title: The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Psychology, School of Psychology, University of Granada, Granda, Spain. mperalta@ugr.es
authors.forename: Maria I
authors.initials: MI
authors.lastname: Peralta-Ramírez
authors.forename: Juan
authors.initials: J
authors.lastname: Jiménez-Alonso
authors.forename: Juan F
authors.initials: JF
authors.lastname: Godoy-García
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-García
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000276:immunology; D003176:Complement C3 / Q000276:immunology; D003181:Complement C4 / Q000276:immunology; D005260:Female; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008179:Lupus Erythematosus, Discoid / Q000175:diagnosis* / Q000276:immunology / Q000523:psychology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D010555:Personality Inventory; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis* / Q000276:immunology / Q000523:psychology
chemical_list: D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4