Everyone experiences stress from time to time. But between managing medications, appointments, and flare-ups, living with rheumatoid arthritis (RA) can make everyday tasks and challenges all the more stressful.

Although the stress of RA can feel overwhelming, there are ways to manage it. Meditation, mindfulness practices, talk therapy, and exercise are just a sampling of stress-management techniques you can add to your toolkit. If you need more support or feel that your stress is out of your control, consider talking to a health care provider about ways to manage it.

The Relationship Between Stress and RA

Rheumatoid arthritis is an autoimmune disorder in which the immune system mistakenly attacks the joints in the same way it normally would fight viruses or bacteria. In other words, the damage in RA is caused by the body’s immune system, most commonly affecting joints of the hands, feet, wrists, elbows, ankles, and knees.

The relationship between stress and RA appears to be bidirectional. In other words, rheumatoid arthritis can cause a person to experience stress, and that stress can worsen the symptoms of rheumatoid arthritis.

See what rheumatologist Dr. Ashira Blazer says about stress and flare-ups.

How RA Causes Stress

The symptoms of RA — including pain, stiffness, and fatigue — can cause a great deal of stress, especially during flare-ups. “I feel super stressed out,” one myRAteam member wrote, “because I’m worried about work and providing for my family, and at the same time trying to cope with the pain, which just stresses me out so much more.”

As another member explained, “It seems like it’s impossible to relax when you’re hurting.”

As these members described, living with RA and its symptoms can be challenging. Aside from dealing with the immediate physical aspects of RA, you may also find other facets of life with the disease stressful, including managing doctors' appointments and medications, paying for treatments, or worrying about the disease's progression. This ongoing stress (referred to as chronic stress) can lead to additional health problems over time.

How Stress Affects RA

As many myRAteam members have shared, stress can make RA symptoms worse. One member shared that being stressed out was causing difficult flare-ups. “When I am stressed,” wrote another member, “my RA is really bad.”

A third member observed, “Stress is not our friend. It causes difficulties.”

When you experience stress, your body responds mentally and physically. When faced with a stressor (a stress-inducing event or thought), the body releases hormones that heighten your alertness, increase your heart rate, and tense your muscles. This response can exacerbate RA symptoms in several ways.

Chronic muscle tension due to stress can cause RA-related pain to worsen. Additionally, the body’s stress response triggers the immune system to produce an inflammatory response. As RA is an autoimmune disease, inflammation is responsible for the joint damage that can develop in RA. This inflammation has also been found to heighten pain sensitivity, which can make existing RA symptoms feel even more painful.

Managing Stress With RA

You don’t have to accept constant stress as part of life with RA. Although some days will be more difficult than others, there may be ways you can manage stress before it starts to worsen your symptoms and impact your quality of life. You and your doctor can work together to determine which stress-busting approaches are best for you to have on hand.

Treat Your RA

Treating the underlying disease and getting your symptoms under control will help prevent them from contributing to your daily stresses.

There are several approaches to treating and managing RA. Over-the-counter nonsteroidal anti-inflammatory drugs (or NSAIDs) and prescription corticosteroid injections can help manage pain in the short term, while systemic treatments, like disease-modifying antirheumatic drugs (or DMARDs) and biologics, can help manage disease activity. You can work with your rheumatologist to find the best way of managing your RA.

Identify Your Stressors

One of the first steps to managing stress with RA is to identify what is contributing to it. You may want to start by keeping a stress-management journal, in which you record when and where you experience stress, what causes it, and how it makes you feel physically and emotionally.

Some stressors can be managed, while others are unavoidable. “With all that is going on in our world today,” one member wrote, “many of us feel very stressed out.”

As another shared, “Stress is not good for RA, and COVID-19 doesn’t make things any better.”

Even without heightened public health concerns, events such as natural disasters, job loss, and relationship conflicts can contribute to stress. Although you can’t control some stressors, you can control how you respond to them. Methods like mindfulness and meditation can help. And when there is a stressor you can address, you can identify it and take steps to avoid it or mitigate its impacts on your daily life.

Meditation, Mindfulness, and Breathing Exercises

Relaxation and mindfulness techniques can provide significant benefits to people dealing with RA-related stress. As one member suggested to another dealing with stress, “You could try meditation, relaxation techniques, or visualization. I know it won’t take away your pain, but it can be lessened by relieving stress.”

Relaxing may not seem easy at first. One myRAteam member notes that remaining calm can be hard “when you feel your pain is in chaos, but relaxing is better than stressing out.”

Research has found that mindfulness, over time, can have significant positive impacts on emotional well-being in people with rheumatoid arthritis. Mindfulness entails focusing on the present moment, including noticing your feelings and thoughts without judging them. Mindfulness techniques can include practicing different types of breathing methods and engaging in guided imagery.

Visualization may also be a helpful stress management technique. You can start this practice by sitting in a calm environment, closing your eyes, and taking slow, deep breaths. Next, picture yourself in a relaxing environment that makes you happy. Whether it's on a warm beach or reading a book in front of a fire, try to visualize all the details of this scene — how it looks, feels, sounds, and smells.

Talk Therapy

If you have become overwhelmed by your stress or feel you can’t manage it on your own, it may be a good idea to seek out counseling or talk therapy. Cognitive behavioral therapy is one type of talk therapy that can help you learn to respond to stress in healthier ways.

Exercise

Exercise releases chemicals called endorphins, which naturally promote “feel good” sensations and decrease stress. Physical activity — even light exercise — can help improve sleep and reduce stress levels, with the added benefit of reducing levels of pain, stiffness, and fatigue. You may find that yoga and tai chi are particularly helpful, as these practices combine physical movement, deep breathing, and mindfulness.

Get Plenty of Rest

As one myRAteam member wrote, “Keeping my stress down and getting enough rest are key parts of handling my symptoms.”

Although getting a good night’s sleep can do wonders, dealing with stress can make falling asleep a challenge.

Improving your sleep habits (also known as sleep hygiene) may make it easier to fall and stay asleep. Reducing your caffeine intake (especially late in the day), setting a regular bedtime that you adhere to every day, avoiding electronics at least one hour before bedtime, and making sure you have a dark, quiet place to sleep can make a difference in your sleep quality.

Take Time for Yourself

It is important that you find time to do things you enjoy. As one myRAteam member said, “If you are feeling stressed, try to find your happy place. Turn up your music, sing out loud, dance in your chair, or get up and dance around your house. Do whatever you need to do to release the stress. RA does not like it when you’re happy and feel peaceful.”

Meet Your Team

Navigating life with RA can be a challenge. The good news? You don’t have to go it alone. On myRAteam, the social network for people diagnosed with rheumatoid arthritis and their loved ones, more than 148,000 members from across the world come together to ask questions, offer support and advice, and share stories of life with RA.

What ways have you found of managing stress with rheumatoid arthritis? Share your tips in the comments below, or by posting on myRAteam.