Stress, Treatment, and Lupus

Managing stress is essential for people with lupus because stress can both make lupus worse and also cause lupus symptoms to appear in the first place.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects the entire body. Every person with lupus has different symptoms, but stress is known to make all of the symptoms of lupus worse, and even to lead to flares, periods of intense symptoms that can lay a person with lupus low.

SLE happens when the immune system starts acting wrong. The immune system functions by recognizing invaders such as bacteria and viruses and then mobilizing an immune response to clear them out. In autoimmune diseases, this process is not working properly. 

Stress and autoimmune disease are related because both psychological and physiological stress cause a release of hormones related to stress. These hormones increase the production of cytokines, molecules that have several functions in the immune system. Inflammation, the alarm state of the immune system, happens more often in autoimmune diseases such as lupus, and the body’s own cells are attacked. The release of stress hormones causes issues with immune system regulation, which leads to damage and inflammation in the immune system. 

So, what types of stress lead to lupus, and does stress actually cause lupus?

What Stresses Lead to Lupus?

Stress can take the form of depression and anxiety, so it is important for doctors and researchers to look at more than just the test results. A patient’s life affects their health outcomes as much as or more than their medications. You can read more about the relationship of quality of life and disease severity here.  Worse, stress may even cause lupus!

In a retrospective cohort study of 15,357 adults in 1995-1997, researchers found that people who experienced trauma and stress in childhood were more likely to develop and be hospitalized for autoimmune diseases later in life. 64% of people who experienced hospitalizations for autoimmune disease reported at least one adverse childhood event in their past. The researchers calculated that having 2 or more adverse childhood experiences increased the risk of hospitalization by 70% and the risk of developing rheumatic disease by 100%! 

Other studies such as this 2018 Swedish study looking at patients with stress related disorders, their siblings, and a control group of people with similar lives and lifestyle (a matched cohort study) support the finding that stress-related disorders and traumas are associated with developing autoimmune disease. You can read more about the relationship between trauma and lupus here.

Lupus appears to be passed down in families and is especially prevalent in black, Hispanic, and Native-American women.

Some researchers think that, because women and BIPOC (Black and Indigenous People of Color) are also historically stressed, traumatized, and overloaded by societal expectations and racism. While genetics definitely are a component, people in these groups often are not given a fair shake in their social determinants of health: economic stability tends to be lower, as well as education access, quality, healthcare access and quality, their neighborhood characteristics, and the pressures of society. You can read more about the social determinants of health, here. Higher levels of stress in these groups may also contribute to their higher rates of lupus. 

It is important to keep these higher levels of stress in mind and to treat the stress as well as the disease. As it turns out, there is evidence that treating stress-related disorders such as PTSD or depression with therapy, antidepressants, and other medications can also reduce the risk of autoimmune disease. 

The stress can also be as ‘minor’ as work, life, and sleep-related stress. In a study on sleep deprivation stress and the immune system, researchers found that (in mice,) more of two immune system components involved in inflammation were found in the bloodstream, Interleukin 12 and 23. Since stress seems to increase their amounts, the researchers believe that they may be a way to diagnose lupus or, even, a potential target for certain therapies. 

So, stress can cause autoimmune disease to rear its painful face, and disease can cause stress with pain, fatigue, and other symptoms. It is difficult to tell what is causing stress to intensify the symptoms of lupus, but it is clear – something needs to be done.  Breaking the cycle of stress is important for people with lupus, and there are many methods that people with lupus have at their disposal.

Treating Stress and Lupus

Stress is treatable, though what treatments are most effective depend on the person, the source or sources of stress, and the effects of the stress. Managing stress and flare triggers are something that all lupus warriors have to manage, and there are a few techniques that can be used by nearly everyone!

Meditation, including mindfulness meditation, can have an enormously beneficial effect on stress and people with lupus. Even if symptoms do not improve, meditation of various sorts has been associated with reduced worrying, improved memory and focus, and better emotional resilience – fewer ups and downs. There are apps dedicated to assisting with meditation, and various types of meditation, so it’s not difficult to find one that is right for you or your life. You can read more about meditation here. 

Therapy, such as cognitive-behavioral therapy, is a type of talk-based therapy that focuses on creating good coping habits and reducing thoughts related to anxiety and depression. Art therapy and writing therapy are known and noninvasive methods for stress relief that have been proven to improve mental health immensely. Since anxiety, depression, and trauma all contribute to stress – and also are often made worse by lupus – therapy can help people with lupus in many ways besides reducing stress. Artificial reality is a new method of therapy that shows promise both as emotional healing and even pain relief – read more about it here! 

Alternative medicines such as acupuncture and massage may also be useful. Although the research on them is sparse, what research there is seems to support the claims that these treatments reduce stress and chronic pain when done correctly. 

Healthier diets and safe physical activity are are very important for people with lupus for many reasons, including stress reduction.

Not every stress-relief strategy will work for every person, so try a few until you find one that works.