As you know, stress can negatively affect one’s health in many ways.  It can range from minor concerns to severe traumas that can lead to post-traumatic stress disorder (PTSD).  The latest research on stress and lupus shows growing evidence that the effects of PTSD may actually trigger the development of lupus as a disease!  What is the relationship between lupus and PTSD?  Read on to find out.

.

• Introduction: The 30-second Overview
• What is PTSD?
• What is the relationship between PTSD and lupus?
• What to do about PTSD and lupus?
• In Conclusion

.

Introduction:  The 30-second Overview

Systemic lupus erythematosus (SLE) can have a dramatic effect on a person’s emotional health, causing among other symptoms, high levels of stress and anxiety.  Likewise, there is an increasing amount of research that shows that the reverse is also true. High levels of stress, in particular those associated with post-traumatic stress disorder (PTSD), can dramatically increase a person’s risk for developing lupus.  There is also increasing evidence that this kind of stress can significantly increase the frequency and severity of flares for those who are already living with lupus.

The actual mechanisms are not well known, however research has found some important connections:

• Traumatic events can trigger or induce a person’s first lupus symptoms.
• Even “moderate” stress can trigger flares in people already living with lupus.
• People with PTSD are 2-3 times more likely to develop lupus.
• Both lupus and PTSD affect the immune system – including the hormones that regulate the systemic inflammatory response.
• Emotional health and stress-reducing therapies can both help heal the injuries caused by PTSD while reducing the symptoms of lupus.

So, what does this mean and what can you do about these connections?  Here is a bit more information about PTSD and how it may affect lupus.

.

What is PTSD?

PTSD is a condition that can develop in people who have experienced a shocking, threatening or dangerous event in their lives.  These traumatic events are typically caused by natural disasters, serious injuries, violence and crime, or living under dangerous circumstances for long periods of time.  Recently, they have been associated with historical trauma (like racism) and in the virtual realm of cyberbullying.  PTSD occurs when a person’s natural emotional and physical reactions to danger remain long after the traumatic event itself.  Symptoms can occur immediately or can be delayed for long periods of time.  They can last days, months or years and may require a wide range of therapies to treat.

Symptoms of post-traumatic stress syndrome often include:

• Experiencing unwanted memories, “flashbacks” or nightmares of the event.
• Avoiding thinking or talking about the trauma or anything that may remind a person about the event.
• Negatively thinking about one’s self or others, which can lead to hopelessness, difficulty with close relationships, a lack of interest or generally feeling numb.
• Changes in physical or emotional reactions, such as easily being startled, always “on guard,” being irritable or having self-destructive behaviors.

Anyone can develop PTSD.  However, those whose lives or professions expose them to more frequent or intense situations of trauma, have higher risks for PTSD.   Here are some statistics:

• PTSD is estimated to affect anywhere from 3% to 7% of the U.S. population.
• One study estimated that 1 in 11 people will be diagnosed with PTSD in their lifetime.
• Those in the military are twice as likely to suffer from PTSD, which was formerly called “shell shock” or “combat fatigue.”
• Women are affected at least twice as often as men.
• African Americans also have a higher rate of PTSD than those who are White.

Finally, research has shown that stress and PTSD can affect a person at the epigenetic level.  This means that trauma can affect how the body’s cells access their own DNA.  This can even influence the development of the children of those who experience PTSD – creating long-term effects that can affect entire communities for generations.  These social determinants of health may partially explain why lupus is more common in women and communities of color!

What is the relationship between PTSD and lupus?

The relationship between stress and SLE is well-known to those living with lupus.  Even relatively minor physical or emotionally stress can trigger lupus flares.  Yet, can severe traumatic events that produce PTSD also initiate or “cause” lupus?

The short answer is probably yes, though the specific mechanisms are still not known.

The Statistics:  Several recent studies have shown that those who experience traumatic events in life are 2-times as likely to develop lupus, and those specifically diagnosed with PTSD have 3-times the risk for lupus.

 The Science:  Chronic stress has long been known to cause damaging systemic inflammation.  While it is not known how this may lead to lupus, there is evidence that severe trauma can affect the body’s neuroendocrine system.  This system includes the hypothalamus, pituitary and adrenal glands, which communicate through complex chemical feedback loops to regulate several stress hormones, in particular, cortisol.

Normally, cortisol inhibits inflammation, which is why cortisone shots are effective treatments for localized pain and inflammation.  However, it seems that severe trauma can damage this system and the body may actually become resistant to cortisol – allowing inflammation and possibly autoimmunity to go unchecked.

Those with PTSD also show higher levels of inflammatory chemicals called cytokines, such as interleukin-6, which over time may also lead to lupus developing in individuals who are already genetically prone to SLE.

The Co-morbidities:  PTSD can also lead to other disorders that make living with lupus even more difficult.

• PTSD can cause insomnia or sleep disorders that can increase the fatigue, pain and depression that those with lupus may already face.
• PTSD can also lead to substance abuse, self-injury or other behaviors that affect not only a person’s SLE, but also how well they follow their lupus treatment plans … leading to even more problems later.

The Vicious Cycle:  Of course, whether a person’s trauma and stress cause their lupus or a person’s lupus leads to more stress, together they can create a particularly damaging feedback loop.   This can turn one’s life upside-down, leading to social anxiety, mood swings, problems at work, in school and at home … and each of these can lead to worsening symptoms and more frequent and severe flares.

 

What to do about PTSD and lupus?

Even though it can be challenging to deal with the psychological and physical effects of both trauma and lupus, there are some techniques for managing stress that can really improve the symptoms associated with both lupus and PTSD:

• Cognitive behavioral therapy (CBT) can help patients recognize their emotional triggers and give them the tools to manage the stress that leads to the symptoms of PTSD and lupus.
• Regular exercise can be challenging for many living with lupus.  Yet, if appropriate to the individual, it can relieve stress and promote a healthier balance of hormones.
• Maintain a nutritious diet that avoids inflammatory ingredients and promotes a healthy weight and energy level.
• Meditation, yoga and breathing activities can exercise and improve the mind-body connection and “reset” neuroendocrine pathways to healthier levels.
• Pet therapy has also been particularly successful in helping those suffering from PTSD as well as providing comfort to those with chronic conditions like lupus.
• Other creative therapies such as art therapy, music therapy and even journaling can improve your outlook and reduce stress.

Remember, it is important to consult with your healthcare provider before making any significant additions or changes to your diet, exercise regimen or treatment plan!

.

In Conclusion

Though it is unclear how PTSD specifically might cause a person to develop lupus, it is clear that severe trauma can have long-term effects on your health and significantly increases the risk for developing SLE.  Together, lupus and PTSD are a vicious combination.  They can lead to similarly debilitating symptoms, and create a cycle of anxiety and physical damage that can be difficult to deal with.  Yet, there are a large and growing list of things that can really help!  Manage stress while living with lupus is possible.  Hopefully, as we learn more about the complex relationship between lupus and PTSD, we will find better therapies that can treat them both!

 

. 

References

Bookwalter, D.B., Roenfeldt, K.A., LeardMann, C.A., Kong, S.Y., Riddle, M.S., & Rull, R.P. (2020). Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel. BMC Psychiatry, 20, Article 23. https://doi.org/10.1186/s12888-020-2432-9

Case, S. M., Feldman, C. H., Guan, H., Stevens, E., Kubzansky, L. D.,  Koenen, K. C., &  Costenbader, K. H. (2023). Posttraumatic stress disorder and risk of systemic lupus erythematosus among medicaid recipients. Arthritis Care & Research, 75(1), 174-179. https://doi-org.proxy.lib.pdx.edu/10.1002/acr.24758

Goldschen, L., Ellrodt, J., Amonoo, H.L., Feldman, C.H., Case, S. M., Koenen, K.C., Kubzansky, L.D., & Costenbader, K.H. (2023). The link between post-traumatic stress disorder and systemic lupus erythematosus. Brain, Behavior, and Immunity, 108, 292-301. https://doi.org/10.1016/j.bbi.2022.12.012

Moroni, L., Mazzetti, M., Ramirez, G.A., Farina, N., Bozzolo, E.P., Guerrieri, S., Moiola, L., Filippi, M., Mattei, V.D., & Dagna, L.. (2021). Beyond neuropsychiatric manifestations of systemic lupus erythematosus: Focus on post-traumatic stress disorder and alexithymia. Current Rheumatology Reports, (23), Article 52.  https://doi-org.proxy.lib.pdx.edu/10.1007/s11926-021-01019-5

Moroni, L., Mazzetti, M., Ramirez, G.A., Zuffada, S., Ciancio, A., Gallina, G., Farina, N., Bozzolo, E., Mattei, V.D., & Dagna, L. (2023). Post-traumatic stress disorder in patients with systemic lupus erythematosus healvily affects quality of life. A cross-sectional web survey-based study. Lupus, 32(2), 263-269.

Roberts, A.L., Malspeis, S., Kubzansky, L.D., Feldman, C.H., Chang, S.-C., Koenen, K.C., & Costenbader, K.H. (2017). Association of trauma and posttraumatic stress disorder with incident systemic lupus erythematosus in a longitudinal cohort of women. Athritis & Rheumatology, 69(11), 2162-2169. https://doi-org.proxy.lib.pdx.edu/10.1002/art.40222

.

Author: Greg Dardis, MS      

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University.  His focus has been human biology and physiology with an interest in  autoimmunity.  Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.