If you’re like many people who have rheumatoid arthritis (RA), you probably notice that when your stress level rises, your symptoms get worse. RELATED: The Science Behind Stress and Rheumatoid Arthritis Symptoms It’s a connection that took years for Aberdeen Allen to notice. Allen, a scientist in Parlin, New Jersey, was diagnosed with RA nearly two decades ago, but it was only four years ago when he realized how stress impacted his disease. “It was a super-stressful time at work, and I noticed my fatigue, swelling, and pain were so much worse than usual,” he says. “Since then, I’ve recognized that stress is a huge trigger for me. I really have to work to keep my stress level down if I want to control my RA.”

Inflammation and Stress: They’re Closely Connected

Research shows that stress may play a role in the cascading process that leads to inflammation and causes RA pain. Inflammation in RA is partly caused by molecules called cytokines. While cytokines can be released for a variety of reasons, stress also releases them. If you’re stressed and are producing more cytokines, you will most likely develop more inflammation, which may result in more pain. “Whether we consider rheumatoid arthritis, osteoarthritis, systemic lupus, or any other rheumatic disease, the presence of emotional stress may well exacerbate the condition,” says Richard Roseff, MD, a rheumatologist at Danbury Hospital and a private practitioner in Danbury and Ridgefield, Connecticut. People who suffer from stress long-term can develop other chronic conditions as well. Irritable bowel syndrome, cardiovascular disease, and depression are just some of the conditions that have been linked to chronic stress. Some people are more naturally resilient to stress, but anyone can learn to build their resilience, such as by teaching themselves to reframe situations in a more positive light. Scientists are also coming to see that many things play a role in our stress response, including gender; for example, women are more apt to seek social support in stressful times (they “tend and befriend”). RELATED:Can Mindfulness Meditation Help Ease Rheumatoid Arthritis Pain? It helps if you can determine the factors that bring on most of your stress. “Stress can result from many different situations. Some stress is relatively self-limiting, but other stresses are more chronic, and we do make attempts, as clinicians, to figure out where these stresses may be coming from,” Dr. Roseff says. In some cases, to determine this you might benefit from an outsider’s perspective, especially a psychotherapist or other mental health professional, says Daniel Muller, MD, a rheumatologist at UCHealth in Ft. Collins, Colorado, and a coauthor of Integrative Rheumatology.

It’s also important to develop habits that boost your resilience to stress, so you’re not a prisoner of stress or the RA flares it can yield. Here are some top ways to keep your own stress response in check.

  1. Practice yoga, meditation, and other mindfulness techniques. “I have a handout on breathing and mindfulness that I give to my patients,” Dr. Muller says, noting that people are much more open to this mind-body connection than when he started as a physician decades ago. You can practice a formal sitting meditation by closing your eyes and counting to four as you watch yourself inhale, and four as you observe your exhale. Or simply become aware of the thoughts and senses that arise, without judging them, as you mindfully go about your day. Yoga and breathwork are Allen’s most important techniques. He does yoga at least three times weekly (you may need to modify some poses to protect your joints when you have RA) and scatters breathing practices throughout the day. Allen’s favorite is called “anchoring,” where he closes his eyes and focuses on a sound as he takes 10 slow deep breaths. “When I open my eyes, I’m so much more relaxed,” he says.
  2. Get plenty of exercise. “Exercise benefits you both physically and emotionally,” Muller says. It also helps you sleep better, which also provides its own stress relief, he notes. Allen adores walking in nature and swimming, both especially calming activities. “When I swim, I just glide through the water without a thought in my mind,” he says. Plus, the warm water of his gym’s heated pool feels soothing to his joints.
  3. Make time for fun. Whether you enjoy gardening, dancing, bird-watching, reading, or any other arthritis-friendly hobby, it’s important to carve out time for things that give you pleasure. This also includes sex: Even during a pandemic there are ways of having safe and satisfying intimacy that brings you joy.
  4. Find a supportive community. Being able to talk with people who understand what you’re going through can be a major stress-reliever. For Allen, one way comes from being a member of the online arthritis community CreakyJoints. Finding people to talk about his situation within this community has been very important, he says. “I was in such a state of denial about my RA for so long, which is very stressful. Now when I wake up in the morning feeling stiff, it helps me to know there are others around me who are feeling the same, and that it’s okay,” he says.
  5. Develop healthy lifestyle habits. Stress impacts not just the immune system, but so many other parts of the body, Muller says. Eating whole, plant-based foods, getting enough sleep, avoiding excess alcohol, and not smoking are some of the ways to keep all these systems in balance, which not only keeps you healthy, but can make you more resilient in the midst of stress, he says.
  6. Find a doctor who truly listens. “When you have someone who listens to your story, spends time with you, is present during your appointments — there’s great healing in that. On the flip side, having a physician who pooh-poohs you when you’re hurting can be very stressful,” Muller says. It’s especially important to talk to you physician if your current RA treatment plan isn’t sufficiently working, because suffering from pain and other symptoms can be its own form of stress. “We now have treatments that have the ability to both control symptoms and stop progression of disease. These medications were not available as recently as twenty years ago,” Roseff says. Additional reporting by Marijke Vroomen-Durning, RN.