Background: Stress is a risk factor of various diseases including autoimmune diseases. Autoimmune diseases are one of the leading causes of morbidity in young adults. ⁽¹⁾ Examination stress is a main concern nowadays due to the study style, lack of preparation, doctor- student relationship and family pressure. ⁽²⁾ The previous studies declared that stress may causes neuroendocrinal changes leading to immune dysregulations and cytokines production. ⁽³⁾

Objectives: The aim of study is to scope the light on the importance of stress as a predisposing factor in autoimmune disease flares particularly Examination stress.

Methods: A three-year (2017-2019) cross-sectional prospective study conducted on 1365 students who presented to the Alexandria University rheumatology clinic during examinations. Clinical assessments, routine investigations, activity markers, activity indices, stress and anxiety questionnaires and perceived stress scale (PSS) were applied to all patients during consecutive visits.

Results: Through 5800 visits in three years during examination sessions, patients age ranged from (17 -25) years with 76% females and 24% males. They grouped into SLE (31.35%), Rheumatoid arthritis (RA) (37.28%), Fibromyalgia (13.91%), FMF (2.63%), Ankylosing Spondylitis (1.75%), Psoriatic arthritis (0.73%), systemic sclerosis (0.58%), and undifferentiated connective tissue (11.73%). According to SLE patients, 43.92% were newly diagnosed whilst 54.16% of previously diagnosed SLE presented with Flare in particular lupus nephritis (56.33%), arthritis (43.22%), hematological (49.76%) and serositis (21.36%). Interestingly, RA patients who newly diagnosed were 35.16% of total RA patients while 42.42% of previously diagnosed RA patients presented with moderate and high DAS-28 due to incompliance with treatment in (64.37%) of patients, (11.53% on biological, 88.47% on conventional treatment). In addition, (49.36%) of FMF presented in recent attacks. It was also found that Arthralgia, bone aches and sleep deprivation are the main complaints. Concerning, A High perceived stress scale (PSS) was associated with High DAS28 and SLEDI-2K scores. (r _s = 0.723, 0.865) (P<0.001)

Conclusion: Examination stress is one of triggering factor for autoimmune disease flares. It is associated with high disease activities and ruthless outcomes.

REFERENCES:

[1]Cooper, G. S., & Stroehla, B. C. The epidemiology of autoimmune diseases. Autoimmunity Reviews,2003:2(3);119–25.

[2]Archana kumari, jagrati jain. Examination stress and anxiety: a study of college students. Global Journal of Multidisciplinary Studies 2014:4:ISSN 2348-0459

Disclosure of Interests: None declared