Rheumatoid arthritis (RA) is characterized by tenderness and swelling of the synovial joints that can result in debilitating conditions, chronic pain and deformed digits. Other symptoms include the gelling of joints after an individual has time to rest, general malaise, fatigue and the presence of systemic disease marked by pleural effusions, pericarditis, pulmonary fibrosis, neuropathies and ocular disorders. RA cases are subject to heritability such as a Native American ethnicity and other underlying genetic factors and at any age in some rare cases.
Autoimmune Factors of RA
RA is an observable trait found in the blood and can be considered an antibody that binds to specific antigens. These antigens can consist of any potential threat to the immune system. For instance, toxins, bacteria, foreign blood cells or foreign tissue can be called antigens. The immune system and antibodies work like an army to combat foreign intruders and to keep the body disease-free. Yet, if there are more antigens present than antibodies, the immune system becomes compromised and diseased. In RA, the joint lining carries activated cells present with stress and chronic inflammation.
Hormonal Changes in RA
The British Society for Neuroendocrinology published an article by Pariante titled "Depression, Stress, and the Adrenal Axis," which defined the hypothalamus as critical in the RA disease process. The hypothalamus is activated by the stress response that releases corticotrophin-releasing hormone (CRH). The CRH then releases adrenocorticotrophic hormone, which further initiates the release of glucocorticoids by the adrenal cortex. Glucocorticoids work as a group of hormones that regulate carbohydrates, proteins and fat metabolism in the body. When functioning normally, they also have an anti-inflammatory effect. However, in RA the over-stimulation of these hormones due to stress or infection leads to the flooding of cortisol. Instead of having an anti-inflammatory role in this scenario, receptors and responses to excess cortisol become pro-inflammatory (i.e., where the joints are prone to swelling and pain), permanently altering the immune system.
HPA Axis and the Role of Cortisol in RA
Hypothalmic-pituitary-adrenal (HPA) axis activation to acute stress is accumulative in nature and results in adverse physiological consequences to include abnormalities to glucose metabolism (e.g., obesity, diabetes melitis) permanent hippocampal damage (like long-term memory loss and retention) and depression. These changes with RA create a environment in the body referred to as "metabolic syndrome." This metabolic syndrome in RA begins with a compromised immune system and excess cortisol and can become a gateway to a painful and sedentary lifestyle, increased insulin resistance/glucose intolerance, rapid disease progression and heart disease.
References
- "British Society for Neuroendocrinology"; Depression, stress, and the adrenal axis; Pariante, C.; 19,1, 2007.
- "The Journal of the American Medical Association"; Spiegel, D.; 14, 1999.
- "Human Psychoneuroimmunology"; Vedhara, K. & Irwin, M.; 2005.
