The role of stress and trauma in rheumatoid arthritis and systemic lupus erythematosus.

Only one study, albeit inconclusive, has specifically addressed the etiologic role of physical trauma in RA. The weight of evidence from a variety of studies strongly suggests a role for psychologic stress in inducing, exacerbating, and effecting the ultimate outcome in RA. Well designed controlled trials aimed specifically at deciding these issues are urgently needed. This also applies to SLE, where the role of physical trauma has never been investigated, and disease exacerbation induced by emotional stress has been strongly suggested, but not yet verified in a scientifically acceptable fashion. Stress can depress immune responsiveness, but the end result of this (eg, increased susceptibility to infection, increased disease activity) is not known. It is uncertain how much or what kind of stress is required to depress responsiveness, or even how differing degrees of stress can be quantitated or reproduced. Even though eight million Americans have RA and SLE, we still know very little about the influences of stress and trauma on these disorders.