Rheumatoid arthritis (RA) is an autoimmune disease affecting the joints. People with RA experience pain, stiffness, swelling, and sometimes damage and deformity in their joints. RA can also cause intense fatigue and dysfunction of other organ systems.
All of this can be very challenging for a person with RA, limiting them from doing the things they want or need to do. Because of its effect on a person’s quality of life, it is linked to higher rates of mental health conditions, including anxiety and depression.
This article discusses the link between RA and mental health, and why it’s important to prioritize mental health treatment to improve RA outcomes.
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Rheumatoid Arthritis and Mental Health
Research has repeatedly shown that there are higher rates of certain mental health conditions among people with RA compared to the general public. This includes depression, anxiety disorders, and bipolar disorder.
One study found that among people with RA, the incidence of anxiety was 24% higher, depression was 46% higher, and bipolar disorder was 21% higher than in the general public.
The exact relationship between RA and mental health conditions is complex. Scientists believe that this relationship is bidirectional, meaning that RA may cause mental health conditions, but those mental health conditions can also worsen RA.
Social and Physical Factors
RA can cause significant pain, fatigue, and physical disability. When someone is in pain and unable to do the things that are meaningful to them—like driving, playing sports, knitting, or even buttoning up their shirt—they may become isolated, affecting their overall mental health.
Biological Factors
It’s also believed that the biological changes, such as the increase in inflammation that occurs due to RA, can impact mental health. Higher levels of inflammation through C-reactive protein (CRP) levels have been associated with depression and anxiety among people with RA.
Mental Health Impact on RA Treatment
Mental health conditions are also associated with worse outcomes in RA treatment. Studies have found that people with depression and RA had a worse quality of life, increased pain, lower rates of RA remission, and worse response to biologic treatment.
A 2020 study, the first systematic review on anxiety and RA, found that people with anxiety and RA had a poorer quality of life and higher disease activity, particularly in early RA.
Mental health conditions like depression, anxiety, or bipolar disorder affect coping mechanisms. For example, you may have difficulty adhering to a medication regimen or a schedule for wearing a splint or brace, performing therapeutic exercises, attending medical appointments, and more. All of this can lead to worse RA outcomes.
Treatment
Because of this link between mental health conditions and RA outcomes, it’s imperative that any conditions be treated along with RA.
In the United States, the Centers for Disease Control and Prevention (CDC) recommends that healthcare providers offer mental health screenings and discuss strategies to manage both physical and mental health in all arthritis treatment plans.
Some of these treatment strategies include:
- Stress reduction techniques, such as mindfulness or meditation
- Taking medications on schedule
- Regular physical activity, such as an arthritis-approved physical activity program
- Education or workshops in self-management of RA
Your healthcare provider may also recommend medication, psychotherapy, or other lifestyle changes to help manage your mental health.
A 2021 study found that higher physical disability was associated with depression, whereas higher disease activity of RA was not associated with depression. What this implies is that treatment should focus on promoting well-being and finding adaptive techniques to reduce physical disability, rather than singularly focusing on medical management of RA.
A referral to physical therapy or occupational therapy can help address this.
When to Seek Help
If you are struggling with managing RA and your mental health, talk to your healthcare provider about options available for you. Signs and symptoms of mental health issues may not always be obvious. Some symptoms to look out for are:
- Low mood
- Less energy
- Feelings of nervousness or restlessness
- Changes in sleep schedule
- Changes in appetite or weight
- Trouble sticking to a routine
- Difficulty managing medications
- Irritability
- Trembling or shaking
- Trouble concentrating
- Difficulty communicating or in relationships
- Loss of interest in hobbies or activities
- Taking part in risky behaviors
Prevention
Unfortunately, mental health conditions appear to be underdiagnosed among people with RA. This is compounded by the fact that people with RA may seek mental health care less often due to:
- Fear of being stigmatized
- Feeling that they may not be a candidate for mental health care
- The belief that healthcare providers value physical over mental health
It’s recommended that healthcare providers screen all RA patients for mental health conditions, including depression and anxiety, at diagnosis and at least once annually. Identifying these conditions early could help improve the person’s quality of life, as well as improve response to RA treatment.
Summary
People with RA have a higher likelihood of developing a co-occurring mental health condition. The most common condition is depression, but anxiety and bipolar disorder have also been found to occur more often among people with RA.
The social, physical, and biological factors of RA as a disease can lead to mental health issues, but poor mental health can also worsen a person’s response to RA treatment. Therefore, it’s essential that people with RA have mental health screenings and subsequent treatment if necessary.
A Word From Verywell
Many chronic conditions are linked to higher rates of mental health conditions, including RA. It can be stressful to manage a lifelong disease and also live with symptoms like pain, fatigue, and functional impacts. However, treatments are available to you if you feel that your mental health is suffering. You are not alone in this, and you will likely find that seeking help for your mental health condition may also improve your RA symptoms.
