The Link Between PTSD and Autoimmune Diseases: A Path to Effective Treatment. Literature review
DOI:
https://doi.org/10.12775/QS.2024.20.53147Keywords
autoimmune diseases, post-traumatic stress disorders, trauma and stressor related disordersAbstract
Introduction and Objective:PTSD is a psychiatric disorder associated with the experience of a traumatic event in the past. Changes in the immune system are presented as one of the mechanisms involved in its pathophysiology. The purpose of this review is to investigate the potential link between PTSD and autoimmune diseases, as well as to highlight the therapeutic implications.
Review methods:
The review is based on scientific publications in PubMed, Science Direct and NCBI databases. After an initial evaluation of the articles, primarily observational studies and meta-analyses on the relationship between PTSD and autoimmune diseases, the underlying pathophysiology, and new potential therapeutic options were selected.
Abbreviated description of the state of knowledge:
PTSD is associated with numerous changes in the immune and neuroendocrine systems. As a result, patients affected by the disorder are susceptible to developing somatic diseases, including autoimmune diseases. Numerous studies indicate a reciprocal effect on the increased risk and aggravation of symptoms for PTSD and autoimmune diseases due to certain similarities in pathophysiology. New treatment options for PTSD targeting the immune system with anti-inflammatory and immunomodulatory drugs are currently being explored.
Summary:
This review article highlights the existing reciprocal relationship between PTSD and autoimmune diseases, which carries important clinical implications. The authors of the review emphasize the importance of better understanding the pathophysiology of PTSD and the early diagnosis and treatment of people with PTSD, as well as the need to develop new effective treatments for PTSD that can help reduce the risk of developing autoimmune diseases in people with the disorder. As suggested, treatment targeting the immune system may be an effective therapeutic option for patients with PTSD.
References
K. C. Koenen et al., ‘Posttraumatic stress disorder in the World Mental Health Surveys’, Psychol. Med., vol. 47, no. 13, pp. 2260–2274, Oct. 2017, doi: 10.1017/S0033291717000708.
T. H. Hoppen and N. Morina, ‘The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers’, Eur. J. Psychotraumatology, vol. 10, no. 1, p. 1578637, 2019, doi: 10.1080/20008198.2019.1578637.
T. Qassem, D. Aly-ElGabry, A. Alzarouni, K. Abdel-Aziz, and D. Arnone, ‘Psychiatric Co-Morbidities in Post-Traumatic Stress Disorder: Detailed Findings from the Adult Psychiatric Morbidity Survey in the English Population’, Psychiatr. Q., vol. 92, no. 1, pp. 321–330, Mar. 2021, doi: 10.1007/s11126-020-09797-4.
J. Zhou et al., ‘Dysregulation in microRNA expression is associated with alterations in immune functions in combat veterans with post-traumatic stress disorder’, PloS One, vol. 9, no. 4, p. e94075, 2014, doi: 10.1371/journal.pone.0094075.
J. Morath et al., ‘The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD: evidence from a randomized controlled trial’, J. Psychiatr. Res., vol. 54, pp. 1–10, Jul. 2014, doi: 10.1016/j.jpsychires.2014.03.016.
A. E. Aiello et al., ‘PTSD is associated with an increase in aged T cell phenotypes in adults living in Detroit’, Psychoneuroendocrinology, vol. 67, pp. 133–141, May 2016, doi: 10.1016/j.psyneuen.2016.01.024.
A. O’Donovan, A. J. Ahmadian, T. C. Neylan, M. A. Pacult, D. Edmondson, and B. E. Cohen, ‘Current posttraumatic stress disorder and exaggerated threat sensitivity associated with elevated inflammation in the Mind Your Heart Study’, Brain. Behav. Immun., vol. 60, pp. 198–205, Feb. 2017, doi: 10.1016/j.bbi.2016.10.014.
M. W. Miller et al., ‘CRP polymorphisms and DNA methylation of the AIM2 gene influence associations between trauma exposure, PTSD, and C-reactive protein’, Brain. Behav. Immun., vol. 67, pp. 194–202, Jan. 2018, doi: 10.1016/j.bbi.2017.08.022.
D. Lindqvist et al., ‘Increased pro-inflammatory milieu in combat related PTSD - A new cohort replication study’, Brain. Behav. Immun., vol. 59, pp. 260–264, Jan. 2017, doi: 10.1016/j.bbi.2016.09.012.
H. Toft, J. G. Bramness, and L. Lien, ‘Levels of Peripheral Circulating IL-6 and IL-10 Decrease Over Time Despite High Depression Burden in PTSD Patients’, Neuropsychiatr. Dis. Treat., vol. 18, pp. 737–747, 2022, doi: 10.2147/NDT.S357797.
S. Speakman, K. White, A. J. LaPorta, M. E. Payton, K. D. Gubler, and R. J. Ryznar, ‘Cytokine fluctuation during acute stress is correlated to life trauma’, J. Trauma Acute Care Surg., vol. 95, no. 4, pp. 535–541, Oct. 2023, doi: 10.1097/TA.0000000000004006.
P. Wójcik, A. Gęgotek, N. Žarković, and E. Skrzydlewska, ‘Oxidative Stress and Lipid Mediators Modulate Immune Cell Functions in Autoimmune Diseases’, Int. J. Mol. Sci., vol. 22, no. 2, p. 723, Jan. 2021, doi: 10.3390/ijms22020723.
F. Herman, S. Westfall, J. Brathwaite, and G. M. Pasinetti, ‘Suppression of Presymptomatic Oxidative Stress and Inflammation in Neurodegeneration by Grape-Derived Polyphenols’, Front. Pharmacol., vol. 9, p. 867, 2018, doi: 10.3389/fphar.2018.00867.
K. Theilgaard-Mönch, ‘Gut microbiota sustains hematopoiesis’, Blood, vol. 129, no. 6, pp. 662–663, Feb. 2017, doi: 10.1182/blood-2016-12-754481.
S. Schumacher et al., ‘HPA axis regulation in posttraumatic stress disorder: A meta-analysis focusing on potential moderators’, Neurosci. Biobehav. Rev., vol. 100, pp. 35–57, May 2019, doi: 10.1016/j.neubiorev.2019.02.005.
E. O. Melin, M. Thunander, M. Landin-Olsson, M. Hillman, and H. O. Thulesius, ‘Depression differed by midnight cortisol secretion, alexithymia and anxiety between diabetes types: a cross sectional comparison’, BMC Psychiatry, vol. 17, no. 1, p. 335, Sep. 2017, doi: 10.1186/s12888-017-1495-8.
X. Pan, A. C. Kaminga, S. W. Wen, Z. Wang, X. Wu, and A. Liu, ‘The 24-hour urinary cortisol in post-traumatic stress disorder: A meta-analysis’, PLoS ONE, vol. 15, no. 1, p. e0227560, Jan. 2020, doi: 10.1371/journal.pone.0227560.
X. Pan, Z. Wang, X. Wu, S. W. Wen, and A. Liu, ‘Salivary cortisol in post-traumatic stress disorder: a systematic review and meta-analysis’, BMC Psychiatry, vol. 18, p. 324, Oct. 2018, doi: 10.1186/s12888-018-1910-9.
F. B. Almeida, G. Pinna, and H. M. T. Barros, ‘The Role of HPA Axis and Allopregnanolone on the Neurobiology of Major Depressive Disorders and PTSD’, Int. J. Mol. Sci., vol. 22, no. 11, p. 5495, May 2021, doi: 10.3390/ijms22115495.
S. Engel, H. Klusmann, S. Laufer, C. Kapp, S. Schumacher, and C. Knaevelsrud, ‘Biological markers in clinical psychological research - A systematic framework applied to HPA axis regulation in PTSD’, Compr. Psychoneuroendocrinology, vol. 11, p. 100148, Jun. 2022, doi: 10.1016/j.cpnec.2022.100148.
M. F. Donadon, R. Martin-Santos, and F. de L. Osório, ‘The Associations Between Oxytocin and Trauma in Humans: A Systematic Review’, Front. Pharmacol., vol. 9, p. 154, 2018, doi: 10.3389/fphar.2018.00154.
A. Vidović et al., ‘Changes in immune and endocrine systems in posttraumatic stress disorder - prospective study’, Acta Neuropsychiatr., vol. 21 Suppl 2, pp. 46–50, Jun. 2009, doi: 10.1017/S0924270800032725.
M. B. Stein et al., ‘Genomewide Association Studies of Posttraumatic Stress Disorder in Two Cohorts of US Army Soldiers’, JAMA Psychiatry, vol. 73, no. 7, pp. 695–704, Jul. 2016, doi: 10.1001/jamapsychiatry.2016.0350.
Y. Wang et al., ‘Post-traumatic stress following military deployment: Genetic associations and cross-disorder genetic correlations’, J. Affect. Disord., vol. 252, Apr. 2019, doi: 10.1016/j.jad.2019.04.070.
S. Katrinli et al., ‘Association of HLA Locus Alleles with Posttraumatic Stress Disorder’, Brain. Behav. Immun., vol. 81, pp. 655–658, Oct. 2019, doi: 10.1016/j.bbi.2019.07.016.
N. A. Patsopoulos et al., ‘Fine-Mapping the Genetic Association of the Major Histocompatibility Complex in Multiple Sclerosis: HLA and Non-HLA Effects’, PLOS Genet., vol. 9, no. 11, p. e1003926, lis 2013, doi: 10.1371/journal.pgen.1003926.
S. Katrinli and A. K. Smith, ‘Immune system regulation and role of the human leukocyte antigen in posttraumatic stress disorder’, Neurobiol. Stress, vol. 15, p. 100366, Nov. 2021, doi: 10.1016/j.ynstr.2021.100366.
F. G. Morrison, M. W. Miller, M. W. Logue, M. Assef, and E. J. Wolf, ‘DNA methylation correlates of PTSD: Recent findings and technical challenges’, Prog. Neuropsychopharmacol. Biol. Psychiatry, vol. 90, pp. 223–234, Mar. 2019, doi: 10.1016/j.pnpbp.2018.11.011.
E. Ortona, M. Pierdominici, A. Maselli, C. Veroni, F. Aloisi, and Y. Shoenfeld, ‘Sex-based differences in autoimmune diseases’, Ann. Ist. Super. Sanita, vol. 52, no. 2, pp. 205–212, 2016, doi: 10.4415/ANN_16_02_12.
A. Lerner, P. Jeremias, and T. Matthias, ‘The World Incidence and Prevalence of Autoimmune Diseases is Increasing’, Int. J. Celiac Dis., vol. 3, no. 4, Art. no. 4, Nov. 2015, doi: 10.12691/ijcd-3-4-8.
H. Kim et al., ‘An increased disease burden of autoimmune inflammatory rheumatic diseases in Korea’, Semin. Arthritis Rheum., vol. 50, no. 3, pp. 526–533, Jun. 2020, doi: 10.1016/j.semarthrit.2019.11.007.
A. O’Donovan et al., ‘Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder’, Biol. Psychiatry, vol. 77, no. 4, pp. 365–374, Feb. 2015, doi: 10.1016/j.biopsych.2014.06.015.
D. B. Bookwalter, K. A. Roenfeldt, C. A. LeardMann, S. Y. Kong, M. S. Riddle, and R. P. Rull, ‘Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel’, BMC Psychiatry, vol. 20, no. 1, p. 23, Jan. 2020, doi: 10.1186/s12888-020-2432-9.
H. Song et al., ‘Association of Stress-Related Disorders With Subsequent Autoimmune Disease’, JAMA, vol. 319, no. 23, pp. 2388–2400, Jun. 2018, doi: 10.1001/jama.2018.7028.
K. A. Jones et al., ‘A prospective study of lupus and rheumatoid arthritis in relation to deployment in support of iraq and afghanistan: the millennium cohort study’, Autoimmune Dis., vol. 2011, p. 741267, 2011, doi: 10.4061/2011/741267.
J. A. Boscarino, ‘Post-traumatic stress and associated disorders among Vietnam veterans: the significance of combat exposure and social support’, J. Trauma. Stress, vol. 8, no. 2, pp. 317–336, Apr. 1995, doi: 10.1007/BF02109567.
R. K. Blais et al., ‘Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis’, Eur. J. Psychotraumatology, vol. 12, no. 1, p. 1851078, 2021, doi: 10.1080/20008198.2020.1851078.
M. P. Webber et al., ‘Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers’, Mayo Clin. Proc., vol. 91, no. 1, pp. 23–32, Jan. 2016, doi: 10.1016/j.mayocp.2015.09.019.
C. P. Fagundes, R. Glaser, and J. K. Kiecolt-Glaser, ‘Stressful early life experiences and immune dysregulation across the lifespan’, Brain. Behav. Immun., vol. 27, no. 1, pp. 8–12, Jan. 2013, doi: 10.1016/j.bbi.2012.06.014.
S. R. Dube, D. Fairweather, W. S. Pearson, V. J. Felitti, R. F. Anda, and J. B. Croft, ‘Cumulative Childhood Stress and Autoimmune Diseases in Adults’, Psychosom. Med., vol. 71, no. 2, pp. 243–250, Feb. 2009, doi: 10.1097/PSY.0b013e3181907888.
Y. C. Lee et al., ‘Post-Traumatic Stress Disorder and Risk for Incident Rheumatoid Arthritis’, Arthritis Care Res., vol. 68, no. 3, pp. 292–298, Mar. 2016, doi: 10.1002/acr.22683.
C. Carmassi et al., ‘Post-traumatic stress disorder and post-traumatic stress symptoms in patients with systemic autoimmune diseases during the COVID-19 pandemic’, Clin. Exp. Rheumatol., vol. 42, no. 5, pp. 1075–1082, May 2024, doi: 10.55563/clinexprheumatol/rnm6tz.
L. Moroni et al., ‘Post-traumatic stress disorder in patients with systemic lupus erythematosus heavily affects quality of life. A cross-sectional web survey-based study’, Lupus, vol. 32, no. 2, pp. 263–269, Feb. 2023, doi: 10.1177/09612033221145634.
J. I. Bisson and M. Olff, ‘Prevention and treatment of PTSD: the current evidence base’, Eur. J. Psychotraumatology, vol. 12, no. 1, 2021, doi: 10.1080/20008198.2020.1824381.
D.-H. Lee et al., ‘Neuroinflammation in Post-Traumatic Stress Disorder’, Biomedicines, vol. 10, no. 5, p. 953, Apr. 2022, doi: 10.3390/biomedicines10050953.
G. N. Neigh and F. F. Ali, ‘Co-Morbidity of PTSD and Immune System Dysfunction: Opportunities for Treatment’, Curr. Opin. Pharmacol., vol. 29, pp. 104–110, Aug. 2016, doi: 10.1016/j.coph.2016.07.011.
M. van Zuiden et al., ‘Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients’, Biol. Psychiatry, vol. 81, no. 12, pp. 1030–1040, Jun. 2017, doi: 10.1016/j.biopsych.2016.11.012.
S. Szafoni and M. Piegza, ‘Progress in Personalized Psychiatric Therapy with the Example of Using Intranasal Oxytocin in PTSD Treatment’, J. Pers. Med., vol. 12, no. 7, p. 1067, Jun. 2022, doi: 10.3390/jpm12071067.
Y. Wu, K. Mao, L. Dennett, Y. Zhang, and J. Chen, ‘Systematic review of machine learning in PTSD studies for automated diagnosis evaluation’, Npj Ment. Health Res., vol. 2, no. 1, pp. 1–10, Sep. 2023, doi: 10.1038/s44184-023-00035-w.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Anna Kajka, Joanna Antczak, Karolina Wojtczak, Julia Lipska, Urszula Fenrych, Laura Hamerska, Julia Hamerska, Bogumił Bocianiak, Damian Ruta, Olga Skupińska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 204
Number of citations: 0
