Psychological Factors in Rheumatoid Arthritis
There is no particular personality type susceptible to develop-ment of RA and earlier research suggesting that stressful events play a role in the development or onset of RA has not been sup-ported by more recent studies. Psychological factors and disease manifestations account for comparable proportions of disability. Psychological morbidity in RA results in more pain, poorer qual-ity of life, more joint surgery, lower compliance and increased use of health care resources.
Depression has been the most frequently studied psycho-logical disturbance in RA; depression is very common, as in other chronic medical conditions. Depression appears to adversely affect outcome in rheumatoid arthritis, aggravating chronic pain, increasing health care use and increasing social isolation. Randomized controlled trials of antidepressants in depressed RA patients demonstrate improvements in pain, morning stiffness and disability in addition to depression.
There is a consensus among investigators that passive, avoidant, emotion-laden coping strategies (e.g., wish-fulfilling fantasy, self-blame) are associated with poorer adjustment to ill-ness in RA compared with active, problem-focused coping (e.g., information seeking, cognitive restructuring). Rheumatoid ar-thritis patients with high helplessness are more likely to receive psychotropic, analgesic and anti-inflammatory drugs and to be less adherent with treatment than those with low helplessness. Patients with RA may be more vulnerable to stress-induced in-creases in immune and endocrine function. A randomized con-trolled trial of cognitive–behavioral therapy as an adjunct to standard treatment in recently diagnosed patients with rheuma-toid arthritis showed it efficacious in reducing both psychological and physical morbidity (Sharpe et al., 2001).