A dual pathway model of daily stressor effects on rheumatoid arthritis
A dual pathway model of daily stressor effects on rheumatoid arthritis
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DOI：
10.1007/bf02883333
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发表时间：
1997-03-01
影响因子：
3.8
通讯作者：
Aloisi, R
中科院分区：
文献类型：
--
作者：
Affleck, G;Urrows, S;Aloisi, R
这项研究评估了双途径概念模型的初步前景，该模型通过免疫系统激活和情绪的变化将日常事件应激源与类风湿性关节炎(RA)疾病活动联系起来。50名受试者分别在两周内进行了五次研究，在日常生活体验检查表上报告了日常事件压力源，在情绪状态B简略版上报告了日常情绪，在风湿学疾病活动快速评估中报告了日常关节疼痛。一系列临床检查包括关节压痛和肿胀评级，检查期间抽取的血液分析沉降率(全身炎症的指标)和可溶性白介素2受体(已知的免疫系统激活的标志，与RA疾病活动相关)。当对神经质对自我报告测量的影响进行调整时，跨人分析未能建立日常事件应激源与疾病活动或关节疼痛和关节炎症的组合之间的联系。然而，汇集的人内分析总体上与双途径模型预测的关系一致。在每次临床检查前一周，日常事件应激源的增加与关节疼痛的增加有关(与情绪变化无关)。同时，日常应激源的增加通过降低可溶性白介素2受体的水平间接地与关节炎症的减少有关。双途径模型可能仅限于短期的心理和心理免疫学过程，强调了在类风湿关节炎患者中区分应激对疼痛的潜在相反影响和炎症的重要性。
This study evaluated the initial promise of a dual-pathway conceptual model linking daily event stressors to rheumatoid arthritis (RA) disease activity through changes in immune system activation and mood. Fifty individuals, who were studied on five occasions two weeks apart reported daily event stressors on the Daily Life Experience Checklist, daily mood on an abbreviated version of the Profile of Mood States-B, and daily joint pain on the Rapid Assessment of Disease Activity in Rheumatology. Serial clinical examinations comprised ratings of joint tenderness and swelling, and blood drawn during exams was analyzed for sedimentation rate (an indicator of systemic inflammation) and soluble interleukin-2 receptors (a marker of immune system activation known to correlate with RA disease activity). Across-person analyses failed to establish links from daily event stressors to either disease activity or composites of joint pain and joint inflammation when associations were adjusted for the effect of neuroticism on self-report measures. Pooled within-person analyses, however were generally consistent with the relations predicted by the dual-pathway model. Increases in daily event stressors during the week preceding each clinical exam were associated with increased joint pain (regardless of changes in mood). At the same time, increased daily stressors were indirectly associated with decreased joint inflammation through reduction in levels of soluble interleukin-2 receptors. The dual-pathway model, which may be limited to short-term psychological and psychoimmunologic processes, underscores the importance of distinguishing potentially apposing effects of stress on pain versus inflammation in individuals with rheumatoid arthritis.