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14-07-2016 | Comorbidities | Article

Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways

John A. Sturgeon, Patrick H. Finan, Alex J. Zautra


In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.

Nat Rev Rheumatol 2016;12:532–542. doi:10.1038/nrrheum.2016.112

In comparison to the general population, individuals with rheumatoid arthritis (RA) have an increased prevalence of both physical disability and psychiatric comorbidity1, 2. The relationship between RA and psychological factors is evident both from the altered prevalence rates of some psychiatric disorders causing affective disturbance in patients with RA versus the general population, and from the close links between physiological and psychological mechanisms that underlie these comorbidities. In this Review, we examine the extant literature on psychiatric comorbidities in RA and explore the relationships between characteristics of RA and psychosocial, physiological, and neural factors. We discuss these data in the context of effective adaptation to RA, delineating the processes that could protect affected individuals against the declines in physical and psychological functioning that commonly occur with progression of RA. We also describe the importance of social context in the experience of living with RA, and the role of social factors in the effective treatment of RA.

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