Psychophysiological stress mechanisms in chronic inflammatory diseases; an experimental study

There is increasing evidence for the idea that psychological stress factors can
influence chronic inflammatory diseases, such as rheumatoid arthritis (RA) and
psoriasis (PS). These relationships are assumed to be (at least partly)
mediated by immune and neuroendocrine function. Despite preliminary evidence,
the limited research revealed inconsistent findings, particularly regarding
immune and neuroendocrine mediation. In addition, our and other previous work
suggests that stress mechanisms affecting disease activity and immunological
parameters are primarily evident in patients with a psychological risk profile
for stress.
Referring to the previous CMO approved research proposal (2004/222), the
present experimental project is aimed at elucidating the effects of short-term
stress and a short-term stress management intervention in a group of 64 RA
patients and 64 PS patients (high risk and low risk). It is expected that, only
in patients at risk, short-term stress and the stress management intervention
affect self-reported, immune and neuroendocrine indicators of
stress-reactivity, which in turn affect disease activity and physical symptoms
of pain and itching.

Referring to the previous CMO approved research proposal (2004/222), in this
study the effects of a short-term stressor and a stress-reducing intervention
on neuroendocrine, immune and self-reported indicators of stress reactivity in
patients with RA and PS will be investigated. Special attention will be paid to
patients psychologically at risk for stress.

This study is composed of two parts: a stress experiment and a stress
management intervention.

Stress experiment:
During 4 months, 128 patients (64 RA and 64 PS patients) will visit the Radboud
hospital 3 times for an experimental stress experiment (Trier Social Stress
Task). During these visits, different clinical, physiological and self-reported
variables will be assessed. Additionally, for matching control data 32 healthy
participants will participate in the stress experiment once.

Stress management intervention:
In a randomized controlled trial half of all RA and PS patients with
respectively a high and low risk profile for stress (2 times 32 patients) will
receive a stress management intervention. This intervention takes place in
between the first and second visit for the stress experiment. Patients in the
intervention group will visit the hospital twice every week during one month.
Additionally, they have some homework assignments (15 minutes daily).

The intervention study is a randomized controlled trial. Half of all
participants with respectively a high and low risk profile for stress will be
asked to participate in a stress management intervention. Participants will
visit the Radboud hospital 8 times (2 sessions a week during 4 weeks; ca. 1
hour each session). During these visits participants are offered relaxation
therapy. Additionally, they will get homework assignments (15 minutes each
day). The control groups (half of all RA and PS patients and all healthy
controls) will not be offered the stress management intervention.

There are no risks involved for the participants of this study, only investment
in time. The design of this study is necessary to elucidate the role of
psychophysiological stress mechanisms in the chronic inflammatory diseases RA
and PS. In the long run, this study might contribute to the improvement of
diagnostics and treatment of chronic inflammatory diseases.