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Open Access Research article

Immune responses to stress after stress management training in patients with rheumatoid arthritis

Sabine JM de Brouwer1*, Henriët van Middendorp1, Floris W Kraaimaat1, Timothy RDJ Radstake23, Irma Joosten4, A Rogier T Donders5, Agnes Eijsbouts6, Saskia Spillekom-van Koulil1, Piet LCM van Riel2 and Andrea WM Evers7

Author Affiliations

1 Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands

2 Department of Rheumatology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands

3 Department of Rheumatology and Clinical Immunology & Laboratory of Translational Immunology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands

4 Department of Laboratory Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands

5 Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands

6 Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, the Netherlands

7 Department of Clinical, Health, and Neuropsychology, Leiden University, P.O. Box 9555, 2300 RB Leiden, the Netherlands

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Arthritis Research & Therapy 2013, 15:R200  doi:10.1186/ar4390

Published: 26 November 2013

Abstract

Introduction

Psychological stress may alter immune function by activating physiological stress pathways. Building on our previous study, in which we report that stress management training led to an altered self-reported and cortisol response to psychological stress in patients with rheumatoid arthritis (RA), we explored the effects of this stress management intervention on the immune response to a psychological stress task in patients with RA.

Methods

In this study, 74 patients with RA, who were randomly assigned to either a control group or a group that received short stress management training, performed the Trier Social Stress Test (TSST) 1 week after the intervention and at a 9-week follow-up. Stress-induced changes in levels of key cytokines involved in stress and inflammatory processes (for example, interleukin (IL)-6 and IL-8) were assessed.

Results

Basal and stress-induced cytokine levels were not significantly different in patients in the intervention and control groups one week after treatment, but stress-induced IL-8 levels were lower in patients in the intervention group than in the control group at the follow-up assessment.

Conclusions

In line with our previous findings of lower stress-induced cortisol levels at the follow-up of stress management intervention, this is the first study to show that relatively short stress management training might also alter stress-induced IL-8 levels in patients with RA. These results might help to determine the role of immunological mediators in stress and disease.

Trial registration

The Netherlands National Trial Register (NTR1193)