Perceived Stress and Prediction of Worse Patient-Reported Outcomes in a Rheumatoid Arthritis Cohort

Studies have suggested a potential link among traumatic experiences, psychologic stress, and autoimmunity, but the impact of stress on disease activity and symptom severity in rheumatoid arthritis (RA) remains unclear. We examined whether perceived stress independently associates with worse RA disease outcomes at subsequent visits over 18 months of follow-up.

Participants were enrolled in a longitudinal RA cohort with study assessments every six months. We measured stress via the four-item Perceived Stress Scale and the following disease outcomes: patient-reported disease activity (Rheumatoid Arthritis Disease Activity Index), pain (Patient-Reported Outcome Measurement Information System [PROMIS] Pain Interference), fatigue (PROMIS Fatigue), and physical function (PROMIS Physical Function). Time-lagged linear mixed effects models evaluated longitudinal associations of stress with all four outcomes at the subsequent time point while controlling for potential confounders.

The sample (N = 133) was 88% female, 45% White, 35% Hispanic, 9% African American, and 6% Asian American; the mean ± SD age was 58 ± 13 years. In adjusted time-lagged longitudinal analyses, stress independently associated with greater self-reported disease activity (β = 0.11, 95% confidence interval [CI] 0.03-0.19), more pain (β = 0.61, 95% CI 0.29-0.94), more fatigue (β = 0.71, 95% CI 0.32-1.11), and lower physical function (β = -0.33, 95% CI -0.59 to -0.06). The effect size represented clinically significant differences for pain, fatigue, and physical function, but not disease activity.

Among a longitudinal RA cohort, those with greater perceived stress had worse pain, greater fatigue, and lower physical function at follow-up. 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.