Background: Prolonged exposure to stress associated with armed conflict may serve as a significant modifier of disease activity in individuals with rheumatoid arthritis (RA). This effect is particularly pronounced in environments where access to consistent medical care is restricted.

Objectives: To evaluate the association between war-related psychological stress and RA disease activity in patients treated in a frontline clinical setting.

Methods: This prospective observational cohort study included adult patients fulfilling the 2010 ACR/EULAR RA classification criteria and followed for 12 months at a single rheumatology center of Sumy Regional Clinical Hospital in the frontline Ukrainian city Sumy. Psychological stress was assessed using the Perceived Stress Scale (PSS-10). War-related clinical stressors, including displacement, shelling exposure, and interruption of medical care, were recorded. Disease activity (DAS28-ESR), pain (VAS), and functional status (HAQ-DI) were assessed every 3 months, either in person or via telemedicine. Patients were stratified into low-, moderate-, and high-stress groups based on PSS-10 result. Associations between stress levels and disease activity over time were analysed using correlation analysis and mixed-effects regression models adjusted for baseline DAS28-ESR, age, sex, disease duration, treatment category, and glucocorticoid use.

Results: Eighty patients were included (75% female, mean age 51±13 years, mean disease duration 6.8±4.6 years). Baseline DAS28-ESR was comparable across stress groups. Over 12 months, patients in the high-stress group demonstrated numerically higher disease activity compared with the low-stress group (mean DAS28-ESR change +0.6 vs +0.2). Disease flares occurred more frequently in patients with higher stress exposure (approximately 1.5 vs 1.0 flares per patient-year). Higher PSS-10 scores were independently associated with higher DAS28-ESR over time in adjusted analyses (p<0.05). Patients with higher stress levels also reported higher pain scores and worse functional status at follow-up. War-related treatment interruptions were more commonly observed in the high-stress group.

Conclusions: In a clinical frontline setting, greater psychological stress from war was linked to poorer control of RA disease. Acknowledging stress-related factors may enhance the management of RA patients in regions affected by conflict.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.