STRESS AND LUPUS

Howard Hauptman, MD

STRESS

2011 APA SURVEY

• MOST AMERICANS REPORT FEELING MOD-HIGH STRESS LEVELS

• 44%: STRESS LEVELS INCREASED IN PAST 5 YEARS

• 39%: OVEREAT OR EAT UNHEALTHY 2/2 STRESS

• ≥ 50%: EXERCISE IS IMPORTANT, BUT ≤ 33% WAS SATISFIED WITH LEVEL OF EXERCISE

STRESS

• A REACTION TO A STIMULUS THAT DISTURBS PHYSICAL OR MENTAL EQUILIBRIUM

• PREVENTS US FROM LIVING IN A STATE OF CONTENTMENT AND FULFILLMENT

• BOTH ACUTE OR CHRONIC STRESS CAN CAUSE ILLNESS

STRESS

• OUT OF BALANCE BETWEEN: DEMANDS PLACED ON US

V.S.RESOURCES TO DEAL WITH THEM

• GOAL: DEMANDS, R ESOURCES

DEMANDS

• ACUTE: INFECTIONS TRAUMADANGER ENVIRONMENTAL: NOISE, HUNGER…

• CHRONIC: WORK RELATIONSHIPS/FAMILYCHRONIC ILLNESS

DEMANDS

• MAJOR LIFE EVENTSDIVORCE

DEATH OF A LOVED ONELOSS OF JOB

MAJOR ILLNESS

STRESS

• GOOD VS BAD STRESS:STIMULATES SAME CHEMICALS/HORMONESFIGHT OR FLIGHT RESPONSE

• ACUTE VS CHRONIC: SUDDEN NEGATIVE CHANGES : DANGER, INFECTIONS, ENVIRONMENTAL TRAUMA: ACCIDENT, WAR, NATURAL DISASTER ROUTINE: DAILY, WORK, FAMILY PRESSURES CHRONIC ILLNESS

STRESS RESPONSE

• BRAIN: INCREASED HORMONE PRODUCTION;CORTISOL, CATECHOLAMINES,

NEUROTRANSMITTERS• HEART, LUNGS, CIRCULATION• IMMUNE SYSTEM• MOUTH, THROAT, SKIN, MUSCLES• RELAXATION RESPONSE

MECHANISM OF ACTION

CORTISOL

SIGNS OF STRESS

• DIFFICULTY SLEEPING• EASILY ANGERED• FEELING DEPRESSED• LOW ENERGY• INCREASED ALCOHOL/SUBSTANCE ABUSE• CHANGE IN EATING HABITS

STRESS AND DISEASE

• UP TO 80% OF PATIENTS REPORT UNCOMMON EMOTIONAL STRESS BEFORE DISEASE ONSET

• LINKED TO DISEASE FLARES

• UNDERLYING DISEASE CAN CAUSE INCR. STRESS

STUDIES

• BF/CBT VS CONTROLS IN SLE: LESS PAIN, IMPROVED PSYCHOLOGICAL AND PHYSICAL FUNCTION

• VACCINE STUDY: BETTER RESPONSE TO VACCINATION IN NON-STRESSED PATIENTS

• RETROSPECTIVE STUDIES: SLE,RA FIRST/RECURRENT FLARES ASSOCIATED WITH STRESSFUL PERIODS

• ?LIFETIME VS LIFESTYLE STRESSORS?

FACTORS THAT INFLUENCE THE RESPONSE TO STRESS

• EARLY NURTURING• PERSONALITY TRAITS• GENETIC FACTORS• IMMUNE DISEASES• LENGTH, INTENSITY OF STRESSORS

STRESS REDUCTION

COPING WITH STRESS

• GET PROPER HEALTH CARE• SEEK HELP: HEALTH CARE PROVIDER, FAMILY,

FRIENDS, COMMUNITY• SET PRIORITIES• EXERCISE DAILY• SCHEDULE HEALTHY/RELAXING ACTIVITIES• STRESS COPING PROGRAMS

STRESS COPING PROGRAMS

• EXERCISES: AEROBIC, YOGA, TAI CHI• MINDFULNESS BASED PROGRAMS:

MEDITATION• COGNITIVE-BEHAVIORAL THERAPY (CBT)

COGNITIVE BEHAVIORAL THERAPY

• IDENTIFYING SOURCES OF STRESS• QUESTIONING THE SOURCES OF STRESS• RESTRUCTURING PRIORITIES• FINDING METHODS TO MANAGE/REDUCE

STRESS

STRESS

• CHOICES WE MAKE:DISTINGUISH WHAT WE HAVE CONTROL OVER VS NO CONTROL!

• “OUT OF CONTROL EVENT”• MANAGING EXPECTATIONS: REALISTIC GOALS• “SMALL STEPS”