Psiconeuroinmunoendocrinología de la Respuesta al Estrés, el Ciclo Circadiano y la Microbiota en la Artritis Reumatoide

Introduction and objectives

Psychoneuroimmunoendocrinology is a field of science that documents bidirectional communication originating on a physiological level between the mind and the nervous, immune and endocrine systems, and centres on the effects of stress on these systems. Various studies have shown that stress and certain emotions such as anger, anxiety and depression affect clinical outcomes in conditions such as cardiovascular diseases, autoimmune diseases, cancer and human immunodeficiency virus infection. This paper focuses on rheumatoid arthritis as a paradigmatic autoimmune disease and documents the changes that occur from a psychoneuroimmunoendocrinology perspective and the effects of stress on the activity of the disease.

Methods

Literature indexed to date describing the effects of stress on the onset or course of rheumatoid arthritis was reviewed.

Results

In the stress response system, patients with rheumatoid arthritis present dysfunction of the hypothalamic–pituitary–adrenal axis, predominance of the sympathetic nervous system, increased pro-inflammatory interleukins, marked dysbiosis and dual immunomodulatory effects of melatonin.

Conclusions

In an era in which medicine is divided into multiple subspecialisations, it is important to return to the concept of health as a complex state based on a dynamic balance among biopsychosocial factors of mind/body/environment interaction in disease processes. For this reason, a psychoneuroimmunoendocrinological approach to individuals and their illnesses constitutes an important challenge in the treatment of patients with autoimmune diseases.