Perceived Stress Predicts Worse Pain, Fatigue, and Function in Rheumatoid Arthritis Over Time

New research from a longitudinal cohort study demonstrates that perceived stress is a significant and independent predictor of worse pain, fatigue, and physical function in individuals living with rheumatoid arthritis (RA). The findings published in Arthritis Care & Research support growing evidence that psychological stress has measurable effects on disease experience, even when controlling for clinical confounders.

“Studies have suggested a potential link among traumatic experiences, psychologic stress, and autoimmunity, but the impact of stress on disease activity and symptom severity in RA remains unclear,” the authors noted. “We examined whether perceived stress independently associates with worse RA disease outcomes at subsequent visits over 18 months of follow-up.”

The study followed 133 RA patients who were assessed every 6 months over 18 months. Stress was measured using the 4-item Perceived Stress Scale. Patient-reported disease activity, pain, fatigue, and physical function were assessed using the rheumatoid arthritis disease activity index and PROMIS measures. Time-lagged linear mixed effects models were used to evaluate whether stress predicted worse outcomes at the subsequent visit.

Participants were predominantly female (88%) with a diverse racial and ethnic profile: 45% White, 35% Hispanic, 9% African American, and 6% Asian American. The mean age was 58 years (SD ±13). After adjusting for potential confounders, higher stress scores were associated with increased disease activity (β = 0.11; 95% CI: 0.03–0.19), more pain (β = 0.61; 95% CI: 0.29–0.94), more fatigue (β = 0.71; 95% CI: 0.32–1.11), and worse physical function (β = –0.33; 95% CI: –0.59 to –0.06).

The effect sizes for pain, fatigue, and physical function met thresholds for clinical significance, suggesting that perceived stress is more than just a psychological concern—it has real implications for symptom burden and functional health in RA.

“Among a longitudinal RA cohort, those with greater perceived stress had worse pain, greater fatigue, and lower physical function at follow-up,” the authors concluded. “Findings underscore the need to integrate stress resilience interventions and programs that augment psychosocial support in health care systems that serve people living with RA.”

Reference
Patterson SL, Park J, Hartogensis W, Katz P. Perceived stress and prediction of worse patient-reported outcomes in a rheumatoid arthritis cohort. Arthritis Care Res (Hoboken). 2025 Sep;77(9):1085-1094. doi: 10.1002/acr.25543. Epub 2025 May 2. PMID: 40181767; PMCID: PMC12354076.