Several studies demonstrate that clinical diseases may worsen under the influence of psychologically stressing factors. However few studies have been realized to establish this correlation in systemic lupus erythematosus (SLE). In the present article, studies about the association and influence of psychological or social stress in patients with SLE were reviewed. Studies were identified by a Medline search, relating the terms "stress", "lupus", "disease activity", and "flare". Fourteen articles were selected but presented a great variability in the employed methodology. The majority failed to find associations between the presence of stress and worsening of clinical or laboratorial activity of SLE. Nevertheless, association between presence of stress and worse perception of physical health by the patient, through subjective measures of health was identified. Three studies of laboratorial model of psychological stress showed that biological response to stress in SLE patients differs from normal controls and patients with rheumatoid arthritis. Only one study showed that daily stress in social relationships or social duties in the previous month preceded SLE exacerbation.
stress; psychological stress; systemic lupus erythematosus; disease activity