What Is The Stress Circuit And Why We Need to Care
I began to learn about something called the HPA axis and psychoneuroimmunology fifteen years ago. At the time my JRA was so active that I was barely functioning and I spent most of my energy researching what to do next. My body seemed to reject every drug I tried, and I felt like I was running out of ideas. But when I came across an article about how the immune system and our stress response are connected it peaked my curiosity. A few years earlier I had been in remission. But after a series of both physical and emotional stresses, things quickly changed and within a year I was in the worst flare-up in my life. Reading what science was finding out about how stress affects physiology made sense to me. Years later, I still try to keep what I learned at the forefront of my mind, especially when I’m going through stressful periods, because I know that, for me personally at least, there is a direct correlation with stress and how I feel physically. My personal history has taught me that certain kinds of stress will feed the inflammation, that the response takes a while to build, and seemingly even longer to get back to baseline.
For most people with rheumatoid arthritis it won’t be shocking to hear that scientists have studied how people with RA handle stress. What they’ve found has brought more questions than answers - like many aspects of treating this complex disease, all we have to work with is best guesses. Sometimes I think, like life itself, living well with RA comes down to a series of best guesses, and the actions that follow. So, what is the HPA axis, and what is psychoneuroimmunology, and is any of it relevant to your daily life?
Psychoneuroimmunology and RA
Psychoneuroimmunology is essentially an umbrella term for the study of the mind-body connection. Miriam Webster on-line defines it this way:
“A branch of medicine that deals with the influence of emotional states (such as stress) and nervous system activities on immune function especially in relation to the onset and progression of disease.”1
The HPA axis, is the Hypothalamic- Pituitary-Adrenal axis, or a circuit that nerves travel on in the brain which helps regulate our stress response. Here is one formal definition:
“The hypothalamic pituitary adrenal (HPA) axis is our central stress response system. The HPA axis is an eloquent and every-dynamic intertwining of the central nervous system and endocrine system.”2
Medicine first started really looking into stress and RA in the 1950’s, when steroids were discovered to be such an effective treatment. At the time, it was thought they had discovered the cure. It took a few years to figure out how destructive long-term use of high doses of steroids was to the body. But, even though steroids proved to be a horrible idea, it led to the discovery that people with RA have an altered response to stress. When we feel stress there is a cascade of physiological changes that happen, and one change is that the immune response becomes activated. When that happens, chemicals called cytokines, which increase inflammation, are called into action. Once the stressful issue is resolved, immediately the adrenal glands secrete cortisol, our body’s natural steroid, which brings the inflammation back down. For some reason, people with RA have a blunted steroid response, meaning we don’t produce as much cortisol which dampens the inflammation that was produced under stress. What that could mean is, over time, if the inflammatory response is triggered on a regular basis without enough cortisol being produced to balance it, disease activity could stay high. This is, as I said earlier, just a best guess.
But that best guess, and the information that created it, helps guide me in my life because I think every little bit counts. If I can keep inflammation low, I’ll feel better, and if I know that stress can increase inflammation I’m going to do my best to lower my stress as much as possible and handle the stress thrown my way as best as I can. Each one of us has a unique set of life circumstances, some of them extremely stressful, that we can’t control. And each one of us will, at times, handle stress in the worst way possible; it’s important not to over- think or worry about every stressful event and to forgive yourself when you don’t handle things well. The important part, at least for me, is to recognize that, in this fast-paced, and very stressful world we live in, incorporating soothing, calming activities into daily life can help.
Over the years I’ve created a pain toolbox, where I have a lot of things to do when my pain is worse. I’ve also created a stress toolbox. In that one I have meditation, brainwave music, massage, time alone, naps, books, essential oils, and many more things that help me to relax as I go through my day. Depending on what is happening around me and the time I have, I’ll incorporate one or more of these ideas into my life at any given time. What I’ve come to find out is that by dealing with stress head-on instead of waiting until I feel overwhelmed, I am more relaxed and able to handle the ups and downs of the JRA. It would be hard to gauge how this has affected the overall course of my disease, and it may not. But at least I feel better, and anytime that happens I pay attention. This small but significant victory helps me to weather all of the setbacks that are an inevitable part of living with a chronic, painful disease. And it helps me to know that it’s not all out of my control.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?