A Case of Rheumatoid Arthritis in the Wake of Bereavement

Psychological stress, including bereavement and depression, can have immunological consequences that promote the development of autoimmune disease. Activation of the hypothalamic-pituitary axis (HPA) and sympathetic nervous system are potential mechanisms for crosstalk between emotional stress and immune system function. Studies have shown increased proinflammatory cytokines in individuals who experience major life stressors; these individuals are also at increased risk for developing autoimmune diseases, including rheumatoid arthritis. In this report, we present the case of a woman who presented to primary care after the sudden death of her son. She was found to be prediabetic with hyperlipidemia and, within several months of the acute psychological stressor, was diagnosed with rheumatoid arthritis (RA). Altogether, this new diagnosis of RA was likely triggered by grief, with a background of potential predisposing factors. This case illustrates a close temporal relationship between an acute stressor and onset of autoimmune disease. It underscores the importance of integrated care and psychosocial considerations in the evaluation and management of autoimmune diseases.