Women with post-traumatic stress disorder at risk of developing rheumatoid arthritis, says study

According to a new study, women with post-traumatic stress disorder (PTSD), are at an increased risk of developing rheumatoid arthritis, whether or not they smoke.

The aim of the study, which was published in Arthritis Care & Research, was to examine the association between symptoms of PTSD and risk of rheumatoid arthritis and to characterise the role of smoking.

PTSD is a condition that can develop after someone has been exposed to one or more traumatic events and the role of the condition has been of interest to researchers because several studies implicate stress in the development of autoimmune diseases.

For the study titled researchers studied 49,693 women enrolled in the Nurses’ Health Study II, an ongoing cohort study of 116,430 female nurses aged 25 – 42 years at the time of enrollment in 1989.

Participants answered a number of questionnaires at the beginning of the study and then every two years, including the Brief Trauma Questionnaire and a PTSD screener to identify whether and when trauma and PTSD symptoms may have occurred. Importantly, none of the study subjects had rheumatoid arthritis or systemic lupus erythematosus at the beginning of the study.

The incidence of smoking was higher among participants who had PTSD symptoms, with a prevalence of 8% among women with four or more PTSD symptoms compared to 5.6% among women with fewer than four symptoms.

The results further revealed that compared to no history of trauma/PTSD symptoms, the hazards ratio (HR) for more than four PTSD symptoms and incident rheumatoid arthritis was 1.76 in models adjusted for age, race, and socioeconomic status.

Importantly, the risk to develop rheumatoid arthritis increased with more symptoms of PTSD. When smoking was added to this model, the HR for rheumatoid arthritis remained elevated (HR 1.60). Results from a subgroup analysis, excluding women who smoked before PTSD onset, were basically unchanged (HR 1.68).

These results indicate that women with high PTSD have an elevated risk for rheumatoid arthritis, independent of smoking; however, the mechanisms behind this association remain unclear.

“Further studies are necessary to examine the role of other behaviours and clinical characteristics, such as alcohol consumption and obesity, as potential confounders and/or mediators of the association between PTSD and risk for rheumatoid arthritis,” the authors concluded in their study. “In addition, assessments of serum and salivary cortisol levels, to characterise basal HPA axis activity and the stress response, are needed to investigate biologic pathways linking PTSD with an increased risk for RA,” say the authors.

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