Clin Rheumatol. 2025 Dec 2. doi: 10.1007/s10067-025-07859-1. Online ahead of print.
ABSTRACT
BACKGROUND: While stress is associated with the exacerbation of rheumatoid arthritis (RA), empirical evidence linking specific, acute real-world stressors to objective inflammatory markers and clinical symptoms remains limited. This study investigated the short-term effects of a defined occupational stressor-24-h hospital duty-on C-reactive protein (CRP) levels and pain in a patient with RA.
METHODS: A 40-day prospective, within-subject observational study was conducted on a male participant with stable, low disease activity RA. During this period, the participant completed six 24-h duty shifts. A total of 20 high-sensitivity CRP blood tests were performed, and daily self-reported data on pain and stress/fatigue were collected. Fisher’s exact test was used to compare the proportion of CRP-positive samples ( exact tedL) obtained within 2 days after a duty shift to those from all other periods. Spearman correlation analysis was employed to evaluate the relationships between CRP levels, pain intensity, and fatigue.
RESULTS: CRP levels showed statistically significant, strong positive correlations with both pain intensity (rho = 0.68, p < 0.001) and fatigue (rho = 0.74, p < 0.001). The CRP positivity rate was 63.6% (7/11) within 2 days following a 24-h duty shift, which was significantly higher than the rate of 0% (0/9) during non-post-duty periods (p = 0.0067). Furthermore, even minimal elevations in CRP were associated with substantial increases in pain intensity.
CONCLUSION: This single-case study provides preliminary evidence that acute, real-world occupational stress can trigger a significant increase in systemic inflammation (CRP) and associated clinical symptoms in RA. These findings underscore the importance of stress management in RA care and suggest that clinically meaningful disease activity may persist even when CRP levels are normal (< 0.50 mg/dL) or only minimally elevated.
PMID:41329429 | DOI:10.1007/s10067-025-07859-1
