It’s important to address the patient’s concerns about side effects and long-term benefits, while building a trusting relationship with the clinician. “The patient is a partner in their own care and has to understand why you are asking them these questions.” For example, the clinician might tell their patient, “All drugs have side effects, but if we spend too much time dwelling on the side effects, you may worry more.”
Explore this issueDecember 2017
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Second, Dr. Evers recommends developing more training about the placebo effect for clinicians. “It’s a hot topic right now. Along with European and federal funding support, we have been given a grant from the Dutch Arthritis Foundation to do more work in this area.”
Re-Think Your Role
Jose Pereira da Silva, MD, PhD, associate professor of medicine and rheumatology at the University of Coimbra and University of Hospital of Coimbra in Portugal, sees psychological and mental aspects of treatment as complex, multi-faceted issues that serve to underscore the mind-body connection while challenging practitioners to look beyond conventional physical disease models if they want to serve their patients’ real needs. But the psychological domains are not well defined. “Most of us are not properly trained in how to respond,” he says.
“Do you believe your role as clinician is to take care of the disease—as defined by its clinical markers—or the patient’s illness, with all of its impacts on the person’s life? I believe my concern lies with the person. I try to engage my patients in a conversation about what’s happening in their lives.” Clinicians who don’t look at these issues miss an important opportunity to make their patients feel better, he says.
Fibromyalgia, in particular, is seen by some clinicians as largely psychological, in part because good clinical markers for it don’t exist. “But we know tumor necrosis factor [TNF] travels to the brain and affects the patient in many ways, [and] anti-TNF drugs can have an antidepressive effect. Some treatments are better at improving the patient’s sense of well-being than actually improving their disease. Biology brings all of these issues together.”
Dr. da Silva illustrates the concept with the story of a young female patient who had been treated with three biologics for RA. “One day, she came to my office with her disease finally in remission. ‘Doctor,’ she said, ‘may this be because I’m in love?’”
Larry Beresford is a freelance medical journalist in Oakland, Calif.
- Geenen R, Newman S, Bussema ER, et al. Psychological interventions for patients with rheumatic diseases and anxiety or depression. Best Pract Res Clin Rheumatol. 2012 June;26(3):305–319.
- Matcham F, Rayner L, Steer S, et al. The prevalence of depression in rheumatoid arthritis: A systematic review and meta analysis. Rheumatology (Oxford). 2013 Dec;52(12):2136–2148.
- Matcham F, Norton S, Scott DL, et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: Secondary analysis of a randomized controlled trip. Rheumatology (Oxford). 2016 Feb;55(2):268–278.
- Matcham F, Scott IC, Rayner L, et al. The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):123–130.
- Anyfanti P, Gavriilaki E, Pyrpasopoulou A, et al. Depression, anxiety and quality of life in a large cohort of patients with rheumatic diseases: Common, yet undertreated. Clin Rheumatol. 2016 Mar;35(3):733–739.
- Matcham F, Ali S, Hotopf M, Chalder T. Psychological correlates of fatigue in rheumatoid arthritis: A systematic review. Clin Psychol Rev. 2015 Jul;39:16–29.
- Evers AWM, Zautra A, Thieme K. Stress and resilience in rheumatic diseases: A review and glimpse into the future. Nat Rev Rheumatol. 2011 Jun 21;7(7):409–415.
- Santiago T, Geenen R, Jacobs JW, et al. Psychological factors associated with response to treatment in rheumatoid arthritis. Curr Pharm Des. 2015;21(2):257–269.
- Wolf LD, Davis MD. Loneliness, daily pain and perceptions of interpersonal events in adults with fibromyalgia. Health Psychol. 2014 Sep;33(9):929–937.
- Kool MB, Geenen R. Loneliness in patients with rheumatic diseases: The significance of invalidation and lack of social support. J Psychol. 2012 Jan–Apr;146(1-2):229–241.
- Krishnadas R, Krishnadas R, Cavanagh J. Sustained remission of rheumatoid arthritis with a specific serotonin reuptake inhibitor antidepressant: A case report and review of the literature. J Med Case Rep. 2011 Mar 19;5:112.
- Marenaro M, Preete C, Badini A, et al. Rheumatoid arthritis, personality, stress response style and coping with illness. A preliminary survey. Ann N Y Acad Sci. 1999 June 22;876:419–425.
- da Silva JAP, Jaobs JWG, Branco JC, et al. Can health providers recognize a fibromyalgia personality? Clin Exp Rheumatol. 2017 May–Jun;35 Suppl 105(3):43–49.
- Matcham F, Norton S, Scott DL, et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: Secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2016 Feb;55(2):268–278.