How does lupus affect mental health. What is the connection between lupus and anxiety. How can stress impact lupus symptoms. What are effective strategies for managing stress with lupus. How does anxiety treatment benefit lupus patients. Why is addressing mental health crucial for lupus management. What role does lifestyle play in lupus stress reduction.

The Complex Relationship Between Lupus and Anxiety

Lupus, a chronic autoimmune disease, often intertwines with mental health challenges, particularly anxiety. Recent studies have shed light on the intricate connection between lupus and anxiety disorders, revealing a significant impact on patients’ overall well-being. Understanding this relationship is crucial for effective lupus management and improved quality of life.

Research indicates that approximately 37% of individuals with lupus have also been diagnosed with anxiety. This high prevalence underscores the importance of addressing mental health concerns alongside physical symptoms in lupus treatment plans. Chronic stress, a common experience for lupus patients, can perpetuate a cycle of anxiety and worsening lupus symptoms.

Generalized Anxiety Disorder (GAD) and Lupus

Generalized Anxiety Disorder (GAD) is a specific type of anxiety that can affect lupus patients. Unlike normal worrying, GAD is characterized by persistent and often irrational concerns that permeate various aspects of life. For lupus warriors, the unpredictable nature of their condition can contribute to the development of GAD, creating additional challenges in disease management.

The Impact of Chronic Stress on Lupus Symptoms

Chronic stress plays a significant role in exacerbating lupus symptoms and triggering flares. The constant worry and fear associated with managing a chronic illness can lead to a state of heightened stress, which in turn affects the body’s immune response. This creates a vicious cycle where stress worsens lupus symptoms, and worsening symptoms further increase stress levels.

Recent studies have demonstrated a clear link between the severity of lupus symptoms and the intensity of anxiety and depression experienced by patients. Pain, fatigue, and other lupus-related symptoms can be amplified by anxiety, making it essential to address both physical and mental health concerns simultaneously.

The Physiological Effects of Anxiety on Lupus

Anxiety’s impact on lupus extends beyond emotional distress. Research has shown that anxiety is associated with increased inflammation levels in the body, which can directly contribute to lupus flares and more severe symptoms. Some patients have even reported first noticing lupus symptoms following periods of intense anxiety, suggesting a potential triggering effect.

Medications and Their Role in Lupus-Related Anxiety

It’s important to note that certain medications commonly used in lupus treatment can potentially contribute to anxiety symptoms. These include:

• Aspirin
• Acetaminophen
• Prednisone
• Steroids
• Caffeine

Patients experiencing anxiety should communicate openly with their healthcare providers about their symptoms, as adjustments to the treatment plan may be necessary to alleviate medication-induced anxiety.

Effective Strategies for Managing Anxiety in Lupus Patients

Addressing anxiety is crucial for comprehensive lupus management. Various treatment options and lifestyle modifications can help lupus warriors cope with anxiety and improve their overall well-being:

1. Antidepressant medications: These can be effective in treating anxiety and typically do not interfere with most lupus medications.
2. Psychotherapy: Visiting a mental health professional for talk therapy or cognitive behavioral therapy (CBT) can help identify and manage unhelpful thought patterns.
3. Exercise: Regular physical activity can help manage stress and release endorphins, which act as natural painkillers.
4. Dietary adjustments: Certain foods can stimulate the release of neurotransmitters like serotonin and dopamine, potentially improving mood and reducing anxiety.
5. Pet therapy: Interacting with animals has been shown to reduce anxiety levels in many individuals.
6. Positive self-talk: Practicing affirmations and maintaining a positive mindset can be powerful tools in managing anxiety.
7. Improved sleep hygiene: Developing better sleep habits can significantly impact anxiety levels and overall health.

The Role of Social Support in Lupus Stress Management

Building a strong support network is crucial for lupus patients dealing with anxiety and chronic stress. Surrounding oneself with understanding and supportive individuals can provide emotional grounding and help put worries into perspective. Support groups, both in-person and online, can offer valuable connections with others facing similar challenges.

Family members and friends play a vital role in providing emotional support and practical assistance. Educating loved ones about lupus and its impact on mental health can foster a more supportive environment and reduce feelings of isolation often experienced by lupus warriors.

The Importance of Open Communication

Encouraging open dialogue about mental health concerns within the lupus community is essential. By reducing stigma and promoting awareness, patients may feel more comfortable seeking help and discussing their anxiety with healthcare providers. This open communication can lead to more comprehensive and effective treatment plans.

Integrating Mental Health Care into Lupus Treatment Plans

Given the strong connection between lupus and anxiety, it’s crucial to integrate mental health care into overall lupus management strategies. This holistic approach can lead to better outcomes for patients, addressing both physical symptoms and emotional well-being.

Healthcare providers should consider routine mental health screenings for lupus patients, allowing for early detection and intervention of anxiety disorders. Collaboration between rheumatologists, primary care physicians, and mental health professionals can ensure comprehensive care that addresses all aspects of a patient’s health.

The Benefits of a Multidisciplinary Approach

A multidisciplinary approach to lupus care, including mental health professionals, can offer several benefits:

• More comprehensive symptom management
• Improved medication adherence
• Enhanced coping strategies for dealing with chronic illness
• Better overall quality of life
• Reduced risk of complications related to chronic stress

The Impact of Lifestyle Modifications on Lupus-Related Stress

While medical interventions are crucial, lifestyle modifications can play a significant role in managing stress and anxiety for lupus patients. Incorporating stress-reduction techniques into daily routines can help mitigate the impact of anxiety on lupus symptoms.

Mindfulness and Meditation

Practicing mindfulness and meditation can be particularly beneficial for lupus warriors dealing with anxiety. These techniques can help individuals stay present, reduce rumination on worries, and develop a more balanced perspective on their health challenges. Regular mindfulness practice has been shown to reduce stress levels and improve overall well-being in chronic illness patients.

The Importance of Self-Care

Prioritizing self-care is essential for lupus patients managing anxiety. This can include:

• Setting realistic goals and expectations
• Learning to say no to overwhelming commitments
• Engaging in enjoyable activities and hobbies
• Practicing relaxation techniques such as deep breathing or progressive muscle relaxation
• Maintaining a balanced diet and staying hydrated
• Ensuring adequate rest and pacing activities to avoid overexertion

The Role of Education in Lupus Stress Management

Knowledge is power when it comes to managing lupus and associated anxiety. Educating patients about their condition, treatment options, and coping strategies can significantly reduce stress and improve their sense of control over their health.

Healthcare providers should strive to provide comprehensive education to lupus patients, covering topics such as:

• The nature of lupus and its potential impact on mental health
• Recognizing signs of anxiety and stress
• Available treatment options for both lupus and anxiety
• Stress management techniques specific to lupus patients
• The importance of adherence to treatment plans
• Resources for additional support and information

Empowering Patients Through Knowledge

By empowering patients with knowledge, healthcare providers can help reduce anxiety stemming from uncertainty about their condition. Well-informed patients are better equipped to make decisions about their care, communicate effectively with their healthcare team, and take proactive steps in managing their health.

The Future of Lupus and Anxiety Research

As our understanding of the relationship between lupus and anxiety continues to grow, ongoing research is crucial to developing more effective treatment strategies. Future studies may focus on:

• Identifying specific biological mechanisms linking lupus and anxiety
• Developing targeted interventions for lupus-related anxiety
• Exploring the potential of novel therapies, such as biofeedback or virtual reality-based treatments
• Investigating the long-term impact of anxiety management on lupus progression
• Assessing the effectiveness of integrative approaches combining conventional and complementary therapies

As research progresses, lupus warriors can look forward to more personalized and effective strategies for managing both their physical symptoms and mental health challenges.

The Promise of Precision Medicine

Advancements in precision medicine hold promise for tailoring treatments to individual patients based on their unique genetic, environmental, and lifestyle factors. This approach could lead to more effective management of both lupus symptoms and associated anxiety, minimizing side effects and improving overall outcomes.

Building Resilience in the Face of Lupus and Anxiety

Living with lupus and anxiety requires tremendous strength and resilience. While the challenges can be significant, many lupus warriors have found ways to thrive despite their condition. Building resilience involves developing coping strategies, maintaining a positive outlook, and learning to adapt to the unpredictable nature of lupus.

Strategies for Cultivating Resilience

Some effective strategies for building resilience include:

• Practicing gratitude and focusing on positive aspects of life
• Setting and celebrating small, achievable goals
• Developing a strong support network of friends, family, and fellow lupus warriors
• Engaging in activities that bring joy and a sense of purpose
• Learning from setbacks and viewing challenges as opportunities for growth
• Maintaining a sense of humor and finding laughter in daily life

By cultivating resilience, lupus patients can better navigate the emotional challenges associated with their condition and maintain a higher quality of life.

The Power of Shared Experiences

Connecting with other lupus warriors who have successfully managed their anxiety can be incredibly empowering. Sharing experiences, coping strategies, and mutual support can provide hope and inspiration for those struggling with the dual challenges of lupus and anxiety.

Support groups, online forums, and peer mentoring programs can offer valuable opportunities for lupus patients to connect with others who truly understand their experiences. These connections can help reduce feelings of isolation and provide practical advice for managing both the physical and emotional aspects of living with lupus.

Anxiety, Chronic Stress, and Lupus Symptoms

About 37% of people with lupus have also been diagnosed with anxiety. Feelings of chronic stress can permeate your life and these feelings shouldn’t be ignored.

Anxiety is a sense of fear or panic that intrudes into your thoughts, keeps you awake at night, interferes with eating, and can make you feel sick. It is a response to chronic stress, so it’s no surprise that people with lupus are likely to feel anxious.

What is Generalized Anxiety Disorder (GAD)?

Generalized Anxiety Disorder, or GAD, is a type of worrying that invades any and all aspects of life. Unlike post-traumatic stress disorder (PTSD) which typically is caused by one event or a specific series of events, GAD is connected to everyday stressors.

Worrying is a normal behavior. And, Lupus Warriors have many things to worry about. Worry and fear come and go, depending on the situation. What makes GAD different from normal worrying is that it doesn’t go away and it can be irrational, triggered by small things.  

Anxiety and lupus have a complicated relationship with each other. Having lupus can cause you to develop anxiety, and anxiety can worsen symptoms and trigger flares.

What causes anxiety?

People with lupus have a high likelihood of also having anxiety, which can be caused by many things. One common factor is chronic stress. This is recurring levels of high stress that a person feels. Lupus symptoms, particularly when they fluctuate, add exactly this type of stress to Lupus Warriors.

Chronic stress can make it so that the amygdala, the part of the brain responsible for intense emotions and responding to stress (such as fight or flight,) have trouble “turning off.”

In a 2009 study, 326 Caucasian women with SLE were given the Composite International Diagnostic Interview, a telephone interview used to assess psychiatric disorders. Nearly 65% of the women had symptoms of depression or anxiety. The study also found that many people with lupus also experienced included major depressive disorder (which can include anxiety), social phobia, panic disorder, bipolar I disorder, GAD, and others.

A 2018 study looked a little closer, finding that the severity of lupus symptoms, including pain and fatigue, is linked to the severity of anxiety and depression. 

Anxiety can also be a side effect of medications, including some common lupus treatments. A few medications that have been linked to anxiety include:

• aspirin
• acetaminophen
• prednisone
• steroids
• caffeine

Speak with your lupus treatment team if you are experiencing anxiety as your current treatment plan may be exacerbating symptoms. 

Does being anxious make lupus worse?

Unfortunately, yes anxiety can make autoimmune disease symptoms more severe. Anxiety is linked to increased inflammation levels in the body. This can lead to lupus flares and worse symptoms. Some Lupus Warriors even reported first started seeing symptoms after a period of anxiety.

A large study that evaluated people with rheumatoid arthritis and psoriatic arthritis showed that stress from depression and anxiety could trigger those diseases, and this is the case for other autoimmune diseases, too.

In short, anxiety and lupus can be part of a negative feedback loop. Treating lupus also means treating anxiety. Check out the 4 questions to ask a mental health provider as answered by a Licensed Clinical Social Worker.

Treatments for anxiety

Anxiety can be treated with antidepressant medications, which do not interfere with most other medications for lupus.

Aside from medications, there are many other ways you can reduce your anxiety:

• Visiting a psychologist or other mental health care provider. Talk therapy strategies and cognitive behavioral therapy (CBT) can help with the identification of unhelpful thoughts.
• Surround yourself with people who can ground you and remind you about what you don’t need to worry about.
• Exercise is an effective tool for the management of stress. Additionally, it can cause the release of endorphins in the brain which act as natural painkillers.
• Diet and drinking enough water can help, too. A range of foods can stimulate the release of neurotransmitters like serotonin and dopamine.
• Animals can be especially effective at reducing anxiety, so if you can take care of a pet or have access to an animal, this could be a good option.
• Don’t underestimate the power of your own mind! Saying positive things to yourself can also be a good strategy for getting through anxiety. By telling yourself positive and affirming things, you put yourself in a mindset for solving problems
• Get more sleep. Try different sleep strategies and see if you find a difference.

Learn more

Take the time to prioritize your mental health. If you are feeling anxious, consult with your lupus treatment team and consider adding mental health professionals to your treatment team.

Many health insurance plans include coverage for some mental health services. Be sure to check your plan to make sure providers are in network!

Looking for more tips on managing stress? Read more here

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Pathogenic neuropsychiatric effect of stress-induced microglial interleukin 12/23 axis in systemic lupus erythematosus

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Systemic lupus erythematosus

Pathogenic neuropsychiatric effect of stress-induced microglial interleukin 12/23 axis in systemic lupus erythematosus

1. http://orcid. org/0000-0001-8644-1007Nobuya Abe1,2,
2. Masato Tarumi1,2,
3. http://orcid.org/0000-0003-4705-341XYuichiro Fujieda2,
4. Nobuhiko Takahashi1,
5. Kohei Karino2,
6. Mona Uchida1,
7. http://orcid.org/0000-0002-7663-534XMichihito Kono2,
8. Yuki Tanaka1,3,
9. Rie Hasebe4,5,
10. http://orcid.org/0000-0002-2023-6585Masaru Kato2,
11. Olga Amengual2,
12. http://orcid.org/0000-0003-1305-991XYoshiyuki Arinuma6,
13. Kenji Oku2,6,
14. Wakiro Sato7,
15. Khin Khin Tha8,9,
16. Miwako Yamasaki10,
17. Masahiko Watanabe10,
18. Tatsuya Atsumi2,
19. http://orcid.org/0000-0001-7159-7279Masaaki Murakami1,3,5

1. ¹
   Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
   
2. ²
   Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
   
3. ³
   Group of Quantum Immunology, Institute for Quantum Life Science, National Institute for Quantum and Radiological Science and Technology, Inage, Japan
   
4. ⁴
   Center for Infectious Cancers, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
   
5. ⁵
   Division of Molecular Neuroimmunology, National Institute for Physiological Sciences, National Institute of Natural Sciences, Okazaki, Japan
   
6. ⁶
   Department of Rheumatology and Infectious Diseases, School of Medicine, Kitasato University, Sagamihara, Japan
   
7. ⁷
   Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
   
8. ⁸
   Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
   
9. ⁹
   Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
   
10. ¹⁰
    Department of Anatomy, Faculty of Medicine, Hokkaido University, Sapporo, Japan
    

1. Correspondence to
   Professor Masaaki Murakami, Division of Molecular Psychoimmunology, Institute for Genetic Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; murakami{at}igm. hokudai.ac.jp; Professor Tatsuya Atsumi, Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Sapporo, Japan; at3tat{at}med.hokudai.ac.jp

Abstract

Objectives The central nervous system disorder in systemic lupus erythematosus (SLE), called neuropsychiatric lupus (NPSLE), is one of the most severe phenotypes with various clinical symptoms, including mood disorder, psychosis and delirium as diffuse neuropsychological manifestations (dNPSLE). Although stress is one of the aggravating factors for neuropsychiatric symptoms, its role in the pathogenesis of dNPSLE remains to be elucidated. We aimed to investigate stress effects on the neuropsychiatric pathophysiology in SLE using lupus-prone mice and patients’ data.

Methods Sleep disturbance stress (SDS) for 2 weeks was placed on 6–8-week-old female MRL/lpr and control mice. Behavioural phenotyping, histopathological analyses and gene and protein expression analyses were performed to assess SDS-induced neuroimmunological alterations. We also evaluated cytokines of the cerebrospinal fluid and brain regional volumes in patients with dNPSLE and patients with non-dNPSLE.

Results SDS-subjected MRL/lpr mice exhibited less anxiety-like behaviour, whereas stressed control mice showed increased anxiety. Furthermore, stress strongly activated the medial prefrontal cortex (mPFC) in SDS-subjected MRL/lpr. A transcriptome analysis of the PFC revealed the upregulation of microglial activation-related genes, including Il12b. We confirmed that stress-induced microglial activation and the upregulation of interleukin (IL) 12/23p40 proteins and increased dendritic spines in the mPFC of stressed MRL/lpr mice. IL-12/23p40 neutralisation and tyrosine kinase 2 inhibition mitigated the stress-induced neuropsychiatric phenotypes of MRL/lpr mice. We also found a higher level of cerebrospinal fluid IL-12/23p40 and more atrophy in the mPFC of patients with dNPSLE than those with non-dNPSLE.

Conclusions The microglial IL-12/23 axis in the mPFC might be associated with the pathogenesis and a promising therapeutic target for dNPSLE.

• cytokines
• lupus erythematosus, systemic
• psychology
• Magnetic Resonance Imaging
• inflammation

Data availability statement

Data are available in a public, open access repository. Data are available upon reasonable request. In detail, RNA-seq datasets that support the observations of this study have been deposited in the Gene Expression Omnibus with the series accession number GSE176429. MRI data have been stored locally following national and Japanese laws on the protection of individuals with regard to the processing of personal data. Other data are available in the main text or the supplementary materials and are available upon reasonable request to the corresponding author.

http://dx.doi.org/10.1136/ard-2022-222566

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• cytokines
• lupus erythematosus, systemic
• psychology
• Magnetic Resonance Imaging
• inflammation

Data availability statement

Data are available in a public, open access repository. Data are available upon reasonable request. In detail, RNA-seq datasets that support the observations of this study have been deposited in the Gene Expression Omnibus with the series accession number GSE176429. MRI data have been stored locally following national and Japanese laws on the protection of individuals with regard to the processing of personal data. Other data are available in the main text or the supplementary materials and are available upon reasonable request to the corresponding author.

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Footnotes

• Handling editor Josef S Smolen

• Contributors Conceptualisation: NA and MM. Methodology: NA, NT, YF, YT, RH and KKT. Investigation: NA, NT, MT, KK, MU and KKT. Visualisation: NA and YF. Resources: YA, WS, KKT and MY. Funding acquisition and project administration: KO, TA and MM. Supervision: MKono, MKato, MY, MW, TA and MM. Writing—original draft: NA, YF and KO. Writing—review and editing: OA, KKT, MW, TA and MM. Guarantors: TA and MM.

• Funding This work was funded by the grant from Bristol Myers Squibb Foundation to TA, and grants from JSPS KAKENHI, Q-Leap (JPMXS0120330644), AMED, The Joint Usage/Research Center Institute for Genetic Medicine, Hokkaido University, the Photo-excitonix Project at Hokkaido University and the Promotion Project for Young Investigators at Hokkaido University to MM.

• Competing interests None declared.

• Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

• Provenance and peer review Not commissioned; externally peer reviewed.

• Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Biologists have found the molecular mechanism of exacerbation of lupus in chronic stress – Gazeta.

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Biologists have found the molecular mechanism of exacerbation of lupus in chronic stress – Gazeta.Ru | News

July 11, 2022, 19:30

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Exacerbation of systemic lupus erythematosus can be caused by stress, which was previously observed by doctors, and now confirmed by biologists. The molecular mechanism underlying this phenomenon could be a target for the first lupus drugs. The study was published in the journal Annals of the Rheumatic Diseases .

Systemic lupus erythematosus is an incurable autoimmune disease that alternates between periods of remission and exacerbation. There is no cure for it, doctors can only reduce the risk of exacerbation and relieve some of the symptoms. It is known that stress can worsen the patient’s condition. As researchers from the Institute of Genetic Medicine at Hokkaido University found out, stress triggers a molecular mechanism that ultimately leads to an increase in the levels of interleukins IL12 and IL23.

So far, they have only reached this conclusion in mice that have been subjected to sleep deprivation, which resulted in a change in the activity of at least 509 genes. Blocking the IL12 and IL23 pathways in mice suppressed stress-induced neuropsychiatric symptoms. But even in people with lupus, the levels of these interleukins in the cerebrospinal fluid are so much higher than in healthy people that they can be used as a diagnostic marker. IL12 and IL23 thus may become important therapeutic targets for the treatment of neuropsychiatric lupus with diffuse neuropsychological manifestations (dNPSLE), which has been studied by biologists.

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Stress induces inflammation in the prefrontal cortex in lupus – PCR News

Prepared by

Alina Suleymanova

Japanese scientists have shown in a mouse model of lupus that stress caused by sleep deprivation leads to the activation of microglia and the synthesis of interleukins 12 and 23 in the prefrontal cortex (PFC). Similar phenomena – high levels of interleukins and PFC atrophy – have been found in people with lupus. Thus, interleukins can be considered as a potential target for the treatment of the disease.

Prepared by

Alina Suleymanova

Systemic lupus erythematosus (SLE) is a serious autoimmune disease in which there is multiple organ damage, including inflammation in the central nervous system (CNS). Neuropsychiatric SLE (NPSLE) is one of the most severe forms of the disease, characterized by a range of symptoms ranging from mood swings to psychosis and delirium. It is known that stress increases the risk of developing autoimmune diseases and is involved in their exacerbation. But its role in the pathogenesis of NPSLE is poorly understood.

To investigate this issue, researchers from the University of Hokkaido disturbed the sleep of mice of the MRL / lpr line, reproducing the symptoms of lupus. To provoke stress in the body of rodents, they were placed in cages with a spinning wheel for two weeks. These observations were compared with MRL/MpJ control mice, which were also bred to study autoimmune diseases but showed an increased ability to regenerate. The authors then subjected the animals to behavioral tests, as well as immunohistochemical analysis of brain tissue and RNA sequencing to assess the effect of stress.

Lack of sleep really caused stress in rodents: the level of the hormone corticosterone in their blood increased. However, the MRL/lpr experimental mice were less anxious in behavioral tests than the MRL/MpJ mice, as well as their sleepy counterparts. It turned out that the anxiolytic effect (stress reduction) was mediated by medial prefrontal cortex (mPFC) neurons, which were abnormally active in stressed MRL/lpr rodents.

According to transcriptome analysis of mPFC cells, stress affected the expression of 509genes associated with microglial activation in MRL/lpr mice. Thus, activity was increased in microglia activating genes h3-Eb1 , Nos2, Il12b and Fcgr4 , and decreased in inhibitory genes Arg1, Nr4a3 and Treml4 . In particular, gene Il12b
encodes a subunit of interleukins IL12 and IL23, which are involved in the development of inflammation. The content of these cytokines was high in the cerebrospinal fluid of mice. Blocking of the IL12 and IL23 signaling pathways, as well as inhibition of the tyrosine kinase 2 involved in them, suppressed the stress-induced anxiolytic effect and microglial activation in mPFC in MRL/lpr mice.