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Participants without IA were recruited if they were a first\u2010degree relative of an RA proband or screened positive for anti\u2013citrullinated protein antibody. Perceived stress was measured using the Perceived Stress Scale\u201314 (PSS\u201014), in which scores can range from 0 to 56, and a higher score indicates greater perceived stress. The total PSS\u201014 score, as well as 2 subscores indicative of perceived distress and self\u2010efficacy, were averaged across all study visits until development of IA or the last follow\u2010up. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of IA associated with average PSS\u201014 scores were obtained using Cox proportional hazards models.<\/jats:p><\/jats:sec>Results<\/jats:title>The mean total PSS\u201014 score was 20.4. We found that a 1\u2010point increase in the perceived distress score was significantly associated with a 10\u2010percent increase in the risk of IA (adjusted HR 1.10 [95% CI 1.02\u20131.19]). Total PSS\u201014 and self\u2010efficacy were not associated with IA risk (adjusted HR 1.05 [95% CI 0.99\u20131.10] and 1.04 [95% CI 0.91\u20131.18], respectively).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>An association between perceived distress and incident IA was observed in this at\u2010risk cohort. Replication of this finding in other preclinical and at\u2010risk RA populations is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24085","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T15:58:50Z","timestamp":1570723130000},"page":"1766-1771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Perceived Stress and Inflammatory Arthritis: A Prospective Investigation in the Studies of the Etiologies of Rheumatoid Arthritis Cohort"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9825-6095","authenticated-orcid":false,"given":"Kristen J.","family":"Polinski","sequence":"first","affiliation":[{"name":"Colorado School of Public Health Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Bemis","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Feser","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Seifert","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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