A lot of us have spoken about flares caused by stress. For the life of me though, I am struggling to understand the physiological reasoning behind it. In theory, we should all be producing cortisol, a very strong anti-inflammatory when stress events happen - so why the flares?
I haven't had my coffee yet, so I'm posting links instead of trying to explain! LOL
http://www.everydayhealth.com/rheumatoid-arthritis/rheumatoid-arthritis-stress.aspx
"Inflammation ... is partly caused by molecules called cytokines. While cytokines can be released for a variety of reasons, stress also releases them. If you’re stressed and are releasing more cytokines, you probably will develop more inflammation. This may result in more pain."
http://www.arthritistoday.org/daily-living/stress/managing-stress-2.php
"The processes that fire up the immune system and lead to the proliferation of inflammation-inducing chemicals are the same processes that are stimulated by stress," says Alex Zautra, PhD, an Arthritis Foundation-funded researcher and professor of psychology at Arizona State University in Tempe.
Cortisol production from stress would seem to be a good thing , right? After all we take cortisone to help a flare....
Cortisol production slows the production of prostaglandins which support immune function dialate blood vessels thin blood and as a result are anti inflammatory. But when you have increased Cortisol the adrenal glands take over trying to compensate because the immune system cells are disappearing from the blood. But with PsA and related problems, we have too much TNF already so things really go into overdrive trying to get back in balance. The adrenal system eventually starts to get fatigued, and things really get out of wack. Not only does inflamtion increase, but the production of cortisol actually fails along with other hormone levels.
Rember with the the increased TNF's form PsA this is already happening anyway but NOW its worse because of stress. (sorta like a double dose of PsA) The decrease in other hormones controlling other systems cause all the other problems we are also blessed with Blood sugar, fatigue, heart failure, wieght gain, liver function, and on and on.
Enter the Rheumy.... first they give us NSAIDS to dilate blood vessels, thin the blood and hopefully reduce inflamation. Then they give us steroids to replace the Cortisol we aren't making because of the TNF's and reduce inflamation. Then they give us DMRDS and Biologics to slow down the TnF production. They then spend the next 6 months trying to get the mix right.
The following is why I would never be a Rheumy:
They start to get close to the right mix only to have us try and do our own taxes, or turn our back on the kids just long enough for the 6 year old to give his little sister a haircut. Then it all goes to hell in a hand basket. We have a little flare which the more we worry about it turns to a big flare (the spelling bee is next week and the Halloween costumes aren't done,) only to have us get really concerned and demand changes because the "MEDS ARE FAILING" which the Docs do (sometimes because they rally do have to) or if they don't (knowing things will probably get back to normal or a new normal takes over) we get more anxious and things really blow up, We "can" the doctor because they don't care, are incompetent and their medicines fail to to account for our ever changing life styles, and it doesn't work instantly because our bodies have to change to account for change.
I'm not so sure but what us older folks often get better results from our treatment, because we live a less stressful life (or have learned to keep things on a more even keel)
Anyway hope that helps with the Physiology......
TNT - that was very helpful and the most useful summary I have seen. I am hoping you will find a cure for PsA though soon. Hopefully it won’t involve eating crushed beetles.
Thanks nym and lamb,
I understand it much more now, nym your info even lnked the sleep loss talked about in Petunia's article, and lamb you have made me realize just what the Rheumatologist is constantly up against. You had also mentioned that his job is to control the disease, not the pain. That makes perfect sense, and explains why my Rheumatologist does not want to prescribe pain meds, he just wants to concentrate on the disease. Becoming a better patient will help the Doctor be as good as he can possibly be. Thank you!
Hope you are both having a good day,
SK
You do know that a Strawberry Frappachino is one of lifes true pleasures and Sress relievers, right??? (Not everybody drinks tea over there do they?) Still in most markets Starbucks uses crushed beetles as one of the ingredients as does Ocean spray Juices, Yoplait and Dannon yogurt along with Dole fruit snacks in order to keep things "natural" So what evr the cure is Gwyn, be very careful of anything "red" or "natural
GwynnethP said:
TNT - that was very helpful and the most useful summary I have seen. I am hoping you will find a cure for PsA though soon. Hopefully it won't involve eating crushed beetles.
Thanks so much to everyone for their input. I am starting to realize that whilst we all have over-active immune systems, it’s actually the lack of balance that causes the problems, so instead of TNFa blockers, what we need are some as yet unknown molecules related to IL6 that turn off the inflammatory response so It remains acute, and doesn’t become chronic.
But in the meantime I’d love a TNF blocker…
I would eat crushed beetles. Heck, I'd do the crushing if necessary, in order to be out of this paaaaaaaains.
GwynnethP said:
TNT - that was very helpful and the most useful summary I have seen. I am hoping you will find a cure for PsA though soon. Hopefully it won't involve eating crushed beetles.
Marichano cherries on your Sundae. Oh well, at least you cannot taste them in there...
tntlamb said:
You do know that a Strawberry Frappachino is one of lifes true pleasures and Sress relievers, right??? (Not everybody drinks tea over there do they?) Still in most markets Starbucks uses crushed beetles as one of the ingredients as does Ocean spray Juices, Yoplait and Dannon yogurt along with Dole fruit snacks in order to keep things "natural" So what evr the cure is Gwyn, be very careful of anything "red" or "natural
GwynnethP said:TNT - that was very helpful and the most useful summary I have seen. I am hoping you will find a cure for PsA though soon. Hopefully it won't involve eating crushed beetles.
"Sometimes the stress and pain connection can work in reverse: You may feel that your worsening RA is stressing you."
Ya think??? As soon as my pain level shoots up, my stress level does too. I worry about how I'm going to get things done and keep doing my job. I blame myself for going out and shopping for that one hour. I get angry at the pain. I get frustrated with sitting at home in pain. Yep,I'd say that stress level goes WAAAAAAAAAY up when the symptoms start in.
I made a wee mistake last weekend in Glacier Park. I decided we could hike along St Marys lake for a few miles cool our feet in the lower falls easy hike (a few years ago) only 4 miles down hill. We could bushwack about a half mile (beinvg an old fart I still use a map and compass) to a shuttle stop and catch a shuttle back to the car. Great theory...... Except the shuttles don't start for another week. A fact of course I didn't discover until after waiting a half hour for the Shuttle. I know some of you can appreciate how much stress levels can rise . with two 13year old Aspy kids when things don't go as planned especially when I'm regretting the first half of the hike. But off we go bushwacking back to the trail. What do we meet but a grizzly bear ( no cubs thank god) Stress levels????
We make it to the main trail and who do we meet but a spondy. Hump and all. Shes dragging one foot. Using a four legged cane smiling from ear to ear, this was one of her favorite trails. Visiting with her she stated fusing about 5 years ago got her Dx about 10 years ago. I asked if was alone, she assured me she wasn't. I asked her what her plan was if she started spasaming or any of the bajillion things could go wrong and wasn't she scared/stressed over the possibility. She assured me she wasn't BUT she pointed up the trail and said He might be. It wax her husband dragging a wheel chair
Somehow my stress melted and my expected flare never came
Me too Pet, I'd even catch 'em!
Petunia Girl said:
I would eat crushed beetles. Heck, I'd do the crushing if necessary, in order to be out of this paaaaaaaains.
GwynnethP said:TNT - that was very helpful and the most useful summary I have seen. I am hoping you will find a cure for PsA though soon. Hopefully it won't involve eating crushed beetles.
Glad it all turned out okay! Nothing like a little unexpected excitement! I know that stressing out only makes things worse, but at the thought of the bear, I would have just freaked, that kind of threat makes me too weak to move!
I know that as an Army ranger you have been trained for anything, but defending yourself and two kids with a map and compass... well not a great line of defense! I would have a pistol on my hip for snakes and bears, but that may not have even been enough. I believe it is now legal. I am an animal lover too, but not when 'I' am going to be dinner! I have seen their claws, up close and personal! Can't imagine being in a wheel chair, much less the one pushing it! lamb, you should write your memoirs!
tntlamb said:
I made a wee mistake last weekend in Glacier Park. I decided we could hike along St Marys lake for a few miles cool our feet in the lower falls easy hike (a few years ago) only 4 miles down hill. We could bushwack about a half mile (beinvg an old fart I still use a map and compass) to a shuttle stop and catch a shuttle back to the car. Great theory...... Except the shuttles don't start for another week. A fact of course I didn't discover until after waiting a half hour for the Shuttle. I know some of you can appreciate how much stress levels can rise . with two 13year old Aspy kids when things don't go as planned especially when I'm regretting the first half of the hike. But off we go bushwacking back to the trail. What do we meet but a grizzly bear ( no cubs thank god) Stress levels????
We make it to the main trail and who do we meet but a spondy. Hump and all. Shes dragging one foot. Using a four legged cane smiling from ear to ear, this was one of her favorite trails. Visiting with her she stated fusing about 5 years ago got her Dx about 10 years ago. I asked if was alone, she assured me she wasn't. I asked her what her plan was if she started spasaming or any of the bajillion things could go wrong and wasn't she scared/stressed over the possibility. She assured me she wasn't BUT she pointed up the trail and said He might be. It wax her husband dragging a wheel chair
Somehow my stress melted and my expected flare never came
Speaking of stress and flares, we were under tornado warnings last night, severe storms raged through here, had Mom in the basement, though she refused to go into the root cellar, which is under the big concrete slab that is our front porch, she was in her night clothes and slippers, and wouldn't go. Lightning hit something in back of the house, examined the big trees best I could today, besides smaller limbs down, they seemed okay.
Hubby is away in TN at his Nam reunion, neighbors at the beach. Have already had sheer winds tear through here and snap roots of a 5 story ornamental elm and had to take it down right away, that happended a few years ago, tore a path the entire way up the mountain, trees down on homes everywhere! It is lovely to have big trees around you until the winds rip through here. We are like being in the bottom of a bowl, surrounded by mountains, 40 mph winds are like a light breeze to us!
Power only went out once, came on right away, was surprised we still had cable, and the computer is cable powered. First thing I though of when the power went off was the full box of Enbrel in the fridge! I did manage to stay calm, had we really needed to get in the cellar part and Mom still refused, well then it would have gone off the charts!
News said Rockville was heavily damaged as far as trees and power lines down. Calling for more severe storms tonight, no tornado warnings though. Whew!
Jen, I am definately feeling a good response from the Enbrel. Like lamb tells me 'baby steps', I am just so grateful for the change already taking place, and am trying to be patient, but hoping for some great changes in my life. I hope that these are available to you.
JenAus said:
Thanks so much to everyone for their input. I am starting to realize that whilst we all have over-active immune systems, it's actually the lack of balance that causes the problems, so instead of TNFa blockers, what we need are some as yet unknown molecules related to IL6 that turn off the inflammatory response so It remains acute, and doesn't become chronic.
But in the meantime I'd love a TNF blocker........
Thanks for the wishes SK. It’s pretty hard to get access to it here (despite the fact that my husband and I pay over $7,000 a year in health insurance, and another $3,000 in Medicare levy). I am considering doing a ‘trial’ where I pay for it myself for a month or so, just to see how much difference it makes and how motivated I should be to get on the biologics long term.
My job has just changed and now requires me to travel to remote Africa about 4 times a year, and the Rhuemy is all “boogeyman” about infections on TNF blockers, so although the increased incidence isn’t that high in studies (at least, a level I’m willing to risk to get a semblance of my old self back), I’m pretty sure they didn’t do those studies in a village in Burkina Faso.
Still, if Lamb can fight off bears in the mountains with two aspy kids, and still be in awe of an AS with a wheelchair catching husband on some remote trek, what’s an African bacteria or parasite or two!! 
Indeed Jen!
Not to be a kill joy, but what about refrigeration? My meds are shipped overnight on ice and kept in fridge until 30 minutes before the shot each week. Can you do it? I surely do hope that you can, as it can make all the difference! We're all cheering you on!
SK
To be honest it’s too risky. It’s a 48 hour transit in planes, just to get to the capital. But work has accepted I’ll only do 4 trips a year at just under three weeks each - so although I need to confirm, I can probably just do a shot before I go, and another when I return. It’s probably not ideal, but then I suspect it’s better than what I’ve got now! If it becomes a long term thing, I have a feeling I could get it flown from France, as there are direct flights from there.
That's a great idea, Jen! I hope you can make it work, and I hope that you get great immediate results! I was so pleasantly surprised at the almost immediate difference in the way I felt. Wishing you well.