompanies long-term arthritis.

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References:

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2. Hall GM, Perry LA, Spector TD. Depressed levels of dehydroepiandrosterone sulphate in postmenopausal women with rheumatoid arthritis but no relation with axial bone density. Ann Rheum Dis 1993 Mar;52(3):211-4.
3. Jeffries WM. The etiology of rheumatoid arthritis. Med Hypotheses 1998 Aug;51(2):111-4.
4. Jeffries WM. Mild adrenocortical deficiency, chronic allergies, autoimmune disorders and the chronic fatigue syndrome: a continuation of the cortisone story. Med Hypotheses 1994 Mar;42(3):183-9.
5. Mirone L, et al. A study of serum androgen and cortisol levels in female patients with rheumatoid arthritis. Correlation with disease activity. Clin Rheumatol 1996 Jan;15(1):15-9.
6. Petrovsky N, McNair P, Harrison LC. Diurnal rhythms of pro-inflammatory cytokines: regulation by plasma cortisol and therapeutic implications. Cytokine 1998 Apr;10(4):307-12.
7. Sambrook P, et al. Postmenopausal bone loss in rheumatoid arthritis: effect of estrogens and androgens. J Rheumatol 1992 Mar;19(3):357-61.
8. Templ E, et al. Anterior pituitary function in patients with newly diagnosed rheumatoid arthritis. Br J Rheumatol 1996 Apr;35(4):350-6.
9. Van Vollenhoven RF, McGuire JL. Estrogen, progesterone, and testosterone: can they be used to treat autoimmune diseases? Cleve Clin J Med 1994 Jul-Aug;61(4):276-84.
10. Wilder RL. Adrenal and gonadal steroid hormone deficiency in the pathogenesis of rheumatoid arthritis. J Rheumatol Suppl 1996 Mar;44:10-2.

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