Dr. Kim’s group reported that symptoms of depression persisted over time in his 2021 study of patients with SLE. Of the 144 patients, 61.2% had symptoms of depression for up to four years.4 Subsequently, Dr. Kim’s group reported study results showing that anxiety symptoms persisted over time in 139 patients with SLE and symptoms were independent of SLE disease activity. 5
“While we typically categorize mood disorders within the neuropsychiatric realm of SLE, our data support that mood disorders are much more complex in root cause than just SLE,” Dr. Kim says.
“Further, the severity of mood disorder was durable throughout time: If you had severe anxiety at visit one, you most likely will have equally severe anxiety at visit 10. This is a wake-up call for us at Washington University Lupus Clinic, as we had presumed that treating a patient’s SLE will also help with their anxiety,” Dr Kim adds. “This is clearly not true, and this has motivated us to find effective solutions to better manage mood disorders in our patients with SLE. These solutions will have to address health disparities, as those with more severe anxiety and depression were overwhelmingly Black, who certainly experience a high level of disparities in St. Louis.”
Cross-Provider Training Needed
Learning how different conditions, such as anxiety disorder or major depression, are classified is very important, says R. Swamy Venuturupalli, MD, FACR, founder of Attune Health in Los Angeles. He explains that psychiatry rotations are completed during medical school and while undergoing internal medicine training in residency.
Dr. Venuturupalli suggests that psychology, rather than psychiatry, provides the tools to communicate with patients with a chronic autoimmune disease who are dealing with daily stressors and anxiety.
With chronic disease, the condition can be unrelenting, with daily pain, fear and concern.
“To get past a chronic disease—to get better—one must have a very strong, positive mindset and a belief in the future. Psychological tools can really help in that aspect. But on a more day-to-day basis, the anxiety of having to deal with a chronic illness can also be alleviated by psychological tools,” Dr. Venuturupalli says.
“In that sense, psychology is a key factor in helping our patients do better and have better outcomes overall,” he adds.
A review by Taylor et al. suggests clinicians should consider wellness practices, such as mindfulness, exercise and optimized sleep and nutrition, in addition to treat-to-target pharmacological agents for a more complete and patient-centered approach to the management of patients with rheumatoid arthritis (RA). The researchers note that wellness practices can help people with RA to improve their health status by reducing inflammation and symptoms, along with improving well-being.6
Rheumatologists are often the primary doctors for their patients with chronic autoimmune illnesses. “So it is critical that rheumatologists are trained, and have a basic understanding and knowledge to help our patients, through simple measures, like sleeping and exercising well and breathing techniques, which we can learn from psychology,” Dr. Venuturupalli explains.
Being able to implement these simple measures in the practice and having a referral network for patients are essential, but it is almost impossible for patients to gain access to mental health experts, says Dr. Venuturupalli. “Referral for psychological care is exceedingly difficult, as there are very few psychologists who are available through insurance programs, and it is often very expensive for our patients, so we as rheumatologists do need to get educated.”
Dr. Venuturupalli notes that “there are a few online resources, some of which are free, such as mindfulness-meditation programs, which some of my patients with lupus use. Such resources are exceedingly helpful for our patients.”