“It’s complex, but the two are related almost in a circular or cyclical pattern,” says Bella Fradlis, MD, a rheumatologist at Garnet Health in Goshen, New York. “Increased stress levels can actually worsen symptoms of RA by increasing systemic inflammation.” A study published in June 2020 in the journal Rheumatology and Therapy found that depression is twice as common in people with RA than in the general population. According to researchers, chronic inflammation from RA impairs the body and mind’s responses to stress, including coping behaviors. This can result in depression, which leads to worse outcomes in RA. For these reasons alone, it’s important to find ways to manage stress with RA, Dr. Fradlis says. Getting stress under control, especially when combined with medicines such as disease-modifying antirheumatic drugs (DMARDs), can reduce the need for other medication, such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs).

How to Stress Less With RA

There are a number of things you can try to manage stress and help keep RA under control. Start with these strategies.

  1. Exercise regularly. Staying active can seem like a challenge at times, but regular exercise keeps joints from stiffening up, strengthens muscles, and lifts your mood, according to the Arthritis Foundation. It might seem like exercise will hurt with RA, but it can actually help reduce joint pain. Exercise can also help you maintain a healthy weight. Aerobic activities, such as brisk walking, jogging, swimming, and Zumba, are a good choice. What’s more, mind-body options like yoga and tai chi can lower stress levels while increasing flexibility. Just remember to listen to your body and don’t overdo it, especially during an RA flare. Talk to your doctor about joining either an in-person support group near your home or an online forum, such as CreakyJoints, a free online community of support and resources for people with all forms of arthritis.
  2. Keep a gratitude journal. When struggling with an RA flare, it’s easy to focus on the joint pain and stiffness. In this discomfort and frustration, it can be easy to forget the things you’re grateful for in life. Some people find that writing in a gratitude journal can really help them focus on the good things in life, Fradlis says. It can help you relax, improve your mood, and even distract you from RA pain. Journaling in general can also be an effective and inexpensive way to release stress.
  3. Practice mindfulness. Taking time out of your day to stop, relax, breathe, and focus may help you manage the pain and stress of RA, according to the Arthritis Foundation. A review of four studies published in February 2021 in the journal Research, Society and Development found that people with RA who learned mindfulness had lower depression, stress, and disease activity compared with those who didn’t learn mindfulness — although more research is needed. If you’d like to start practicing mindfulness, consider trying a guided meditation to help restore your emotional and physical health.
  4. Cultivate your sense of humor. “The old adage ‘Laughter is the best medicine’ might not be so crazy after all,” says Victoria K. Shanmugam, MD, director of the division of rheumatology at George Washington University in Washington, D.C. In a review published in the journal Immunology, researchers agree that happiness and good health go hand in hand, noting evidence that “Our emotional and immune states share a complex and bidirectional relationship with one another.”
  5. Unplug and get some rest. Getting a good night’s sleep can help you manage stress and RA, Fradlis says. Turn off the TV and other electronics at least an hour before going to sleep. Leave your cell phone in another room. Unwind by reading a book or listening to music. Try starting a “worry diary” to confine the time you let yourself ruminate and worry, thereby freeing up your nights for sleep. Ultimately, the best way to manage the stress of living with RA is to do what works for you, Fradlis says. You know best what makes you happy, whether it’s chatting with a friend, cuddling with a pet, making art, or practicing meditation. Find what relaxes you and make it part of your daily routine.