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Arthritis Care Res (Hoboken). 2019 Oct 10. doi: 10.1002/acr.24085. [Epub ahead of print]

Perceived stress and inflammatory arthritis: a prospective investigation in the Studies of the Etiologies of Rheumatoid Arthritis (SERA) cohort.

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Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA.
Nine Health Services, Inc, Denver, CO, USA.
University of Nebraska Medical Center, Omaha, Nebraska, USA.
Cedars-Sinai Medical Center, Los Angeles, California, USA.
Feinstein Institute Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
The University of Chicago, Chicago, Illinois, USA.
Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA.
David Geffen School of Medicine, University of California, Los Angeles, California, USA.



The aim of this study was to determine the association of perceived stress with incident inflammatory arthritis (IA) defined as having at least 1 joint consistent with rheumatoid arthritis (RA)-like synovitis based on exam.


We conducted a prospective cohort study in the Studies of the Etiologies of Rheumatoid Arthritis (SERA). Participants without IA were recruited if they were a first degree relative of a RA proband or screened positive for anti-cyclic citrullinated peptide autoantibody (ACPA). Perceived stress was measured using the Perceived Stress Scale-14 (PSS) in which scores can range from 0 to 56 and a higher score indicates greater perceived stress. The total PSS score as well as two sub-scores indicative of perceived distress and self-efficacy were averaged across all study visits until development of IA or last follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) of IA associated with average PSS scores were obtained using Cox proportional hazards models.


The mean total PSS score was 20.4. We found that a one-point increase in the perceived distress score was significantly associated with a 10 percent increase in the risk of IA (adjusted HR: 1.10; 95%CI: 1.02, 1.19). Total PSS and self-efficacy were not associated with IA risk (adjusted HR: 1.05 (95%CI: 0.99, 1.10) and 1.04 (95%CI: 0.91, 1.18), respectively.


An association between perceived distress and incident IA was observed in this at-risk cohort. Replication of this finding in other preclinical and at-risk RA populations is needed.


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