Going Beyond the Physical: The Mental and Emotional Toll of Rheumatic Diseases


Going Beyond the Physical: The Mental & Emotional Toll of Rheumatic Diseases

Rheumatic diseases can be physically devastating. They often cause pain and disability – leading those who suffer from rheumatic diseases to make drastic lifestyle changes.

A once spotless house is covered in dust. Running shoes languish in the closet. A toolbox sits unopened.

Rheumatic diseases can be physically devastating. They often cause pain and disability – leading those who suffer from rheumatic diseases to make drastic lifestyle changes. Simple tasks — such as tying shoes or opening a medicine bottle — become daunting challenges, but the effects of rheumatic diseases go beyond the physical.

Activities that have been part of someone’s daily routine for years can become limited. Habits and hobbies that bring joy and relieve stress are sometimes abandoned. A career that once provided a sense of identity may change.

Faced with the sudden prospect of managing a chronic disease and a new set of limitations impacting every facet of their lives, people with rheumatic diseases can feel overwhelmed by their situation.

“An initial diagnosis of rheumatoid arthritis or other autoimmune diseases has an emotional impact and no one response is the same,” says Karen Smarr, PhD; clinical assistant professor of medicine at the University of Missouri.

While most people with rheumatic diseases are able to cope with the emotional strain that comes with a chronic disease, some may develop symptoms of clinical depression and/or anxiety – two of the most common co-existing conditions in those with rheumatic diseases. Researchers have found that people with RA are twice as likely to experience depression as those in the general population. Researchers have also noted that those with chronic pain, one of the most common symptoms of rheumatic diseases, are more likely to develop anxiety disorder than the general population.

If you think you are experiencing signs of rheumatoid arthritis and depression you should speak with a rheumatologist. There is no formula that can predict which patients will develop depression or anxiety. A number of factors — including biology, coping mechanisms, and a patient’s level of distress — factor into whether or not someone with a rheumatic disease will also develop depression, Dr. Smarr says.

Carol Greco, PhD; assistant professor at the University of Pittsburgh says that, in her 14 years of studying mental health and lupus, she has found that pain and fatigue overlap significantly with depressive symptoms.

“Many patients with rheumatic diseases are dealing with pain and fatigue on a daily basis,” Dr. Greco says.

While emotional distress is greater right after diagnosis and typically lessens over time as patients learn to adapt, health care providers always need to be on watch for symptoms of depression in rheumatic disease patients. The unpredictable nature of rheumatic diseases, characterized by flare ups and changing levels of pain and disability, can take a toll even on patients who have coped well with their condition in the past.

It is important for health care providers to be aware of the symptoms of depression because it is linked to a host of negative effects.

[Health care] Providers should be sensitive to lifestyle changes, and it is recommended that rheumatologists monitor for depression on an ongoing basis,” Dr. Smarr says.

It is also important for patients who think they may have depression or anxiety to seek professional help. A psychiatrist can prescribe medicine, Dr. Greco says, but she also recommends people with rheumatic diseases seek therapy to learn new coping skills. She recommends Cognitive Behavioral Therapy to help patients learn to adapt and change thought patterns. She also recommends Mindfulness Based Stress Reduction to help people with rheumatic diseases learn to live in the moment and manage pain.

Focusing on the disease instead of living a fuller life may lead to depression, Dr. Smarr says. Patients can end up feeling isolated and discouraged, letting their condition hold them back from enjoying life. The key, says Dr. Smarr, is finding balance between enjoyable activities and taking care of your needs.