Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Sep 2005; 64(9): 1299–1304.
Published online Feb 11, 2005. doi:  10.1136/ard.2004.032151
PMCID: PMC1755638

Increased C reactive protein in response to acute stress in patients with rheumatoid arthritis

Abstract

Objective: To assess the effects of acute stress on inflammatory, haemostatic, rheological, and haemodynamic activity in patients with rheumatoid arthritis (RA) in comparison with patients with osteoarthritis (OA).

Methods: 21 patients with RA and 10 with OA underwent a brief mental stress task while standing. Inflammatory, haemostatic, rheological, and haemodynamic variables were measured at baseline, during the task, and at recovery.

Results: At baseline, erythrocyte sedimentation rate and fibrinogen were higher in RA than OA. White blood cell count, fibrinogen, blood pressure, and pulse rate increased, whereas prothrombin time and plasma volume decreased during the task in both patient groups. The stress task increased C reactive protein (CRP) only in patients with RA, and more specifically in those patients with RA with high disease activity.

Conclusions: The increase in the inflammatory marker CRP, which was specific to patients with RA, combined with the haemostatic, rheological, and haemodynamic reactions to the stress task, over and above the already high baseline levels, could underlie the increased risk for myocardial infarction in this vulnerable patient group.

Full Text

The Full Text of this article is available as a PDF (98K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Libby Peter, Ridker Paul M, Maseri Attilio. Inflammation and atherosclerosis. Circulation. 2002 Mar 5;105(9):1135–1143. [PubMed]
  • Worthley SG, Osende JI, Helft G, Badimon JJ, Fuster V. Coronary artery disease: pathogenesis and acute coronary syndromes. Mt Sinai J Med. 2001 May;68(3):167–181. [PubMed]
  • Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999 Jan 14;340(2):115–126. [PubMed]
  • Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995 Aug 1;92(3):657–671. [PubMed]
  • Carroll Douglas, Ebrahim Shah, Tilling Kate, Macleod John, Smith George Davey. Admissions for myocardial infarction and World Cup football: database survey. BMJ. 2002 Dec 21;325(7378):1439–1442. [PMC free article] [PubMed]
  • Kloner RA, Leor J, Poole WK, Perritt R. Population-based analysis of the effect of the Northridge Earthquake on cardiac death in Los Angeles County, California. J Am Coll Cardiol. 1997 Nov 1;30(5):1174–1180. [PubMed]
  • Tofler GH, Stone PH, Maclure M, Edelman E, Davis VG, Robertson T, Antman EM, Muller JE. Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol. 1990 Jul 1;66(1):22–27. [PubMed]
  • Smith M, Little WC. Potential precipitating factors of the onset of myocardial infarction. Am J Med Sci. 1992 Mar;303(3):141–144. [PubMed]
  • Kop Willem J. The integration of cardiovascular behavioral medicine and psychoneuroimmunology: new developments based on converging research fields. Brain Behav Immun. 2003 Aug;17(4):233–237. [PubMed]
  • Allen MT, Patterson SM. Hemoconcentration and stress: a review of physiological mechanisms and relevance for cardiovascular disease risk. Biol Psychol. 1995 Aug;41(1):1–27. [PubMed]
  • von Känel R, Mills PJ, Fainman C, Dimsdale JE. Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease? Psychosom Med. 2001 Jul-Aug;63(4):531–544. [PubMed]
  • Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001 Sep 15;358(9285):903–911. [PubMed]
  • Kitas GD, Erb N. Tackling ischaemic heart disease in rheumatoid arthritis. Rheumatology (Oxford) 2003 May;42(5):607–613. [PubMed]
  • Wisłowska M, Sypuła S, Kowalik I. Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker's criteria, functional index, value of Waaler-Rose titre and duration of disease. Clin Rheumatol. 1998;17(5):369–377. [PubMed]
  • Sattar Naveed, McCarey David W, Capell Hilary, McInnes Iain B. Explaining how "high-grade" systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003 Dec 16;108(24):2957–2963. [PubMed]
  • Wållberg-Jonsson S, Johansson H, Ohman ML, Rantapä-Dahlqvist S. Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset. J Rheumatol. 1999 Dec;26(12):2562–2571. [PubMed]
  • Del Rincón Inmaculada, Williams Ken, Stern Michael P, Freeman Gregory L, O'Leary Daniel H, Escalante Agustín. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum. 2003 Jul;48(7):1833–1840. [PubMed]
  • Hirano D, Nagashima M, Ogawa R, Yoshino S. Serum levels of interleukin 6 and stress related substances indicate mental stress condition in patients with rheumatoid arthritis. J Rheumatol. 2001 Mar;28(3):490–495. [PubMed]
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, van Rijswijk MH, van de Putte LB. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. [PMC free article] [PubMed]
  • Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol. 1974 Aug;37(2):247–248. [PubMed]
  • O'Brien E, Waeber B, Parati G, Staessen J, Myers MG. Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ. 2001 Mar 3;322(7285):531–536. [PMC free article] [PubMed]
  • Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills. 1977 Apr;44(2):367–373. [PubMed]
  • Veldhuijzen van Zanten Jet J C S, Ring Christopher, Burns Victoria E, Edwards Kate M, Drayson Mark, Carroll Douglas. Mental stress-induced hemoconcentration: Sex differences and mechanisms. Psychophysiology. 2004 Jul;41(4):541–551. [PubMed]
  • Veldhuijzen van Zanten Jet J C S, Thrall Graham, Wasche Dean, Carroll Douglas, Ring Christopher. The influence of hydration status on stress-induced hemoconcentration. Psychophysiology. 2005 Jan;42(1):98–107. [PubMed]
  • Steptoe A, Willemsen G, Owen N, Flower L, Mohamed-Ali V. Acute mental stress elicits delayed increases in circulating inflammatory cytokine levels. Clin Sci (Lond) 2001 Aug;101(2):185–192. [PubMed]
  • Paul Antoni, Ko Kerry W S, Li Lan, Yechoor Vijay, McCrory Mark A, Szalai Alexander J, Chan Lawrence. C-reactive protein accelerates the progression of atherosclerosis in apolipoprotein E-deficient mice. Circulation. 2004 Feb 10;109(5):647–655. [PubMed]
  • Kushner I, Feldmann G. Control of the acute phase response. Demonstration of C-reactive protein synthesis and secretion by hepatocytes during acute inflammation in the rabbit. J Exp Med. 1978 Aug 1;148(2):466–477. [PMC free article] [PubMed]
  • Macintyre SS, Kushner I, Samols D. Secretion of C-reactive protein becomes more efficient during the course of the acute phase response. J Biol Chem. 1985 Apr 10;260(7):4169–4173. [PubMed]
  • Yue CC, Muller-Greven J, Dailey P, Lozanski G, Anderson V, Macintyre S. Identification of a C-reactive protein binding site in two hepatic carboxylesterases capable of retaining C-reactive protein within the endoplasmic reticulum. J Biol Chem. 1996 Sep 6;271(36):22245–22250. [PubMed]
  • Jabs Wolfram J, Theissing Elisabeth, Nitschke Martin, Bechtel J F Matthias, Duchrow Michael, Mohamed Salah, Jahrbeck Bernhard, Sievers Hans-Hinrich, Steinhoff Jürgen, Bartels Claus. Local generation of C-reactive protein in diseased coronary artery venous bypass grafts and normal vascular tissue. Circulation. 2003 Sep 23;108(12):1428–1431. [PubMed]
  • Bacon PA, Stevens RJ, Carruthers DM, Young SP, Kitas GD. Accelerated atherogenesis in autoimmune rheumatic diseases. Autoimmun Rev. 2002 Dec;1(6):338–347. [PubMed]
  • Geenen R, Godaert GL, Heijnen CJ, Vianen ME, Wenting MJ, Nederhoff MG, Bijlsma JW. Experimentally induced stress in rheumatoid arthritis of recent onset: effects on peripheral blood lymphocytes. Clin Exp Rheumatol. 1998 Sep-Oct;16(5):553–559. [PubMed]
  • Wållberg-Jonsson S, Cederfelt M, Rantapä Dahlqvist S. Hemostatic factors and cardiovascular disease in active rheumatoid arthritis: an 8 year followup study. J Rheumatol. 2000 Jan;27(1):71–75. [PubMed]

Figures and Tables

Figure 1
 Mean age adjusted (SE) CRP (A), WBC (B), fibrinogen (C), and prothrombin time (D) during baseline, stress task, and recovery in patients with RA and OA.
Figure 2
 Mean age adjusted (SE) CRP during baseline, stress task, and recovery in patients with RA with high disease activity and with low disease activity.
Figure 3
 Mean age adjusted (SE) plasma volume (A), SBP (B), DBP (C), and pulse rate (D) during baseline, stress task, and recovery in patients with RA and OA.

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...