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Review
. 2025 Mar 26;17(3):e81228.
doi: 10.7759/cureus.81228. eCollection 2025 Mar.

The Impact of Stress on Autoimmune Disorders: Type 1 Diabetes Mellitus and Systemic Lupus Erythematosus

Asma A Alzaabi  1 , Fatema M Alzaabi  1 , Dana J Al Tarawneh  1 , Yusuf J Al Tarawneh  1 , Abdallah Khan  1 , Mohammed Abdul Muqsit Khan  1 , Tabish W Siddiqui  1 , Raqshan W Siddiqui  1 , Syed Muhammad Hayyan Nishat  1 , Shiza W Siddiqui  2
Affiliations
Review

The Impact of Stress on Autoimmune Disorders: Type 1 Diabetes Mellitus and Systemic Lupus Erythematosus

Asma A Alzaabi et al. Cureus. .

Abstract

Autoimmune disorders, including type 1 diabetes mellitus (T1DM) and systemic lupus erythematosus (SLE), are influenced by a combination of genetic, environmental, and immunological factors. Among these, stress, both physical and psychological, has been increasingly recognized as a significant contributor to disease onset and progression. This review explores the current literature on the relationship between stress and autoimmune diseases, focusing on the neuroendocrine pathways, such as the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of glucocorticoids on immune modulation. These mechanisms contribute to clinical manifestations, such as disease flares or progression, highlighting the impact of stress on patient outcomes. Evidence suggests that psychological stress can precipitate the onset of T1DM in genetically predisposed individuals, with immune disruptions occurring before diagnosis. In SLE, both acute and chronic stress, particularly trauma-induced stress, has been linked to increased disease activity and flare-ups, largely due to stress-induced immune dysregulation that disrupts the balance between pro-inflammatory and anti-inflammatory cytokines. Despite the substantial evidence supporting the role of stress in autoimmune disease exacerbation, further research is necessary to fully understand the mechanisms by which stress influences autoimmune diseases and to develop effective stress management.

Keywords: autoimmune disorders; disease progression; immune dysregulation; stress; systemic lupus erythematosus; type 1 diabetes mellitus.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart of selected articles.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; T1DM: type 1 diabetes mellitus; SLE: systemic lupus erythematosus Image credits: Asma Alzaabi
Figure 2
Figure 2. Pathways illustrating the role of stress in immune dysregulation.
Note: + means activates HPA: hypothalamic-pituitary-adrenal; SMA: sympathetic-adrenal-medullary; HPO: hypothalamic-pituitary-ovarian; Th1: type 1 helper cells; Th2: type 2 helper cells Image credits: Asma Alzaabi
Figure 3
Figure 3. Schematic representation of the pathophysiological processes in T1DM.
T1DM: type 1 diabetes mellitus; HLA: human leukocyte antigens; Th2: type 2 helper cells; IL-4: interleukin 4; IL-10: interleukin 10; IL-13: interleukin 13 Image credits: Asma Alzaabi
See this image and copyright information in PMC

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