Rheumatic arthritis (RA) is a chronic disease and with stressful events, can have acute episodes of pain and inflammation (Arthritis Foundation, 2015). Triggers for rheumatic pain are different for everyone and can be caused by one thing or many things accumulated over time. Given David’s symptoms, his recent bilateral knee pain may be the result of a recent flare up caused by work related stress and stress in the home environment. It is not unusual for people with rheumatoid pain to experience high stress before a flare up. Overexertion can trigger RA and inflammation as can be caused both physical and psychological factors and increase fatigue (Arthritis Foundation, 2015). Chemicals called cytokines have been shown to promote inflammation
