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Explore This IssueApril 2015
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It’s not uncommon for patients with rheumatic disease to have mental and emotional reactions to their diagnosis and ongoing treatment. These psychological reactions can affect the patient physically in terms of disease progress, pain and overall quality of life. There are additional mental implications for the patient with regard to working with the rheumatologist to actively participate in decision making about their treatment and care.
In addition to dealing with chronic pain, which can cause significant frustration, patients with rheumatic disease frequently struggle with depression and anxiety.1 In one study of 11,704 patients with rheumatic disease, researchers identified depression in 15% of patients with rheumatoid arthritis (RA) or noninflammatory rheumatic disorders and in 34–39% of patients with systemic lupus erythematosus (SLE) and fibromyalgia.2 By comparison, 6.9% of the general U.S. population suffers from depression, according to the National Institute of Mental Health. In patients with RA, depression and anxiety have been correlated with multiple measures of disease-related pain and functional impairment, as well as social difficulties.3,4
Another study of 4,994 participants, including 3,635 patients with skin diseases (e.g., psoriasis) and 1,359 controls, identified clinical depression in 10.1% of patients vs. 4.3% of controls, clinical anxiety among 17.2% of patients vs. 11.1% of controls, and suicidal ideation among 12.7% of patients vs. 8.3% of controls.5 Psoriasis also has been linked with feelings of stigmatization, and researchers report that compared to patients with psoriasis, quality of life is further decreased in patients with psoriatic arthritis.6,7
In the rheumatologist’s office, it’s important to recognize emotional and mental responses to chronic disease. The rheumatologist can refer the patient for help and implement a multidisciplinary approach to help the patient cope. In learning to cope, the patient can see improvements in disease progression and quality of life, as well as accept responsibility for treatment and participate in decision making.
Strategies for Helping Patients Cope
As research into the mental and emotional effects of rheumatic disease expands, the need for psychological interventions in addition to rheumatologic interventions becomes increasingly apparent. For example, researchers who identified a significant link between disease-coping strategies, itch, and quality of life among 60 patients with psoriasis—particularly women and older patients—concluded that psychological interventions are warranted in this population.8
“Targeted interventions to identify and address depression and anxiety can have an important impact on outcomes,” says Theodore Fields, MD, FACP, director, Rheumatology Faculty Practice Plan and professor of Clinical Medicine, at Hospital for Special Surgery (HSS), Weill College of Medicine of Cornell University, New York. “To get better, patients with rheumatic disease need to get into an effective exercise program, find ways to keep functioning at the highest possible level and, when indicated, closely adhere to a medication program. When patients are overwhelmed, as with the new diagnosis of [RA], it is very hard to them to focus on these issues.”