Rheumatoid arthritis in crisis: investigating the impact of stress on RA flares during the COVID-19 pandemic.
Level 4 - case-series / case-control
Cross-sectional survey study
PubMed 41619155 · doi:10.1007/s10067-025-07754-9
What was done
This was a cross-sectional study of patients with rheumatoid arthritis (identified via ICD-9/10 codes) surveyed via email in July and November 2020. The questionnaire assessed disease activity (RAPID3), flare occurrence and frequency (RA Flare Questionnaire), perceived stress (PSS-4), pandemic-related stressors, and demographics. Age, anti-CCP, and rheumatoid factor were extracted from medical records. Regression models evaluated associations between stress metrics and current flare status, flare count, and changes in flare frequency.
What was found
Of 1,138 respondents (22.6% response rate), 69.3% reported at least one flare during the pandemic, 43.0% reported multiple flares, and 36.3% reported currently experiencing a flare. Compared to pre-pandemic recall, 36.3% reported more frequent flares, while 9.2% reported fewer. Current flare was significantly associated with PSS-4 score, financial stress, and sleep quality (all p < 0.03). Number of flares was associated with PSS-4 score, financial stress, and home stress (all p < 0.03). Increased flare frequency was associated with PSS-4, apprehension, panic, financial stress, and sleep quality (all p < 0.05). Asian race was negatively associated with flare count and frequency (both p < 0.05). Point estimates and odds ratios were not reported in the abstract.
Why it matters
It highlights that heightened psychological, financial, and domestic stressors during societal crises correlate with increased patient-reported rheumatoid arthritis flare activity, emphasizing the potential utility of stress-management strategies.
Limits
The study is cross-sectional, precluding causal inference between stress and disease flares. The low response rate (22.6%) creates risk of non-response bias. Flare rates prior to the pandemic relied on retrospective self-report susceptible to recall bias, and the abstract omits specific effect sizes (odds ratios or regression coefficients).
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