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NEWS & RESOURCES

What’s Happening

THE IMPORTANCE OF KEEPING YOUR BODY MOVING THROUGH EXERCISE.

WHAT’S TRENDING? SEE WHAT IS TRENDING IN THE LATEST RESEARCH FOR LUPUS.

RESOURCES THAT ARE AVAILABLE TO YOU.

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NEWS

Media Buzz

RHEUMATOLOGIST SHORTAGE

In March 2015, the American Academy of Family Physicians released a report that indicated the United States would experience a shortage of between 46,000 and 90,000 physicians by 2025. The American College of Rheumatology defines a rheumatologist as "an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic disease. These diseases can affect the joints, muscles and bones causing pain, swelling, stiffness and deformity."

The Journal of Arthritis & Rheumatology, examined the educational system and how its current arrangement wont be able to graduate enough new rheumatologists to keep up with demand for this type of care.

Couple that rising demand with the fact that many doctors currently practicing in the field of rheumatology are nearing retirement age themselves, and you start to see the scope of the predicament.

Reference

U.S. News & World Report (2018),

https://health.usnews.com/health-care/patient-advice/articles/2018-04-04/what-can-be-done-about-the-growing-shortage-of-rheumatologists

Doctor adjusting balance on weighing sca

OBESITY, DISEASE ACTIVITY PARADOX FOUND IN SLE

Meeting showed an inverse correlation between body mass index (BMI) and disease activity in systemic lupus erythematosus (SLE) after adjusting for use of prednisone. "This is the first evidence to our knowledge of an obesity paradox in systemic lupus," the researchers wrote.

To study how BMI changes would affect disease activity, reseachers examined 2406 patients in a prospective SLE cohort, assessing their weight at each visit. Patients were categorized into 5 groups according to weight: low (BMI ,20kg/m2), normal weight (reference; BMI 20-24.9 kg/m2),overweight (BMI 25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2).

Reference

Stojan G, Fu W, Petri M. Body mass index and disease activity in systemic lupus erythematosus-a paradoxical relationship? Presented at ACR/ARHP 2017 Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 1634.

CHARACTERISTICS OF EARLY-ONSET SLE DISTINGUISHED FROM MIMICKING CONDITIONS

Patients with early SLE had higher rates of unexplained fever than those with SLE-mimicking conditions. Clinical manifestations differentiating early-onset systemic lupus erythematosus (SLE) from SLE-mimicking conditions have been identified, according to a study recently published in Arthritis & Rheumatology.

This study included 389 individuals with SLE and 227 with conditions that mimicked SLE. Baseline data were collected using Academic Lupus Centers located in 4 continents and included individuals who had been referred for potential SLE within the past 3 years with less than 1 year of symptoms.

Reference

Mosca M, Costenbader KH, Johnson SR, et al. How do patients with newly diagnosed systemic lupus erythematosus present? A multicenter cohort of early systemic lupus erythematosus to inform the development of new classification criteria [published online July 23, 2018]. Arthritis Rheumatol. doi: 10. 1002/art.40674

DEPRESSION TIED TO DOUBLE THE RISK FOR LUPUS IN WOMEN

A history of depression is associated with more than double the risk of developing systemic lupus erythematosus (SLE) among women, new research suggests.

The study, which included data from almost 200,000 participants in the Nurses' Health Study ll (NHS ll), supports the hypothesis that depression is a causal risk factor for developing SLE, note the investigators.

Reference

JAMA Psychiatry. Published online September 12, 2018. Abstract

Retreived from: https://www.medscape.com (October 01, 2018)

ARTICLE HEADLINEHEALTH PROPOSALS IN PRESIDENT’S BUDGET WOULD REDUCE HEALTH INSURANCE COVERAGE AND ACCESS TO CARE

The health policies in the President's fiscal year 2019 budget are a continuation of the Administration's health care agenda of the past year. Throughout 2017, the President pressed Congress to enact legislation repealing the Affordable Care Act (ACA) and making deep cuts to Medicaid. Meanwhile, the Administration is using waivers and regulatory changes to implement (and allow states to implement) policies that make it harder for eligible people to get health coverage and care. The budget doubles down in both of these areas. It embraces the ACA repeal-and-replace bill sponsored by Senators Bill Cassidy, Lindsey Graham, Dean Heller, and Ron Johnson (the "Cassidy-Graham" proposal), then proposes to cut funding for coverage programs deeply below the levels in that bill. It also includes additional proposals designed to make it harder for low- and moderate-income people to enroll in Medicaid coverage and marketplace subsidies, even while these programs remain available in their current form. In total, the budget cuts Medicaid and ACA marketplace subsidies by $763 billion over ten years, with the cuts growing steeply over time.

The health policies in the President's fiscal year 2019 budget are a continuation of the Administration's health care agenda of the past year.

Outside of these areas, some of the health proposals in the budget have merit and deserve further consideration — for example, a number of its Medicare payment reforms. But even in the areas where the budget puts forward a more positive agenda, such as behavioral health and prescription drugs policy, aspects of its proposals raise concerns.

Affordable Care Act Repeal and Medicaid Overhaul

The budget embraces the Cassidy-Graham ACA repeal-and-replace bill, then proposes to cut coverage funding deeply below the levels in the bill.[2] Specifically:

The budget would completely eliminate the ACA's Medicaid expansion, which has extended coverage to 12 million low-income adults, as well as its marketplace subsidies, which help more than 8 million people afford coverage. The budget wipes out these programs and demands that states come up with alternatives in less than two years. The result, according to the Congressional Budget Office (CBO), state insurance commissioners, and state Medicaid directors, would be massive disruption, given the scope of work, unrealistic timeline, and insufficient resources.[3]
The budget would replace the ACA's major coverage expansions with a vastly inadequate block grant. After an initial increase, block grant funding levels would ultimately fall far below current-law funding for coverage programs, since the block grant would grow only with general inflation, with no adjustment for population growth or health care costs. (These cuts would come on top of the large reductions in federal funding for coverage resulting from the December tax bill's repeal of the ACA's individual mandate, the requirement that most people have health insurance or pay a penalty.) Block grant funding also would not adjust from year to year for unexpected costs, leaving states entirely on the hook for any and all such costs from recessions, natural disasters, public health emergencies, or prescription drug price spikes, making it even harder for states to use these funds to even partially replace ACA coverage programs. In analyzing the Cassidy-Graham legislation, CBO concluded that its block grant would not enable states to establish coverage programs comparable to those in place under current law. Instead, states that did not expand Medicaid would use block grant funds in part to supplant state funding for existing programs, while Medicaid expansion states would struggle to maintain coverage for low-income adults and would generally not be able to replace the ACA subsidies that make marketplace coverage affordable for moderate-income
The Cassidy-Graham bill the budget endorses also gives states broad authority to eliminate or weaken many of the ACA's protections for people with pre-existing conditions. Depending on how they used block grant dollars, states could permit insurers to charge higher premiums for people with pre-existing conditions or exclude key benefits from coverage for all individual market plans. As the CBO wrote in its preliminary analysis of the Cassidy-Graham plan, because the proposal would create such extreme disruption in insurance markets, states would face intense pressure to try to stabilize their markets by weakening these protections.
These proposals — in combination with other proposals in the budget (some discussed below) — would cut federal funding by a total of $763 billion over the ten-year period ending in 2028 (see Figure 1), compared to current-law funding for Medicaid expansion and subsidies, and by about $1.1 trillion relative to the baseline before the tax bill repealed the individual mandate.[5] The result would be millions losing coverage and worse or less affordable coverage for millions more. Experts concluded that the Cassidy-Graham proposal for Medicaid and the ACA used as the framework for the budget would — in combination with repeal of the individual mandate — likely lead to a total coverage loss of more than 20 million people, and the budget's proposed cuts to coverage are much deeper
Reference
Center on Budget and Policy Priorities
February 16, 2018
BY
Peggy Bailey, Matt Broaddus, Shelby Gonzales, Hannah Katch, and Paul Van de Water[1]

Alternative Pain Management For Lupus

The majority of lupus patients are prescribed pain medication for lupus. But have you thought of alternatives that are less harmful to your body? Well, I have. You see I have been in constant pain for the pass 3 months, no I didn't take any prescribed medications for my pain but came so close to going to the ER. I knew that there had to be an alternative to manage my pain, after researching the topic of acupuncture came to the conclusion this was the right choice for me.

Acupuncture The Technique

The Chinese technique of acupuncture is one of the oldest most commonly used integrative procedures in the world. Acupuncture is characterized by the placement of extremely thin needles into the body and reacts with the brain to release chemicals that reduce pain, regulate hormones, and influence many of the bodies systems. A great deal of research has since and continues to be done on acupuncture. Current research in western medicine shows that acupuncture has an impact on many of the bodies functions, receptors, and systems. Its demonstrated that it can be effective for a number of conditions. Back and joint pain, circulation, digestive system regulation, depression, stress, and anxiety, hormone outputs, immune system balance, muscle tone, nervous system regulation.

But what does research state about this treatment for Lupus Pain?

The National Institute of Health ran a study on the use of acupuncture treatment in lupus patients; they found that 10 sessions of acupuncture was safe and very effective for patients with Systemic Lupus. Acupuncture decreased pain and reduced fatigue in the subjects. The objective of this study was to determine the feasibility of studying acupuncture in patients with systemic lupus erythematosus (SLE), and to pilot test the safety and explore benefits of a standardized acupuncture protocol designed to reduce pain and fatigue. Twenty-four patients with SLE were randomly assigned to receive 10 sessions of either acupuncture, minimal needling or usual care. Pain, fatigue and SLE disease activity were assessed at baseline and following the last sessions. Safety was assessed at each session,. Fifty-two patients were screened to enroll 24 eligible and interested persons. Although transient side effects, such as brief needling pain and lightheadedness, were reported, no serious adverse events were associated with either the acupuncture or minimal needling procedures. Twenty-two participants completed the study, and the majority (85%) of acupuncture and minimal needling participants were able to complete their sessions within the specified time period of 5-6 weeks. 40% of patients who received acupuncture or minimal needling had >30% improvement on standard measures of pain, but no usual care patients showed improvement in pain. A ten -session course of acupuncture appears feasible and safe for patients with SLE. Benefits were similar for

acupuncture and minimal needling.

References

Greco DM, Kao AH, Maksimowicz-McKinnon K, et al. Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study. Lupus> 2008;17(12):1108-16.

Experts call for urgent mental health support for autoimmune disease patients

More than half of patients with auto-immune conditions experience mental health conditions such as depression or anxiety, yet the majority are rarely or never asked in clinic about mental health symptoms, according to new research from the University of Cambridge and King's College London.

In a study published today in Rheumatology, researchers found that over half of the patients had rarely or never reported their mental health symptoms to a clinician, and that the range of possible mental health and neurological symptoms is much wider than has been previously reported.

The team surveyed neurological and psychiatric symptoms amongst 1,853 patients with systemic auto-immune rheumatic diseases (SARDs) such as lupus and rheumatoid arthritis. The researchers also surveyed 289 clinicians, mostly rheumatologists, psychiatrists and neurologists, and conducted 113 interviews with patients and clinicians.

The 30 symptoms that the team asked about included fatigue, hallucinations, anxiety and depression. Among the patients in the study, experience of most of these symptoms was very widespread.

55% of SARD patients were experiencing depression, 57% experiencing anxiety, 89% had experienced severe fatigue and 70% had experienced cognitive dysfunction, for example. The overall prevalence of symptoms was significantly higher than previously thought, and much higher than in a control group of healthy volunteers.

The mental health symptoms described by patients contrasted strongly with clinician estimates. For example, three times as many lupus patients reported experiencing suicidal thoughts compared to the estimate by clinicians (47% versus 15%). Clinicians were often surprised and concerned by the frequency and wide range of symptoms that patients reported to the researchers.

Some clinicians were much more focused on joint symptoms over mental health symptoms as they held the opinion that SARDs do not commonly affect the brain.

However, other clinicians felt that these symptoms were under-estimated because patients were rarely asked about them in clinic. One rheumatology nurse interviewed said: "Doctors don't go looking for it [hallucinations], so if we don't ask we don't think it exists much."

The study found disagreements between clinicians specialising in different aspects of care, but very few hospitals had effective systems where rheumatologists, neurologists and psychiatrists worked together.

Pollak stated the study highlights the importance of all clinicians asking their patients about mental health:

The study showed that patients were often reticent to report to clinicians mental health problems they might be having, sometimes feeling that they might be stigmatised. Patients frequently said that even when they did share their mental health symptoms with clinicians, they were often not commented on or not documented accurately or at all.

One patient expressed how this felt: "Feel guilty and useless as well as depressed and very unwell. I don't really feel supported, understood, listened to, hopeful at all. It is awful living like this…. All just feels hopeless."

Dr Melanie Sloan from the Department of Public Health and Primary Care at the University of Cambridge said: "The low level of reporting we identified is a major concern as problems with mental health, fatigue and cognition can be life-changing, and sometimes life-threatening. It's only by fully engaging patients in their healthcare and by asking them for their views that we will be able to determine the extent of these often hidden symptoms, and help patients get the understanding, support and treatment they need."

The research team suggests that though they found neurological and psychiatric symptoms to be under-elicited in clinic, under-identified in research and under-represented in clinical guidelines, they described almost all clinicians as highly motivated to improve care. Rapidly evolving knowledge – including the behavioural and cognitive impacts of chronic inflammation and a widening range of potential biomarkers – means that there is grounds for optimism.

Sarah Campbell, Chief Executive of the British Society for Rheumatology, commented: "This study highlights the urgent need for improvements in the access patients have to integrated mental health support. Given what the study finds on the prevalence of this issue and the deep impact neurological and psychiatric symptoms have on patients, it should be of grave concern to policy makers that only 8% of rheumatology departments in England and Wales have a psychologist embedded in their team. We fully support the study team's conclusion that more inter-disciplinary and patient-clinician collaboration is needed to ensure equity in the care of patients' mental and physical health."

The Rt Hon the Lord Blunkett said: "It's both surprising and deeply concerning that almost half of lupus patients have experienced suicidal thoughts, and that clinicians greatly under-estimate the mental health burden of these chronic diseases. This highlights the importance of extra funding for the NHS and the holistic care that is urgently needed for these patients. I echo the British Society of Rheumatologists' concerns about the poor current provision of mental health support. Now is the time for the Government to act to give them the support they desperately need."

Source:

University of Cambridge

Journal reference:

Sloan, M., et al. (2023) Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study. Rheumatology. doi.org/10.1093/rheumatology/kead369.

Scientists focus on understanding what underlies a difficult disease.

In an article published in Yale Medicine 2023 states.

One of the most difficult things about lupus, a chronic autoimmune disease, is that people who have it don’t always realize it—they know something’s not right, but they’re not sure what. They may feel exhausted and have pain that is vague, nonspecific, and unpredictable. They may look healthy, so if they complain, friends and family—and even some doctors—might not take it too seriously.

Lupus is difficult to diagnose and treat because its symptoms mimic other conditions, it affects the immune system differently in people, and drugs traditionally used to treat it come with serious side effects. Still, doctors and scientists are determined to find solutions.

Why lupus is so difficult to diagnose

It’s important for doctors and patients to know the signs and symptoms of lupus, confusing as they are, since people who have SLE take an average of six years to get a diagnosis, and that’s enough time for lupus to start causing damage in the body, says Dr. Koumpouras.

One problem is that there is no single test for the disease. A diagnosis is primarily based on symptoms, although there are blood tests that are consistent with the diagnosis of lupus, Dr. Craft explains.

One test, called an antinuclear antibody test, looks for a type of antibody that often attacks the body’s own tissue, creating an autoimmune reaction. While a positive result could signal an increased risk for lupus, there are also many people who get a positive result who will never develop the disease, says Dr. Kang.

“So, the important questions are: Who should be tested? When should they be tested? And if the result is positive, who should be treated?” Dr. Kang says. “We hope additional studies will lead to answers.”

While most people with SLE do not have family members with the disease, there is a genetic predisposition to lupus, and the number of genetic factors a person has can be a predictor of their risk for the disease, Dr. Craft adds.

But while such conditions as sickle cell disease or cystic fibrosis can be identified based on the presence of a single genetic mutation, there are well over 100 genetic markers for lupus, and those include genes that are found in people who don’t have the disease. “For example, you and I may have changes in our genes that can also be found in a lupus patient, but we maybe only have five or 10 of those. But if you have more of those changes, you'll be at greater risk of developing the disease. And that's why it's very hard to screen for,” Dr. Craft says.

There also is believed to be a hormonal factor, since lupus is so much more common in women than in men—in fact, nine out of 10 young people who have it are female, Dr. Koumpouras says. Curiously, after menopause—when estrogen levels dip—many women with lupus feel better, he adds.

“There's also a random event, or environmental factor, that we're not quite clear on, that causes further activation of the immune response,” he says.

Scientists are investigating all of this.

Yale Lupus Program: A ‘personalized medicine’ approach to lupus

Lupus manifests differently from patient to patient, which is one thing providers in the Yale Lupus Program have come to expect. “Lupus is like snowflakes in that no two cases are alike,” Dr. Koumpouras says.

The goal is to develop a personalized plan geared to lessen the impact of the disease on that patient’s life, he explains. “Then, I tend to see patients more frequently—maybe at four weeks instead of the typical three or four months after I first meet them,” he says. “We clinically measure how patients are doing with different scales and track their progress, aiming for a goal of remission or low disease activity.”

More lupus research is needed

The new drugs won’t help everyone with lupus, but Drs. Koumpouras and Craft believe there will be more treatments in the future.

“In the last 10 years, we've started to understand a lot more about the pathogenesis [the development path] of the disease, and that's been the major advance,” says Dr. Craft. “That understanding has led to these new drugs, and it will lead to the development of others.”

This is an encouraging time for lupus patients, he adds. “The combined expertise at Yale continues to advance the understanding and clinical care of SLE, and is part of a global mission to accelerate the discovery of a cure.”

Reference

Yale Medicine

Lupus And Lymphoma

We know that SLE (Lupus) is a very complex illness, but did you know that individuals with SLE (Lupus) are more susceptible to lymphoma? We know that lupus mimics many other illnesses, but what is truly the connection between lupus and lymphoma?

What do we know about the connection between lupus and lymphoma? Well, we know more than we did 20 years ago, but the answer may still be “not enough,” according to an article by Boddu and colleagues published online in the March 2017 issue of “Case Reports in Rheumatology.”

When Lymphoma Develops in People With Lupus

Lymphoma is a cancer of the white blood cells, particularly the white blood cells known as lymphocytes. The two basic categories of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma, or NHL. Lymphoma typically begins in the lymph nodes, but can also involve different organs, and it can arise within different tissues and structures of the body, not just the lymph nodes. As with lupus, the symptoms of lymphoma are varied and different people have differing lymphoma symptoms. Sometimes, the only symptom is a swollen lymph node:

Painless swelling of lymph nodes in your neck, armpits, or groin
Fatigue and fever
Drenching night sweats
Loss of appetite, unexplained weight loss—as much as 10% or more of your body weight
Itchy skin
Cough or chest pain, abdominal pain or fullness, rashes, and skin bumps

I truly believe that these two conditions can overlap, both illnesses involve the immune system. There have been several studies that show that individuals who have SLE (Lupus) have a higher incidence of lymphoma compared to the general population. One of the many theories is that, in an immune system that lacks proper regulation (as in someone with SLE), the use of immunosuppressive therapy to treat lupus may cause the increased incidence of lymphoma in SLE.

People with SLE who developed lymphoma:

Majority was women
Age range was typically between 57 and 61 years
On average, they’d had SLE for 18 years prior to lymphoma
Lymphoma risk in people with SLE was higher across all ethnicities
Symptoms, findings and lab tests of early-stage lymphoma overlapped quite a bit with what is seen in SLE.
Lymph node swelling, sometimes the only sign of lymphoma, is also very common in people with SLE, occurring in up to 67%.

Lymphomas that develop in people with SLE:

The most common NHL type in people with SLE was diffuse large B-cell lymphoma (DLBCL), which is also the most common NHL type in the general population.
The subtypes of DLBCL in those with SLE seemed more often be in a category that carries a worse prognosis—the non-germinal center B-cell-like DLBCLs.
NHL in SLE, as with NHL in the general population, usually originates in the lymph nodes, however, lymphomas that begin outside the lymph nodes are also possible in the general population and in those with SLE.

My Story And My Journey

I'm asking myself the question right now "How Can I Start This? The only way I can start is to be upfront and forward with you, so here it goes. I started to experience swelling in the abdomen, nausea, double, triple ok let me put it this way extreme fatigue to the tenth power. The came lymph node swelling in the neck, loss of appetite, blood work, weight loss and then the biopsy, and the diagnosis of Non-Hodgkin Lymphoma.

When the specialist informed me of the new diagnosis that I could add to my, already diverse long list of diagnosis, I stated "Ok", the specialist replied Susan are you alright? My reply was short "Yes", but in my mind I was rebuking everything that was being stated to me by the specialist, I was saying to myself "Don't worry God has you, because By His Stripes I'm Healed."

Lupus and Non-Hodgkins Lymphoma

We know that SLE (Lupus) is a very complex illness, and it mimics so many other illnesses. But do you realize that individuals with SLE (Lupus) are more susceptible to lymphoma? To under stad the complexity of this illness, we must understand how lupus effects body and we must understand how NHL.

The higher malignancy rate among people with systemic lupus is driven mainly by an increased risk of cancers of the white blood cells, particularly a threefold increased risk of lymphoma, says researcher Sasha R. Bernatsky, MD, assistant professor in the divisions of rheumatology and clinical epidemiology at McGill University in Montreal.

When Lymphoma Develops in People With Lupus

Effects of Stress on the Body: Everything You Need to Know

Close to 8.5 million Americans, nearly 3.5 percent of the adult population, report serious psychological distress. More than half, 55 percent, of the U.S. population say they are stressed during the day.

Stress can be beneficial in some cases, helping you to perform or be productive, but prolonged or chronic stress can actually make you sick. Stress, especially long-term stress, can impact nearly all of the body’s systems, having significant physical and mental effects.

Since most people are in some state of stress so much of the time, it can be difficult to recognize what stress actually is. It’s beneficial to know what stress looks like and exactly how it can impact the body, so you can learn how to manage it and better control your body’s stress response.

What Is Stress?

Stress is a response to physical, emotional, or mental tension or pressure. It is generally a reaction to a stimulus that activates the body’s fight-or-flight response.

During this time, your body prepares itself for action. Generally, your heart rate will speed up, your attention becomes focused, your muscles tense up, your blood pressure goes up, your body temperature increases, and your breathing speeds up.

Not all stress is bad. Some levels of stress are even considered beneficial. Stress can help you to focus and get things done as well as help to prevent accidents or injuries by alerting you to a potential danger.

The body is equipped to handle stress in appropriate doses. It is when stress overwhelms the body or becomes chronic that issues can arise.

Symptoms of Stress

Everyone handles and exhibits stress a little differently, so the symptoms can vary from person to person. Stress can impact every system in the body, from the ability to think clearly and emotions to behaviors and physical health.

Emotional

Emotional symptoms of stress can include the following:

Easily frustrated
Agitation
Mood swings
Difficulty relaxing
Poor self-esteem
Feelings of depression, loneliness, and worthlessness
Loss of control or feeling the need to take control
Avoidance or isolation
Feelings of being overwhelmed
Anxiety
Irritability

Physical

Physical symptoms of stress can include the following:

Headaches
Insomnia or sleeping too much
Low energy levels
Muscle aches and tension
Stomach upset, which can include nausea, diarrhea, and constipation
Clenched or stiff jaw or neck
Teeth grinding
Loss of sexual desire
Irregular heart rate
Chest pain
Cold, sweaty hands and feet
Ringing in the ears
Shaking or tremors
Frequent infections or illness
Dry mouth and difficulties swallowing

Cognitive

The cognitive symptoms of stress can include the following:

Nervousness
Worrying
Disorganization
Forgetfulness
Poor judgment
Difficulties focusing
Racing thoughts and inability to quiet the mind
Pessimism

Behavioral

Behavioral symptoms of stress can include the following:

Substance abuse
Procrastination
Social isolation
Nervous behaviors like pacing, nail biting, or fidgeting
Avoiding responsibilities
Appetite changes

Effects of Long-Term Stress

Stress is a common part of everyday life, and it generally resolves when the stressor is gone. If the stressor is not resolved and continues to influence the body’s stress response, the body will be unable to manage the stress levels, and it can remain in a constant state of stress.

When stressed, the body produces the stress hormones cortisol and adrenaline. When the stressor is gone, the hypothalamus should tell the body to return to homeostasis. When this communication is dysfunctional, numerous health problems can arise, including metabolic disorders, chronic fatigue, immune disorders, and depression.

Chronic stress continues for weeks or months. It can have a wide range of negative effects on the brain and body, resulting in issues for both mental and physical health.

Chronic stress can cause a multitude of health problems, including these:

Heart disease
Diabetes
Hypertension (high blood pressure)
Menstrual problems
Obesity
Depression
Anxiety
Sexual dysfunction
Skin problems, including acne or eczema
Gastrointestinal issues, such as an irritable colon, GERD, ulcerative colitis, and gastritis
Substance abuse and addiction

Long-term stress can also exacerbate existing or underlying physical or mental health issues. Chronic stress is a risk factor for suicidal ideations.

Stress left unchecked can wreak havoc on every single system in the body, as the body becomes overwhelmed by the stress hormones.

Stress Effects on the Respiratory System

When you are stressed, your breathing speeds up and you may feel short of breath. The airway between the nose and the lungs constricts. This can be an issue for anyone with breathing problems and pre-existing respiratory issues. Hyperventilation, or rapid breathing, caused by stress can induce a panic attack in those who are prone to panic attacks, for example.

Stress-induced breathing issues can also trigger bigger issues in those with asthma, chronic bronchitis, COPD (chronic obstructive pulmonary disease), and emphysema. Acute stress can even potentially trigger an asthma attack.

How Stress Impacts the Gastrointestinal (GI) System

Neurons in the stomach are in constant communication with the brain, and the gut-brain interactions are altered due to chronic stress. This can increase the odds for developing GI disorders, including IBS (irritable bowel syndrome), IBD (inflammatory bowel disease), GERD (gastroesophageal reflux disease), and peptic ulcers.

Since stress impacts communication between the gut and the brain, gut discomfort, pain, and bloating are common side effects. The gut is also home to millions of bacteria. Stress can change these bacteria, which can then alter moods.

Stress can have the following impact on aspects of the GI system:

Increase in heartburn and acid reflux
Difficulties swallowing foods
Increased amounts of air swallowed, leading to gassiness, bloating, or burping
Stomach pain, bloating, nausea, or vomiting
Decreased appetite
Changes in how fast food moves through the body, causing either diarrhea or constipation
Weakened intestinal barrier, which can cause gut bacteria to leak into the body
Higher levels of stomach acids

Stress can interfere with many parts of the digestive system. When your body is stressed, the liver produces higher levels of glucose (blood sugar), which is intended to boost your energy. If the body is unable to break these higher levels of glucose down, this increases your risk for developing type 2 diabetes.

Stress, the Brain & Mental Health

When in a constant state of stress, changes can actually be made to the brain’s volume and neuronal network — the communication pathways. This can lead to mental health concerns, including depression.

High levels of stress can interfere with the brain’s natural pleasure and reward processing center. This can make it more difficult for you to feel happiness, and it can make you more prone to suicidal ideations.

Chronic stress can also increase rates of anxiety and leave you feeling overwhelmed, irritable, and out of control. Long-term stress can make it difficult to focus and concentrate. It can lead to chronic fatigue, sleep issues, changes in appetite, mood swings, substance abuse problems, tension, body pain, and excessive worry.

The Strain of Stress on the Cardiovascular System

When the stress response is activated, your heart rate speeds up and your blood pressure goes up. This can be tolerated in the short term, but when the stress response is prolonged, and your heart rate and blood pressure stay high for too long, your heart has to work very hard for a long period of time. This can increase the risk for heart attack and stroke.

The Impact of Stress on the Reproductive System & Sexual Function

Long-term stress can cause a lack of sexual desire in both men and women.

In men, chronic stress can cause a dip in testosterone levels, erectile dysfunction, and impotence. It can also interfere with sperm production. Long-term stress can increase a man’s risk for infection in the prostate or testes, the reproductive organs.

In women, chronic stress can interfere with menstruation, leading to heavier, more painful, and irregular periods. The physical symptoms of menopause in women can be exacerbated due to chronic stress.

Chronic stress can also make it more difficult for a woman to conceive. It can negatively impact the health of an unborn baby, and it can worsen the postpartum adjustment period.

Hair & Skin Issues Related to Stress

Stress can cause physical changes to the skin, leading to skin issues and conditions such as acne, psoriasis, and acne. The stress response can make your skin more sensitive and reactive, creating these potential issues and making it harder for your skin to heal.

Your skin produces more oil (sebum) during times of stress, which can lead to breakouts. Permanent hair loss is also related to chronic stress.

Stress changes the brain and body chemistry. Over time, this can have outwardly detrimental effects on the body, which can be seen in skin and hair changes.

Stress on the Muscular System

Part of the stress response is muscle tension. When you are stressed, your muscles get tight, which can cause headaches, body aches, and back and shoulder pain. This can lead to tension headaches and other chronic painful conditions.

Chronic pain can lead to additional issues related to pain, including prescription medication abuse.

The Immune System & Stress

When you are stressed, the immune system is activated as part of the fight-or-flight response. This can help to ward off infections and heal injuries.

When your body is in a chronic state of stress, however, the constant influx of stress hormones can actually weaken the immune system. This can leave you more vulnerable to infections and viral illnesses, such as the flu or a common cold. It can also take your body longer to heal from injury or illness when it is under chronic stress.

Stress Management

There is no way to avoid stress completely. It is actually a necessary part of life that can even be helpful. What really matters is how a person handles stress.

When stress is managed properly, long-term and chronic stress levels can be better tolerated and minimized. There are many things you can do to mitigate and manage stress, which can include the following:

Engage in regular exercise.
Eat a healthy and balanced diet.
Be sure to get enough sleep each night and set a sleep schedule.
Maintain a healthy social support network.
Work toward a positive outlook and mindset.
Set limits to avoid being overwhelmed.
Consider holistic and alternative relaxation techniques, including massage therapy, yoga, mindfulness meditation, and breathing techniques.
Use your support system when needed.
Limit alcohol, tobacco, and substance use.
Keep up with your health using preventative medicine, such as routine checkups, screenings, and dental appointments.
Seek professional help when you are feeling anxious, depressed, or overwhelmed.

Stress does not have to be so overwhelming or controlling. Trained professionals, including counselors, therapists, and psychologists, can work with you to identify your personal stressors.

Using behavioral therapies, the root triggers for stress can be identified. A trained professional can work with you to develop healthy coping strategies and mechanisms for managing your stress triggers.

It is also necessary to manage any underlying conditions, mental health concerns, or health issues to limit stress and keep complications to a minimum. Many of the side effects and symptoms of stress also indicate the presence of a physical health or mental health concern that requires additional treatment or management measures.

Be sure to talk to your doctor about any symptoms you are experiencing. They can help you devise the best treatment approach to manage stress and ensure a healthier life.

Updated April 24, 2023

Resources

More Americans Suffering From Stress, Anxiety, and Depression, Study Finds. (April 2017). CBS News.
What Is Stress? The American Institute of Stress.
Stress and Your Health. (May 2020). U.S. National Library of Medicine.
Stress Effects on the Body. (November 2018). American Psychological Association.
Stress and the Gut: Pathophysiology, Clinical Consequences, Diagnostic Approach and Treatment Options. (December 2011). Journal of Physiology and Pharmacology.
The Effects of Chronic Stress on Health: New Insights into the Molecular Mechanisms of Brain-Body Communication. (November 2015). Future Science OA.
The Impact of Stress on Body Function: A Review. (July 2017). EXCLI Journal.
STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants. (October 2008). Annual Review of Clinical Psychology.
Stress and Health: Major Findings and Policy Implications. (2010). Journal of Health and Social Behavior.

New research highlights mental health support gap for autoimmune disease patients

Research by the University of Cambridge and King’s College London has suggested that the range of mental health and neurological symptoms is much wider than previously reported, as half of the patients with systemic autoimmune rheumatic diseases (SARDs) involved in the study had rarely or never reported their mental health symptoms to a clinician.

With SARDs, connective tissues such as cartilage, joint synovium and skin are more frequently targeted, as seen in conditions such as systemic lupus erythematosus, rheumatoid arthritis and systematic sclerosis.

In the Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases study, the team surveyed neurological and psychiatric symptoms in 1,853 patients with SARDs. Almost 290 clinicians, mostly rheumatologists, psychiatrists and neurologists, were also surveyed and 113 interviews with patients and clinicians were conducted.

The team asked about 30 symptoms, including fatigue, hallucinations, anxiety and depression. Among the patients in the study, which was funded by the Lupus Trust and LUPUS UK, experience of most of those symptoms was found to be very widespread.

Approximately 55% of SARD patients experienced depression, 57% experienced anxiety, 89% experienced severe fatigue and 70% experienced cognitive dysfunction.

They also noticed a contrast in symptoms between patients and clinicians estimates: 47% of lupus patients reported that they were experiencing suicidal thoughts, compared to the 15% estimate by clinicians.

Dr Tom Pollak from the institute of psychiatry, psychology and neuroscience, King’s College London, said: "This study paints a startling picture of the breadth and impact of these symptoms. Everyone working in healthcare with these patients should routinely ask about mental well-being, and patients should be supported to speak up without fear of judgement."

Many patients in the study also expressed hesitancy about reporting mental health problems to clinicians. Patients said that when they did share their mental health symptoms with clinicians, they were often not commented on or documented correctly, if at all.

Dr Melanie Sloan from the Department of Public Health and Primary Care at the University of Cambridge said: "The low level of reporting […] identified is a major concern as problems with mental health, fatigue and cognition can be life-changing, and sometimes life-threatening.”

She added: "It’s only by fully engaging patients in their healthcare and by asking them for their views that we will be able to determine the extent of these often-hidden symptoms, and help patients get the understanding, support and treatment they need."

Reference

PMLive 2023