Perceived Stress Linked to Worsening RA Symptoms, Study Finds
A longitudinal cohort study has found that higher levels of perceived stress independently predict worse symptom outcomes in patients with rheumatoid arthritis (RA), highlighting a potential modifiable factor in disease management.
The findings have significant implications for clinical practice, suggesting a role for stress resilience strategies alongside traditional RA therapies, the authors stated in Arthritis Care & Research.
Over an 18-month follow-up, 133 adults with RA underwent assessments every 6 months to evaluate perceived stress and disease outcomes. Stress was measured using the 4-item Perceived Stress Scale, while outcomes included self-reported disease activity (Rheumatoid Arthritis Disease Activity Index), pain, fatigue, and physical function via PROMIS measures.
In adjusted time-lagged models, elevated stress levels were significantly associated with worse outcomes at the next clinical visit. Specifically, perceived stress correlated with more severe pain (β = 0.61, 95% CI 0.29–0.94), increased fatigue (β = 0.71, 95% CI 0.32–1.11), and reduced physical function (β = −0.33, 95% CI −0.59 to −0.06). Although higher stress was also associated with greater self-reported disease activity (β = 0.11, 95% CI 0.03–0.19), this change was not clinically significant.
“These effect sizes reflect clinically meaningful differences for pain, fatigue, and physical function,” the authors noted, underscoring the relevance for practicing rheumatologists. The study cohort was predominantly female (88%) with a diverse racial and ethnic representation, including 35% Hispanic and 9% African-American participants.
The results support the integration of psychosocial care into RA management, particularly for patients experiencing persistent stress. “Findings underscore the need to integrate stress resilience interventions and programs that augment psychosocial support in health care systems that serve people living with RA,” the authors wrote.
While biologic and pharmacologic treatments remain central to RA care, this study adds to growing evidence that patient-reported outcomes—particularly pain and fatigue—may be meaningfully influenced by psychological factors. Rheumatology teams may consider routine stress assessment as part of comprehensive disease evaluation.
Addressing stress also may help mitigate symptom burden and enhance quality of life, even if it does not directly alter inflammatory disease activity, the authors noted. Future studies may further define how targeted interventions can be optimized for this population. For now, clinicians are encouraged to view stress not just as a background factor, but as a potential contributor to the overall RA disease experience.
Reference
Patterson SL, Park J, Hartogensis W, Katz P. Perceived stress and prediction of worse patient-reported outcomes in a rheumatoid arthritis cohort. Arthritis Care Res (Hoboken). Published online April 4, 2025. doi:10.1002/acr.25543
