Stress and rheumatoid arthritis (RA) can make each other worse, like a cycle. That is, RA symptoms can be stressful, and stress can worsen your symptoms. The pain of arthritis, concern about medical bills and mobility, and other factors all pile on the stress when you have RA. And, studies suggest that having RA increases your risk of stress, and particularly work or social stress.
Meanwhile, stress releases hormones that cause physical tension. In the long term, this can worsen inflammation and therefore RA symptoms.
Luckily, there are a number of ways to combat these symptoms and manage stress with RA.
How to Stress Less With RA
Stress relief, in conjunction with medicines such as disease-modifying antirheumatic drugs (DMARDs), can reduce the need for other medications, such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs).
Here are eight tips that might help.
1. Exercise Regularly
The idea of staying active can sound daunting, but regular exercise keeps joints from stiffening up, strengthens muscles, and lifts your mood. Rather than hurting, the right kind of exercise can help reduce joint pain.
What’s more, a sedentary life has been linked with higher stress levels. Moderate-intensity exercise can benefit your:
Central nervous system
Mood
Ability to think clearly
Overall physical well-being
The processes set in force by regular exercise can also remove dead and unwanted cells and reduce or prevent inflammation. Exercise can boost your resilience to stress, lowering the odds that it will lead to anxiety and depression. It can also help with weight management.
You don’t need to become an olympic athlete to get started: Three sessions of 10 minutes per day can have significant benefits.
Good types of exercise include:
Stretching
Walking
Swimming, which relieves the weight on your joints
Slow movement exercise such as yoga and tai chi to help with flexibility and mindfulness
Stationary cycling
Lifting weights, under the supervision of an instructor
Check with your doctor before starting a new exercise program to make sure it’s suitable for you. And remember to listen to your body and not overdo it, especially during an RA flare.
2. Join a Support Group
Family and friends are often your first line of support, but online and in-person groups offer interaction with others who share the experience of RA. A chance to vent and hear about other people’s experiences can be a huge de-stressor, says Bella Fradlis, MD, a rheumatologist at Garnet Health in Goshen, New York.
You can also pick up smart coping strategies that others with RA have tried, from ways to get dressed quickly for work in the morning to setting a peaceful tone and rhythm for your day, she says. As time goes by and you get your RA under control, you may even discover a desire to mentor new members, which can give you a sense of purpose.
Research also suggests that seeking support from others can improve levels of inflammatory proteins known as CRP in those living with RA. Higher CRP levels imply higher levels of disease activity and inflammation.
Talk to your doctor about joining either an in-person support group near your home or an online forum, such as one of the Arthritis Foundation’s Connect Groups or CreakyJoints, a free online community of support and resources for people with all forms of arthritis.
3. Get Practical Help
You may be more prone to stress with RA if you have:
High pain levels
Low mobility
A lower income
Limited social support
Personality traits such as sensitivity to anxiety and excessive worrying
If you’re struggling to navigate the health system, or worrying about mobility or how to pay for medication, ask your local health center for advice on who to speak to.
During an RA flare, it’s easy to focus on the joint pain and stiffness. This is where journaling may help.
Some people find that writing in a gratitude journal can really help them focus on the good things in life, Dr. Fradlis says. It can help you relax, improve your mood, and even distract you from RA pain. Journaling in general can also be an effective and inexpensive way to release stress.
A review published in 2023 found that people who underwent gratitude interventions experienced better mental health, lower levels of anxiety and depression, and improved satisfaction with life overall.
Ways of getting started include:
Journal with a focus on positive experiences.
Post photos online with captions of gratitude.
Express gratitude to people around you.
Take time to reflect on things you’re grateful for.
Similarly, focus on what you can do, despite RA, to improve how you feel about your body and reduce depression. Cognitive behavioral therapy (CBT) may also help: A meta-analysis showed CBT could significantly reduce levels of anxiety depression and relieve fatigue in RA symptoms.
5. Accept and Adjust to the Challenges
A chronic illness diagnosis can be stressful in itself.
Here are some tips from the Arthritis Foundation to help you adjust:
Remember you are not your RA. Keep being the person you were before, with friends, interests, and so on, only with extra challenges.
Accept the bad days. RA comes in flares, and most people do experience remission. There’s a good chance a better day is around the corner.
Monitor your symptoms. If you know certain factors increase the risk of a flare, try to minimize them. If symptoms are worsening, contact your medical team.
Seek help as needed. If you feel a flare coming on, make sure you have the medications you need at hand. Keep a list of helpful phone numbers handy and don’t be afraid to ask for help.
Express yourself. Share with others how RA is affecting you. It will help them understand your needs and when you might need help.
6. Practice Mindfulness
Take time out to relax, breathe, and focus to manage the pain and stress of RA.
A review published in 2021 found that people with RA who learned mindfulness had less depression, stress, and disease activity than those who didn't, although more research is needed.
In 2022, researchers published the findings of a pilot study in which 28 people with RA received mindfulness-based stress reduction (MBRS) therapy in weekly sessions lasting 2.5 hours for eight weeks, plus a 6-hour retreat between weeks 6 and 7. Up to 12 months after treatment, participants continued to have significantly lower levels of anxiety and depression and a greater ability to sleep, function, and cope with their emotions.
Alongside mindfulness, it can be helpful to identify thoughts, emotions, and body sensations that are linked with your experience of RA, stress, or both.
7. Cultivate Your Sense of Humor
“The old adage ‘Laughter is the best medicine’ might not be so crazy after all,” says Victoria K. Shanmugam, MD, the director of the division of rheumatology at George Washington University in Washington, DC. “Our emotional and immune states share a complex and bidirectional relationship with one another.” And research backs this up: A sense of humor can be an effective coping strategy for people with RA and stress.
Laughter can:
Lighten your mood
Stimulate the heart and other body organs by increasing your intake of oxygen-rich air
Activate and relieve your stress response, leaving you feeling more relaxed
Soothe tension by boosting circulation and relaxing stressed muscles
In the long term, it may:
Support your immune system by releasing stress-reducing neuropeptides
Help relieve pain by stimulating the body to produce natural pain killers
Make tough situations easier to face
Help you connect with other people
Reduce stress and anxiety and boost your self esteem
Here are some tips to help you get a regular laugh:
See the humor in your own experiences and laugh with others about them
Find a funny book or film to enjoy
Share online jokes and funny clips with others
Spend time with people who like to laugh or tell jokes
Find a local “laughter yoga” class
Play with or watch animals or children
8. Get a Good Night’s Sleep
People with RA often find it hard to get a good night’s sleep, which can worsen pain, mood, and fatigue. But, getting enough sleep can help you manage stress and RA, Fradlis says.
Research from 2022 suggests that better sleep may improve your pain and quality of life.
The authors define better sleep as:
A regular number of sleep hours each night
Reduced sleep disturbances
Falling asleep soon after turning the lights out
Tips for achieving this include:
Establish a regular bedtime and morning routine.
Ensure your room is cool, quiet, and dark enough for your comfort.
Avoid large meals in the evening and caffeine after midday.
Exercise regularly.
Switch off electronic devices at least 30 minutes before bedtime and leave them outside the room.
Keep a sleep diary to track your sleep patterns and causes of disturbances.
Ask your doctor to adjust your medication if pain keeps you awake.
When to Get Help for Stress
If you have RA and you’re struggling with stress or anxiety, it’s a good idea to speak with your doctor. They may suggest counseling or prescribe medications to help you.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Nowacka-Chmielewska M et al. Running from Stress: Neurobiological Mechanisms of Exercise-Induced Stress Resilience. International Journal of Molecular Sciences. November 1, 2022.
Wróbel A et al. Relationship between perceived stress, stress coping strategies, and clinical status in patients with rheumatoid arthritis. Rheumatology International. June 18, 2023.
Diniz G et al. The effects of gratitude interventions: a systematic review and meta-analysis. Einstein (São Paulo). July 31, 2023.
Alleva JM et al. More than my RA: A randomized trial investigating body image improvement among women with rheumatoid arthritis using a functionality-focused intervention program. Journal of Consulting and Clinical Psychology. August 2018.
Ionescu C et al. Depression in Rheumatoid Arthritis: Prevalence and Effects on Disease Activity. Journal of Clinical Medicine. April 2, 2024.
Shen B et al. Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis. Psychology, Health & Medicine. November 25, 2020.
Schimming C. 8 tips for coping with a serious diagnosis. Mayo Clinic. April 18, 2022.
Oliveira LN et al. Mindfulness for patients with rheumatoid arthritis: systematic review. Research, Society and Development. February 2, 2021.
Gaboury I et al. Mindfulness-based stress reduction to improve depression, pain and high patient global assessment in controlled rheumatoid arthritis. Rheumatology Advances in Practice. September 5, 2022.
Mayo Clinic Staff. Stress Relief From Laughter? It’s No Joke. Mayo Clinic. September 2023.
Laugher Is the Best Medicine. HelpGuide.Org. February 2024.
McBeth J et al. Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study. Journal of Medical Internet Research. April 22, 2022.
Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.
Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.
Yvette Brazier's career has focused on language, communication, and content production, particularly in health education and information. From 2005 to 2015, she supported learning in the health science department of a higher education establishment, teaching the language of health, research, and other language application skills to paramedic, pharmacy, and medical imaging students.
From 2015 to 2023, Yvette worked as a health information editor at Medical News Today and Healthline. Yvette is now a freelance writer and editor, preparing content for Everyday Health, Medical News Today, and other health information providers.
