-by Esther M. Sternberg, M.D

Esther M. Sternberg, M.D. is the Chief of the Section on Neuroendocrine Immunology and Behavior at the National Institute of Mental Health; Director of the Integrative Neural Immune Program, NIMH/NIH; and Co-Chair of the NIH Intramural Program on Research in Women Health, National Institutes of Health, Bethesda, MD

The notions that stress can make you sick or believing could make you well have been embedded in the popular culture for thousands of years, but only recently have scientists and physicians had the tools to prove that these ideas are real. In ancient Greece, people visited Temples to Asclepius, the Greek God of Healing, to be cured with prayers, music, sleep, dreams, healthy diet, pure water, exercise, and socializing with family and friends. These temples were always built at the tops of hills overlooking the sea, near a fresh water source, and had gently sloping ramps that even the lame could climb.

In this article I will briefly describe some of what we have learned in recent years about the role of the stress response in autoimmune diseases like rheumatoid arthritis, how stress can worsen disease, and how understanding the cross-talk between the brain and the immune system can help us structure our lives to help us heal.

Of course, stress alone does not cause autoimmune diseases like arthritis, and removing stress alone does not cure arthritis. But relaxation can help one=s body to heal and to respond to the advanced medications that have been developed in recent years to treat such diseases.

Many genes--over 20 different ones, each with small effect--contribute to susceptibility to inflammatory arthritis. A blunting of the brain hormonal stress response is also an important contributor to development of autoimmune diseases. The reason for this is that cortisol, the potent anti-inflammatory hormone that is released from the adrenal glands in response to stress, is also released after exposure to inflammatory triggers.

In normal circumstances cortisol keeps the immune system in check, preventing inflammation from going out of control. In many patients with autoimmune diseases, this cortisol response and the cascade of brain hormones that stimulates its release are impaired, so there is no shutoff valve to end inflammation when it is no longer needed. In other patients, the cortisol response may be intact but immune cells are resistant to the anti-inflammatory effects of cortisol due to abnormalities in the cortisol receptor. In both circumstances, inflammation goes on unchecked without the dampening effect of the body own cortisol.

Conversely, chronic stress, like that experienced by chronic caregivers of Alzheimer=s patients, is associated with elevated levels of cortisol which keep the immune system in a sluggish state, predisposing to infection. Such persons are more prone to more severe viral infections, have lower take-rate of vaccines, and have prolonged wound healing--all functions dependent on an intact immune response.

Salubrious activities like meditation, prayer, sleep, exercise, healthy life style and social support--many of those activities that the ancient Greeks practiced in their temples to Asclepius--tend to reduce the stress response and prevent the negative effects of cortisol on the immune system.

Patients often ask me whether reducing the stress response further will have a negative influence on arthritis. The answer to that question is no--there are many other hormones and nerve chemicals that are released during stress that can worsen arthritis, and removing these factors as much as possible can only help.

But it may not be possible to reduce your stress response on your own. If you have tried and failed, it is important to remember that it is not your fault--it=s your biology. Once your stress response is stuck in the on position, as occurs during clinical depression, you cannot fix it on your own. You need to seek professional help from a health care provider who can administer whatever treatments are necessary, including medications to reverse the problem. Today, because of the scientific discoveries that have shown how the brain and immune system communicate, physicians are better able to work with their patients to blend complementary and alternative approaches with the latest advances in modern medicine to help their patients heal.

--Note: Dr. Esther Sternberg is internationally recognized for her discoveries in brain-immune interactions and the brain stress response in diseases including arthritis: the science of the mind-body interaction. She publishes numerous original scientific articles, reviews, and textbook chapters in leading scientific journals; and she has authored the popular book The Balance Within: The Science Connecting Health and Emotions (W. H. Freeman and Company, New York, NY).

The recipient of many prestigious awards, Dr. Sternberg lectures and chairs conferences nationally and internationally, including the Smithsonian Institution (Washington, D.C.) and the Nobel Forum (Karolinska Institute, Stockholm). She is Past-President of the International Society for Neuroimmunomodulation; co-directed the National Library of Medicine Exhibition on "Emotions and Disease" (1996); was featured in the NLM Exhibition on Women in Medicine (2004-05); and is featured in the 2006 PBS Television Special "The New Medicine." For more information and links, go to: www.esthersternberg.com