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The Effects of Daily Stress and Stressful Life Events on the Clinical Symptomatology of Patients With Lupus Erythematosus

Peralta-Ramírez, Maria I. PhD; Jiménez-Alonso, Juan MD; Godoy-García, Juan F. PhD; Pérez-García, Miguel PhDthe group Lupus Virgen de las Nieves

doi: 10.1097/01.psy.0000133327.41044.94
Original Articles

Objective: The purpose of this study was to verify whether stress worsens the clinical symptomatology perceived by patients with lupus erythematosus. Toward this end, we considered two types of stressors—daily stress and high-intensity stressful life events.

Methods: In 46 patients with systemic lupus erythematosus and 12 patients with chronic lupus discoid, we studied the stress they experienced daily for 6 months and their disease symptoms. During this period, we also analyzed the levels of C3 and C4 complements and anti-DNAn antibodies. The systemic lupus erythematosus activity (assessed by the Systemic Lupus Activity Measures) and cumulative organ damage (assessed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were also analyzed.

Results: We did not find that high-intensity stressful life events produced a worsening of the symptomatology of the disease. However, using a time-series analysis (Box–Jenkins), we found that a high percentage of lupus patients (74.1%) perceived a worsening in their clinical symptomatology due to the effects of daily stress. Of this 74.1%, 53.4% worsened the same day they suffered the perceived daily stress, and the remaining 20.7% experienced an increase in symptoms both the same day and the following day. Subsequent Mann–Whitney analyses showed that the patients who worsened for 2 days because of the effects of stress had greater lupus activity, as evaluated by their levels of C3, C4, and anti-DNAn.

Conclusion: Daily stress, and not stressful life events, worsened the clinical symptomatology perceived by lupus erythematosus patients. This increase extended at times to 2 days, and was associated with greater lupic activity.

SLE = systemic lupus erythematosus; SLICC/ACR = Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SSLE = Scale of Stressful Life Events; DSI = Daily Stress Inventory; SLESI = SLE Symptoms Inventory; SLEDAI = SLE Disease Activity Index.

From the Department of Clinical Psychology, School of Psychology, University of Granada, Granda, Spain (M.I.P.-R., J.G.-G., M.P.-G.); and the Systemic Autoimmune Disease Unit, University Hospital “Virgen de las Nieves,” Granada, Spain (J.J.-A.)

Address correspondence and reprint requests to Maria I. Peralta-Ramírez, Campus Universitario de Cartuja s/n, Facultad de Psicología de Granada, Universidad de Granada, 18071 Granada, España. E-mail:

Received for publication July 1, 2003; revision received April 15, 2004.

Other members of the Group Lupus Virgen de las Nieves: Drs. Laura Jáimez, Manuel Guzmán Úbeda, Miguel Ángel Ferrer, Antonio García Sánchez, Rafael Cáliz, Valentín García Mellado, Elena García Lora, Jorge Espelt, Jesús Tercedor, Juan Pasquau, José Manuel Osorio, Santiago Medialdea, MŞ Dolores López Segarra, MŞ Teresa Muros, Gonzalo Piédrola, Jesús Prieto, MŞ José Pimentel, Miguel Ángel Rosales, Pedro Luis Carrillo, José Mario Sabio, Encarnación Milla, David Esteva, Carmen Vera, Julián Muñoz, Nuria Navarrete, Pilar Macías, Concepción García–García, and Fernando Jaén.

Copyright © 2004 by American Psychosomatic Society
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