When you have vasculitis, medications help to tame the inflammation that threatens your organs. But sometimes your vasculitis flares up in spite of them — and you wind up with a headache, or trouble breathing, or kidney or nerve problems, or pain. Could stress be responsible?
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“Many things — genetic, environmental, hormonal and immunologic — trigger the inflammatory process in vasculitis,” says rheumatologist Rula Hajj-Ali, MD. “But some patients notice that, over time, flare-ups happen following stressful events.”
What symptoms can vasculitis cause?
Vasculitis is an umbrella term for a group of rare diseases that attack blood vessels. Weakness and damage from inflammation reduce blood flow to the organs the vessels supply, and tissue damage occurs.
“Vasculitis targets different blood vessels, which determine which organs are affected and what your symptoms are,” explains Dr. Hajj-Ali. Rheumatologists classify these disorders by the size of the blood vessels affected:
- In large vessels: The most common types are giant cell arteritis (GCA, or temporal arteritis) in the elderly, and Takayasu’s arteritis in young people. Because GCA targets blood vessels around the temples, eyes and jaws, flare-ups can trigger vision loss and headaches. Because Takayasu’s targets the aorta and its main branches, symptoms include pain in the arms or legs, joints or muscles; lightheadedness; and reduced blood flow, which weakens the pulse.
- In medium vessels: The most common type is polyarteritis nodosa, which can damage the skin, kidneys, intestines, heart or nerves. This type of vasculitis can occur following infection with hepatitis C.
- In small or medium vessels: Several types of vasculitis affect the small vessels. ANCA-associated vasculitis encompasses the diseases that affect both small and medium blood vessels; the most common is granulomatosis with polyangiitis (GPA, formerly called Wegener’s granulomatosis). It targets the sinuses, respiratory system, nerves, kidneys, muscles and joints, and skin. Flare-ups can trigger pain, rashes, blood in the urine, kidney problems, sinus symptoms and shortness of breath.
Can stress really cause vasculitis flare-ups?
A 2011 study looked at the effect of stress on patients with ANCA-associated vasculitis.
“As one part of a large study on a new treatment’s efficacy in GPA, researchers surveyed patients at different intervals about their physical and mental health. They collected data on how active their vasculitis was, and whether patients had flares on not,” says Dr. Hajj-Ali.
“Those whose mental health scores were lower were more likely to have flare-ups at their next visit.” This suggested that stress might predict a greater likelihood of flaring.
Then, a 2017 study looked at whether stress triggered vasculitis in the first place. Researchers compared patients with ANCA-associated vasculitis or rheumatoid arthritis to healthy controls.
“They found that stressful life events contributed more to the onset of ANCA-associated vasculitis compared to patients with rheumatoid arthritis and healthy controls,” says Dr. Hajj-Ali.
She adds that animal studies of autoimmune disease find that stress alters cytokines (the proteins that trigger inflammation), offering early biological evidence of the toll stress takes.
What sort of stress triggers flare-ups?
Job loss, death of a loved one and financial difficulties are examples of negative life stresses.
“While these types of stress could possibly lead to a vasculitis flare, I would point out that living with a disease which affects your major organs is already stressful,” says Dr. Hajj-Ali.
Rheumatologists treat vasculitis flare-ups with immune-suppressing medications, ranging from corticosteroids to chemotherapy. But addressing patients’ mental health is just as important, she says.
Is mental health linked to fatigue?
Patients often report fatigue when their vasculitis is in remission. A Cleveland Clinic study, which Dr. Hajj-Ali led, found that depression and lack of sleep contribute to fatigue.
“So we always ask vasculitis patients about anxiety and depression,” she says. “We also ask, ‘How many hours are you sleeping?’ and ‘What is your sleep pattern?’”
It’s important to talk about exercise, too, because it affects both energy level and mood.
What if your doctor doesn’t ask about stress?
“Physicians should focus on treating the whole patient rather than on treating the disease only,” says Dr. Hajj-Ali.
If your doctor tells you that your numbers look good, but you don’t feel well, let him or her know.
“Open up to your physician about your mental health and any stress you’re under,” she says. “Don’t be intimidated about raising these concerns, because if you ask for help, you will find it — and you will feel much better.”
Helping patients learn how to address stress is an important aspect of vasculitis care, notes Dr. Hajj-Ali.
Strategies like exercise, yoga, mindfulness and sleep hygiene will improve your ability to deal with stress, as will addressing your eating habits.