Tuesday, 20 Nov 2018

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The Stress - Autoimmune Disease Connection

"Can stresss be the cause of my autoimmune disease?" is an often launched question met with shrugs of uncertainty or strongly held beliefs rooted in bias moreso than fact.

Swedish investigators have analyzed a large registry cohort and shown that exposure to stress-related disorders yields a significantly increased risk of autoimmune disease. 

They analyzed 106,464 patients with stress-related disorders, with 126,652 full siblings, and over a million non-stressed matched controls to assess a future risk of autoimmune disease. Specifically they looked for 41 autoimmune diseases including rheumatoid arthritis, lupus, ulcerative colitis and Crohn’s disease, celiac disease, multiple sclerosis, and type 1 diabetes.

Overall they found an incidence rate was 9.1 per 1000 person-years in stress exposed patients compared with 6.0 and 6.5 per 1000 person-years in matched (unexposed-control) individuals and siblings, respectively. 

With a mean follow-up of 10 years, the incidence rate of autoimmune diseases  in each group was:

  • Stress disorders: 9.1 per 1000 person-years 
  • Non-Stressed controls: 6.0 per 1000 person-years 
  • Siblings: 6.5 per 1000 person-years

Thus the data suggests a 2.5 to 3 fold increased risk of autoimmune disease in those exposed to stress. For all stress-related disorders the risk of autoimmune disease was increased 36% (HR 1.36 [95% CI, 1.33-1.40]).  For those with posttraumatic stress disorder there was a 46% increased risk (HR 1.46 [95% CI, 1.32-1.61]) for any autoimmune disease  and was also increased for having multiple (≥3) autoimmune diseases (HR 2.29 [95% CI, 1.72-3.04]).

The risks were more pronounced among younger patients (HR, 1.48 for ages ≤33 yrs) and with use of selective serotonin reuptake inhibitors during the first year of PTSD (HR, 3.64 [95% CI, 2.00-6.62]).

These data are surprising as they indirectly show that stress is more important than family genetics (siblings) in influencing the risk of autoimmunity.

The diagnosis of a stress-related disorder and longitudinal follow-up appears to associate with a significantly increased risk of subsequent autoimmune disease. This study does not address the role or contribution of routine daily stressors or situations on subsequent autoimmune risk.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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