The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus

Psychosom Med. 2004 Sep-Oct;66(5):788-94. doi: 10.1097/01.psy.0000133327.41044.94.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antibodies, Antinuclear / immunology
  • Complement C3 / immunology
  • Complement C4 / immunology
  • Female
  • Health Status*
  • Humans
  • Life Change Events*
  • Lupus Erythematosus, Discoid / diagnosis*
  • Lupus Erythematosus, Discoid / immunology
  • Lupus Erythematosus, Discoid / psychology
  • Lupus Erythematosus, Systemic / diagnosis*
  • Lupus Erythematosus, Systemic / psychology
  • Male
  • Personality Inventory
  • Severity of Illness Index
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / immunology
  • Stress, Psychological / psychology


  • Antibodies, Antinuclear
  • Complement C3
  • Complement C4