Role of stress in the development of rheumatoid arthritis: a case-control study.
OBJECTIVES
The primary objective of this study was to assess the stressful life events preceding the onset of symptoms in RA. The secondary objectives were to assess how early RA patients perceive stress and cope with stressors.


METHODS
A case-control study was performed, comparing patients recently diagnosed with RA to age- and gender-matched control subjects recently hospitalized for an unplanned surgical procedure not known to be influenced by stress. The Social Readjustment Rating Scale assessed the cumulative stress induced by stressful life events in the year preceding the onset of symptoms. Coping strategies, stress and anxiety symptoms were evaluated using validated psychological scales.


RESULTS
Seventy-six subjects were included in each group. The mean Social Readjustment Rating Scale score was twice as high in cases compared with controls [respectively, 167.0 (172.5) vs 83.3 (124.4), P < 0.001]. The association between cumulative stress and RA was statistically significant only in women, with a dose-dependent association between stress and RA. While female patients with RA attributed more often the onset of symptoms to a life event than female controls (70.2 vs 24.5%, P < 0.001), no significant difference was found when comparing male RA patients with male controls (26.9 vs 18.5%, respectively, P = 0.46). Increased perceived stress score (P = 0.04) and coping based on emotions (P = 0.001) were found in cases compared with controls.


CONCLUSION
Patients with early RA reported more life events in the year preceding the onset of symptoms than controls. Gender specificities were found with a significant association between cumulative stress and RA only in women.
['Germain|Vincent|V|', 'Scherlinger|Marc|M|', 'Barnetche|Thomas|T|', 'Pichon|Clémence|C|', 'Balageas|Alexandre|A|', 'Lequen|Laurence|L|', 'Shipley|Emilie|E|', 'Foret|Jennifer|J|', 'Dublanc|Stéphanie|S|', 'Capuron|Lucile|L|', 'Schaeverbeke|Thierry|T|', '|||']
D000223:Adaptation, Psychological D000328:Adult D001172:Arthritis, Rheumatoid D016022:Case-Control Studies D005260:Female D005602:France D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D013315:Stress, Psychological D011795:Surveys and Questionnaires
stress rheumatoid arthritis life events coping anxiety social support