Hilary Wilson of Duluth, Ga., now 60, was officially diagnosed with rheumatoid arthritis or RA in 1987, but she is pretty sure she had the inflammatory arthritis long before that.
RA is a chronic disease, marked by inflammation of the lining of the joints. It can lead to chronic joint pain, loss of functioning and disability.
But some people with RA manage to thrive despite their condition and that describes Wilson. Ever since the diagnosis, Wilson has followed a healthy lifestyle designed to keep stress -- and her symptoms --under control. She follows the same plan, whether her life is hectic or more relaxed.
"I take steps to help my arthritis, regardless of the stress level," she tells WebMD. That means taking yoga three days or more a week, walking between 8 and 12 miles weekly, and keeping her weight down (she has some clothes from high school she still fits into).
It also means keeping her sense of humor. "I can't flex my head back," she says, as the RA has affected her cervical spine and therefore her neck functioning. It's not uncommon for people to ask her what's up with that, but she easily explains and laughs it off. A sense of humor, she discovered, helps minimize stress, too.
Wilson, who works as an independent management consultant and is on the board of the Arthritis Foundation in Georgia, says she has never noticed a link between the amount of stress she is experiencing on the job and a worsening of symptoms. And her healthy lifestyle, focused on managing stress, could well be the reason.
Stress and RA: The Link
The cause of RA remains unknown, according to the Arthritis Foundation. But most experts agree that genetic and environmental factors play a role, including the body's response to stressors such as physical or emotional trauma. That does not mean, however, that stress alone can cause RA.
"In general, it's felt that stress does not cause RA," says Scott Zashin, MD, a clinical professor of medicine at the University of Texas Southwestern Medical School and attending physician at Presbyterian Hospital, Dallas.
However, he says, a stressful event, such as the loss of a loved one or marital stress, may trigger the RA to develop at that time. "That doesn't mean it wouldn't have developed at another time," he tells WebMD.
Patience H. White, MD, vice president for public health for the Arthritis Foundation agrees. While stress alone will not cause RA, it's one of many factors that may play into getting the disease and the severity of symptoms.
The picture can become complicated from patient to patient. "Many patients with RA have secondary fibromyalgia," Zashin says. Fibromyalgia is a body-wide pain condition, with tender points at the joints, muscles, and tendons and other tissues.
How does stress affect inflammation? According to White, the research is mixed on that.
But whatever that relationship, stress can wreak havoc, she says. "When you are stressed, you don't sleep well," she says. You can get achy. "People with RA have morning stiffness. If they haven't slept well, it feels worse. Once you get tired, you have no resistance to stress."
Some facts are indisputable: stress can make pain, and your whole body, feel worse. Chronically high levels of stress aren't good for anyone.
What To Do, a Patient's View
Hilary Wilson says exercise is a crucial part of her feel-good plan. Knowing what kind of exerciser you are can make it easier to keep moving, she tells WebMD.
"I tend to be a social exerciser, so I always have someone I feel accountable to." She walks with a friend and takes yoga as a group class.
Attitude is everything, she says, and she tries to stay positive.
Getting proper treatment makes a huge difference. She's been on a biologic, a newer type of medication option, since 1999.
Things weren't so rosy in the beginning. "I was told when I was diagnosed I'd be in a wheelchair in three years," she says. "I fired that doctor."
The Benefit of Exercise
Zashin advises his patients that they can reduce stress, and one way to do it is through regular exercise.
Regular exercise has been shown to reduce whole-body inflammation, a good thing for everyone. In a recent study, researchers found that 16 weeks of regular exercise in young women, 18 to 30, reduced their levels of C-reactive protein, a marker of inflammation. They were studying how regular exercise might protect against breast cancer risk, but reduced inflammation is a healthy improvement for many reasons. The study is in Medicine & Science in Sports & Exercise.
Of course, getting on the right medication can help control symptoms, White says. But that's not the whole story. She tells her RA patients: "You need to move, strengthen your joints, eat a good diet, and keep your weight down."
What to Do At Work
Although it's easier said than done, try to make your day simpler, Zashin says. Especially if you are hurting, don't volunteer for on-the-job tasks you might skip--at least this time around.
Ask for accommodations you may need on the job, White says. She's talking about measures such as asking for a stool to sit on periodically if you're on your feet constantly. If you're a nonstop typist, ask for an ergonomically friendly keyboard and a supportive chair.
Touch typists -- who rarely if ever look at the keyboard -- should know they have a tendency to change their typing style if they have joint damage, according to Nancy Baker, ScD, MPH, an occupational therapist and associate professor at the University of Pittsburgh. She reported the findings in November 2010 at the annual meeting of the American College of Rheumatology in Atlanta.
In her study of 33 typists, the 22 who had visual structural deformities of the hands from RA kept their fingers straight, for instance, not curved. ''It puts more stress on the joints when you do that," she says.
Besides being aware of good typing technique, what else should you do? "Find good voice recognition software if it's feasible for your job," she says.
Also, make sure your computer work station fits you. For women, the office chair is often too high, she says, and perhaps too big. For specific advice, she recommends asking the company person in charge of ergonomics.
Overall, Baker says, it's a good idea to "deal with the issue before it becomes an issue. Any time you have a chronic disease, your body is much less forgiving."
''People have this perception they shouldn't be comfortable at work," she says. "The reality is, if you're comfortable at work you are going to be more productive. Look on it as productive pampering."
Kathleen Doheny - WebMD
