Individuals with rheumatoid arthritis (RA) demonstrate an increased prevalence of mood disorders compared with the general population, but a decreased prevalence of schizophrenia, probably due to alterations in inflammatory processes
Several mechanisms underlie the relationship between RA and mental health comorbidities: cognitive, behavioural and affective responses, inflammatory processes, and fatigue
Social factors have important implications in psychological reactions to RA, and could also be involved in pain processing and RA disease activity
Neural reward-processing deficiencies are an emerging area of inquiry in understanding the relationship between pain and psychological states that warrants additional attention in patients with RA
Psychological treatments that increase active coping strategies, ameliorate affective distress, bolster self-efficacy, and increase supportive social relationships could improve treatment outcomes in patients with RA
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.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
A nationwide study of the risks of major mental disorders among the offspring of parents with rheumatoid arthritis
Scientific Reports Open Access 23 March 2022
Differential inflammation-mediated function of prokineticin 2 in the synovial fibroblasts of patients with rheumatoid arthritis compared with osteoarthritis
Scientific Reports Open Access 15 September 2021
BIOlogical Factors that Limit sustAined Remission in rhEumatoid arthritis (the BIO-FLARE study): protocol for a non-randomised longitudinal cohort study
BMC Rheumatology Open Access 19 July 2021
Subscribe to Journal
Get full journal access for 1 year
only $6.58 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Sokka, T., Krishnan, E., Häkkinen, A. & Hannonen, P. Functional disability in rheumatoid arthritis patients compared with a community population in Finland. Arthritis Rheum. 48, 59–63 (2003).
van't Land, H. et al. The association between arthritis and psychiatric disorders; results from a longitudinal population-based study. J. Psychosom. Res. 68, 187–193 (2010).
Rupp, I. et al. Poor and good health outcomes in rheumatoid arthritis: the role of comorbidity. J. Rheumatol. 33, 1488–1495 (2006).
Löwe, B. et al. Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom. Med. 66, 395–402 (2004).
Lee, Y. C. et al. The role of sleep problems in central pain processing in rheumatoid arthritis. Arthritis Rheum. 65, 59–68 (2013).
Covic, T. et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 12, 6 (2012).
Matcham, F., Rayner, L., Steer, S. & Hotopf, M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 52, 2136–2148 (2013).
Härter, M. et al. A descriptive study of psychiatric disorders and psychosocial burden in rehabilitation patients with musculoskeletal diseases. Arch. Phys. Med. Rehabil. 83, 461–468 (2002).
Morris, A., Yelin, E. H., Panopalis, P., Julian, L. & Katz, P. P. Long-term patterns of depression and associations with health and function in a panel study of rheumatoid arthritis. J. Health Psychol. 16, 667–677 (2011).
Edwards, R. R., Cahalan, C., Mensing, G., Smith, M. & Haythornthwaite, J. A. Pain, catastrophizing, and depression in the rheumatic diseases. Nat. Rev. Rheumatol. 7, 216–224 (2011).
DiMatteo, M. R., Lepper, H. S. & Croghan, T. W. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch. Intern. Med. 160, 2101–2107 (2000).
Margaretten, M. et al. Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis. Arthritis Care Res. (Hoboken) 63, 240–246 (2011).
Hyphantis, T. et al. The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis. Clin. Rheumatol. 32, 635–644 (2013).
Piccinni, A. et al. Clinical significance of lifetime mood and panic-agoraphobic spectrum symptoms on quality of life of patients with rheumatoid arthritis. Compr. Psychiatry 47, 201–208 (2006).
Kekow, J. et al. Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis. Rheumatology (Oxford) 50, 401–409 (2011).
Hider, S. L., Tanveer, W., Brownfield, A., Mattey, D. L. & Packham, J. C. Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Rheumatology (Oxford) 48, 1152–1154 (2009).
Rathbun, A. M., Reed, G. W. & Harrold, L. R. The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology (Oxford) 52, 1785–1794 (2013).
Michaud, K. & Wolfe, F. Comorbidities in rheumatoid arthritis. Best Pract. Res. Clin. Rheumatol. 21, 885–906 (2007).
Ang, D. C., Choi, H., Kroenke, K. & Wolfe, F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J. Rheumatol. 32, 1013–1019 (2005).
Scherrer, J. F. et al. Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis. Gen. Hosp. Psychiatry 31, 353–359 (2009).
Timonen, M. et al. Suicides in persons suffering from rheumatoid arthritis. Rheumatology (Oxford) 42, 287–291 (2003).
Shih, M., Hootman, J. M., Strine, T. W., Chapman, D. P. & Brady, T. J. Serious psychological distress in US adults with arthritis. J. Gen. Intern. Med. 21, 1160–1166 (2006).
Murphy, L. B., Sacks, J. J., Brady, T. J., Hootman, J. M. & Chapman, D. P. Anxiety and depression among US adults with arthritis: prevalence and correlates. Arthritis Care Res. (Hoboken) 64, 968–976 (2012).
Lok, E. Y. C., Mok, C. C., Cheng, C. W. & Cheung, E. F. C. Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics 51, 338–338.e8 (2010).
McWilliams, L. A., Goodwin, R. D. & Cox, B. J. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 111, 77–83 (2004).
VanDyke, M. M. et al. Anxiety in rheumatoid arthritis. Arthritis Care Res. (Hoboken) 51, 408–412 (2004).
Mok, C., Lok, E. & Cheung, E. Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis. Scand. J. Rheumatol. 41, 253–259 (2012).
Boscarino, J. A., Forsberg, C. W. & Goldberg, J. A twin study of the association between PTSD symptoms and rheumatoid arthritis. Psychosom. Med. 72, 481–486 (2010).
Mikuls, T. R. et al. Prospective study of posttraumatic stress disorder and disease activity outcomes in US veterans with rheumatoid arthritis. Arthritis Care Res. (Hoboken) 65, 227–234 (2013).
Helzer, J. E., Robins, L. N. & McEvoy, L. Post-traumatic stress disorder in the general population. N. Engl. J. Med. 317, 1630–1634 (1987).
Oken, R. J. & Schulzer, M. At issue: schizophrenia and rheumatoid arthritis: the negative association revisited. Schizophr. Bull. 25, 625 (1999).
Jeste, D. V., Gladsjo, J. A., Lindamer, L. A. & Lacro, J. P. Medical comorbidity in schizophrenia. Schizophr. Bull. 22, 413–430 (1996).
Potvin, S. et al. Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review. Biol. Psychiatry 63, 801–808 (2008).
Gorwood, P. et al. Rheumatoid arthritis and schizophrenia: a negative association at a dimensional level. Schizophr. Res. 66, 21–29 (2004).
Dinarello, C. A. The many worlds of reducing interleukin-1. Arthritis Rheum. 52, 1960–1967 (2005).
Bruce, T. O. Comorbid depression in rheumatoid arthritis: pathophysiology and clinical implications. Curr. Psychiatry. Rep. 10, 258–264 (2008).
Straub, R. H. & Cutolo, M. Involvement of the hypothalamic–pituitary–adrenal/gonadal axis and the peripheral nervous system in rheumatoid arthritis: viewpoint based on a systemic pathogenetic role. Arthritis Rheum. 44, 493–507 (2001).
Straub, R. H. Rheumatoid arthritis: stress in RA: a trigger of proinflammatory pathways? Nat. Rev. Rheumatol. 10, 516–518 (2014).
Straub, R. H., Dhabhar, F. S., Bijlsma, J. W. & Cutolo, M. How psychological stress via hormones and nerve fibers may exacerbate rheumatoid arthritis. Arthritis Rheum. 52, 16–26 (2005).
Dowlati, Y. et al. A meta-analysis of cytokines in major depression. Biol. Psychiatry 67, 446–457 (2010).
Miller, A. H., Maletic, V. & Raison, C. L. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol. Psychiatry 65, 732–741 (2009).
Evers, A. W., Zautra, A. & Thieme, K. Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nat. Rev. Rheumatol. 7, 409–415 (2011).
Zautra, A. J. & Smith, B. W. Depression and reactivity to stress in older women with rheumatoid arthritis and osteoarthritis. Psychosom. Med. 63, 687–696 (2001).
Söderlin, M. K., Hakala, M. & Nieminen, P. Anxiety and depression in a community-based rheumatoid arthritis population. Scand. J. Rheumatol. 29, 177–183 (2000).
Bazzichi, L. et al. Quality of life in rheumatoid arthritis: impact of disability and lifetime depressive spectrum symptomatology. Clin. Exp. Rheumatol. 23, 783 (2005).
Courvoisier, D. S. et al. Pain as an important predictor of psychosocial health in patients with rheumatoid arthritis. Arthritis Care Res. (Hoboken) 64, 190–196 (2012).
Pollard, L., Choy, E., Gonzalez, J., Khoshaba, B. & Scott, D. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford) 45, 885–889 (2006).
Öncü, J., Bas¸og˘lu, F. & Kuran, B. A comparison of impact of fatigue on cognitive, physical, and psychosocial status in patients with fibromyalgia and rheumatoid arthritis. Rheumatol. Int. 33, 3031–3037 (2013).
Rupp, I., Boshuizen, H. C., Jacobi, C. E., Dinant, H. J. & van den Bos, G. A. Impact of fatigue on health-related quality of life in rheumatoid arthritis. Arthritis Care Res. (Hoboken) 51, 578–585 (2004).
Nikolaus, S., Bode, C., Taal, E. & de Laar, M. A. Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis Care Res. (Hoboken) 65, 1128–1146 (2013).
Cutolo, M., Kitas, G. D. & van Riel, P. L. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. Semin. Arthritis Rheum. 43, 479–488 (2014).
Joharatnam, N. et al. A cross-sectional study of pain sensitivity, disease-activity assessment, mental health, and fibromyalgia status in rheumatoid arthritis. Arthritis Res. Ther. 17, 11 (2015).
Fifield, J. et al. History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis. Ann. Behav. Med. 23, 34–41 (2001).
Belt, N., Kronholm, E. & Kauppi, M. Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general population. Clin. Exp. Rheumatol. 27, 35 (2009).
Smedstad, L., Mourn, T., Vaglum, P. & Kvien, T. The impact of early rheumatoid arthritis on psychological distress. Scand. J. Rheumatol. 25, 377–382 (1996).
Wolfe, F. & Michaud, K. Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity. Arthritis Care Res. (Hoboken) 61, 667–673 (2009).
Isik, A., Koca, S. S., Ozturk, A. & Mermi, O. Anxiety and depression in patients with rheumatoid arthritis. Clin. Rheumatol. 26, 872–878 (2007).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR® (American Psychiatric Pub, 2000).
Hegarty, R. S., Conner, T. S., Stebbings, S. & Treharne, G. J. Feel the fatigue and be active anyway: physical activity on high-fatigue days protects adults with arthritis from decrements in same-day positive mood. Arthritis Care Res. (Hoboken) 67, 1230–1236 (2015).
Parrish, B. P., Zautra, A. J. & Davis, M. C. The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis. Health Psychol. 27, 694 (2008).
Finan, P. et al. Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients. Health Psychol. 29, 429 (2010).
Henningsen, P., Zimmermann, T. & Sattel, H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom. Med. 65, 528–533 (2003).
Moss-Morris, R. & Chalder, T. Illness perceptions and levels of disability in patients with chronic fatigue syndrome and rheumatoid arthritis. J. Psychosom. Res. 55, 305–308 (2003).
Smith, B. W. & Zautra, A. J. The effects of anxiety and depression on weekly pain in women with arthritis. Pain 138, 354–361 (2008).
Strand, E. B. et al. Positive affect as a factor of resilience in the pain–negative affect relationship in patients with rheumatoid arthritis. J. Psychosom. Res. 60, 477–484 (2006).
Zautra, A. J., Johnson, L. M. & Davis, M. C. Positive affect as a source of resilience for women in chronic pain. J. Consult. Clin. Psychol. 73, 212–220 (2005).
Conner, T. S. et al. Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed. Pain 126, 198–209 (2006).
Zautra, A. J. et al. Arthritis and perceptions of quality of life: an examination of positive and negative affect in rheumatoid arthritis patients. Health Psychol. 14, 399 (1995).
Sullivan, M. J., Bishop, S. R. & Pivik, J. The pain catastrophizing scale: development and validation. Psychol. Assess. 7, 524 (1995).
Nakajima, A. et al. Disability and patient's appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan. Mod. Rheumatol. 16, 151–157 (2006).
Englbrecht, M. et al. The impact of coping strategies on mental and physical well-being in patients with rheumatoid arthritis. Semin. Arthritis Rheum. 41, 545–555 (2012).
Pinto-Gouveia, J., Costa, J. & Marôco, J. The first 2 years of rheumatoid arthritis: the influence of acceptance on pain, physical limitation and depression. J. Health Psychol. 20, 102–112 (2015).
Treharne, G. J., Kitas, G. D., Lyons, A. C. & Booth, D. A. Well-being in rheumatoid arthritis: the effects of disease duration and psychosocial factors. J. Health Psychol. 10, 457–474 (2005).
Knittle, K. P. et al. Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis. Arthritis Care Res. (Hoboken) 63, 1613–1619 (2011).
Scharloo, M. et al. Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. J. Psychosom. Res. 44, 573–585 (1998).
Wood, P. B., Glabus, M. F., Simpson, R. & Patterson, J. C. Changes in gray matter density in fibromyalgia: correlation with dopamine metabolism. J. Pain 10, 609–618 (2009).
Wood, P. B. et al. Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study. J. Pain 8, 51–58 (2007).
Wood, P. B. et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur. J. Neurosci. 25, 3576–3582 (2007).
Russell, I. J., Vaeroy, H., Javors, M. & Nyberg, F. Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthritis Rheum. 35, 550–556 (1992).
Ashby, F. G. & Isen, A. M. A neuropsychological theory of positive affect and its influence on cognition. Psychol. Rev. 106, 529 (1999).
Schultz, W. Getting formal with dopamine and reward. Neuron 36, 241–263 (2002).
Zautra, A. J. et al. Fibromyalgia: evidence for deficits in positive affect regulation. Psychosom. Med. 67, 147 (2005).
Finan, P. H., Zautra, A. J. & Davis, M. C. Daily affect relations in fibromyalgia patients reveal positive affective disturbance. Psychosom. Med. 71, 474–482 (2009).
Baliki, M. N., Geha, P. Y., Fields, H. L. & Apkarian, A. V. Predicting value of pain and analgesia: nucleus accumbens response to noxious stimuli changes in the presence of chronic pain. Neuron 66, 149–160 (2010).
Martikainen, I. K. et al. Chronic back pain is associated with alterations in dopamine neurotransmission in the ventral striatum. J. Neurosci. 35, 9957–9965 (2015).
Miller, A. H., Haroon, E., Raison, C. L. & Felger, J. C. Cytokine targets in the brain: impact on neurotransmitters and neurocircuits. Depress. Anxiety 30, 297–306 (2013).
Eisenberger, N. I., Inagaki, T. K., Mashal, N. M. & Irwin, M. R. Inflammation and social experience: an inflammatory challenge induces feelings of social disconnection in addition to depressed mood. Brain Behav. Immun. 24, 558–563 (2010).
Reichenberg, A. et al. Cytokine-associated emotional and cognitive disturbances in humans. Arch. Gen. Psychiatry 58, 445–452 (2001).
Brydon, L., Harrison, N. A., Walker, C., Steptoe, A. & Critchley, H. D. Peripheral inflammation is associated with altered substantia nigra activity and psychomotor slowing in humans. Biol. Psychiatry 63, 1022–1029 (2008).
Illi, J. et al. Association between pro-and anti-inflammatory cytokine genes and a symptom cluster of pain, fatigue, sleep disturbance, and depression. Cytokine 58, 437–447 (2012).
Ulus, Y. et al. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin. Exp. Rheumatol. 29, S92–96 (2010).
Lee, Y. C. et al. Subgrouping of patients with rheumatoid arthritis based on pain, fatigue, inflammation, and psychosocial factors. Arthritis Rheumatol. 66, 2006–2014 (2014).
Finan, P. H. & Smith, M. T. The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism. Sleep Med. Rev. 17, 173–183 (2013).
Finan, P. H. & Zautra, A. J. Rheumatoid arthritis: stress affects rheumatoid arthritis, but via what mechanisms? Nat. Rev. Rheumatol. 9, 569–570 (2013).
Carlino, E., Frisaldi, E. & Benedetti, F. Pain and the context. Nat. Rev. Rheumatol. 10, 348–355 (2014).
Zautra, A. J. et al. Examination of changes in interpersonal stress as a factor in disease exacerbations among women with rheumatoid arthritis. Ann. Behav. Med. 19, 279–286 (1997).
Davis, M. C. et al. Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: implications for fatigue. Brain Behav. Immun. 22, 24–32 (2008).
Smith, T. W. & Christensen, A. J. Positive and negative affect in rheumatoid arthritis: increased specificity in the assessment of emotional adjustment. Ann. Behav. Med. 18, 75–78 (1996).
Potter, P. & Zautra, A. Effects of major and minor stressors on disease activity in rheumatoid arthritis patients. J. Consult. Clin. Psychol. 65, 319–323 (1997).
Zautra, A. J., Hamilton, N. & Yocum, D. Patterns of positive social engagement among women with rheumatoid arthritis. OTJR (Thorofare N. J.) 20, 21S–40S (2000).
Bowlby, E. J. M. Attachment: Volume One of the Attachment and Loss Trilogy (Pimlico, 1969).
Fraley, C. R., Niedenthal, P. M., Marks, M., Brumbaugh, C. & Vicary, A. Adult attachment and the perception of emotional expressions: probing the hyperactivating strategies underlying anxious attachment. J. Pers. 74, 1163–1190 (2006).
Infurna, F. J., Rivers, C. T., Reich, J. & Zautra, A. J. Childhood trauma and personal mastery: their influence on emotional reactivity to everyday events in a community sample of middle-aged adults. PLoS ONE 10, e0121840 (2015).
Vrtic˘ka, P., Andersson, F., Grandjean, D., Sander, D. & Vuilleumier, P. Individual attachment style modulates human amygdala and striatum activation during social appraisal. PLoS ONE 3, e2868–e2868 (2008).
Davis, D. A., Luecken, L. J. & Zautra, A. J. Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature. Clin. J. Pain 21, 398–405 (2005).
Weber, S., Jud, A. & Landolt, M. Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review. Qual. Life Res. 25, 237–255 (2016).
Manne, S. L. & Zautra, A. J. Couples coping with chronic illness: women with rheumatoid arthritis and their healthy husbands. J. Behav. Med. 13, 327–342 (1990).
Kasle, S., Wilhelm, M. S. & Zautra, A. J. Rheumatoid arthritis patients' perceptions of mutuality in conversations with spouses/partners and their links with psychological and physical health. Arthritis Care Res. (Hoboken) 59, 921–928 (2008).
Arewasikporn, A., Davis, M. C. & Zautra, A. Health and Social Relationships: the Good, the Bad, and the Complicated (American Psychological Association, 2013).
Manne, S. L. & Zautra, A. J. Spouse criticism and support: their association with coping and psychological adjustment among women with rheumatoid arthritis. J. Pers. Soc. Psychol. 56, 608 (1989).
Zyrianova, Y. et al. Depression and anxiety in rheumatoid arthritis: the role of perceived social support. Ir. J. Med. Sci. 175, 32–36 (2006).
Evers, A. W. M., Kraaimaat, F. W., Geenen, R., Jacobs, J. W. G. & Bijlsma, J. W. J. Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav. Res. Ther. 41, 1295–1310 (2003).
Benka, J. et al. Social support as a moderator of functional disability's effect on depressive feelings in early rheumatoid arthritis: a four-year prospective study. Rehabil. Psychol. 59, 19 (2014).
Makoul, G. & Clayman, M. L. An integrative model of shared decision making in medical encounters. Patient Educ. Couns. 60, 301–312 (2006).
Hibbard, J. H. & Greene, J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 32, 207–214 (2013).
Bennett, J. K., Fuertes, J. N., Keitel, M. & Phillips, R. The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment. Patient Educ. Couns. 85, 53–59 (2011).
Martin, R. W. et al. Patient decision-making related to antirheumatic drugs in rheumatoid arthritis: the importance of patient trust of physician. J. Rheumatol. 35, 618–624 (2008).
Sheehy, C., Murphy, E. & Barry, M. Depression in rheumatoid arthritis — underscoring the problem. Rheumatology (Oxford) 45, 1325–1327 (2006).
Nicassio, P. M. The problem of detecting and managing depression in the rheumatology clinic. Arthritis Care Res. (Hoboken) 59, 155–158 (2008).
Sleath, B. et al. Communication about depression during rheumatoid arthritis patient visits. Arthritis Care Res. (Hoboken) 59, 186–191 (2008).
Repping-Wuts, H., Repping, T., van Riel, P. & van Achterberg, T. Fatigue communication at the out-patient clinic of rheumatology. Patient Educ. Couns. 76, 57–62 (2009).
Khan, N. A. et al. Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity. Arthritis Care Res. (Hoboken) 64, 206–214 (2012).
Tander, B. et al. A comparative evaluation of health related quality of life and depression in patients with fibromyalgia syndrome and rheumatoid arthritis. Rheumatol. Int. 28, 859–865 (2008).
Evers, A. W., Kraaimaat, F. W., van Riel, P. L. & de Jong, A. J. Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial. Pain 100, 141–153 (2002).
Kraaimaat, F., Brons, M., Geenen, R. & Bijlsma, J. The effect of cognitive behavior therapy in patients with rheumatoid arthritis. Behav. Res. Ther. 33, 487–495 (1995).
Hofmann, S. G., Sawyer, A. T., Witt, A. A. & Oh, D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J. Consult. Clin. Psychol. 78, 169 (2010).
Bohlmeijer, E., Prenger, R., Taal, E. & Cuijpers, P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J. Psychosom. Res. 68, 539–544 (2010).
Veehof, M. M., Oskam, M.-J., Schreurs, K. M. & Bohlmeijer, E. T. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 152, 533–542 (2011).
Pradhan, E. K. et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Care Res. (Hoboken) 57, 1134–1142 (2007).
Zautra, A. J. et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J. Consult. Clin. Psychol. 76, 408 (2008).
Dures, E. & Hewlett, S. Cognitive–behavioural approaches to self-management in rheumatic disease. Nat. Rev. Rheumatol. 8, 553–559 (2012).
Lorig, K., Lubeck, D., Kraines, R. G., Seleznick, M. & Holman, H. R. Outcomes of self-help education for patients with arthritis. Arthritis Rheum. 28, 680–685 (1985).
Lorig, K. R., Mazonson, P. D. & Holman, H. R. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum. 36, 439–446 (1993).
Lorig, K. R., Ritter, P. L., Laurent, D. D. & Plant, K. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Arthritis Care Res. (Hoboken) 59, 1009–1017 (2008).
Sturgeon, J. A. & Zautra, A. J. Social pain and physical pain: shared paths to resilience. Pain Manag. 6, 63–74 (2016).
Zautra, E. K., Zautra, A. J., Gallardo, C. E. & Velasco, L. Can we learn to treat one another better? A test of a social intelligence curriculum. PLoS ONE 10, e0128638 (2015).
Lin, E. H. et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA 290, 2428–2429 (2003).
Haack, M., Sanchez, E. & Mullington, J. M. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep 30, 1145 (2007).
Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K. & Haack, M. Sleep loss and inflammation. Best Pract. Res. Clin. Endocrinol. Metab. 24, 775–784 (2010).
Irwin, M. R. et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep 35, 537 (2012).
de Wild-Hartmann, J. A. et al. Day-to-day associations between subjective sleep and affect in regard to future depression in a female population-based sample. Br. J. Psychiatry 202, 407–412 (2013).
Kalmbach, D. A., Pillai, V., Roth, T. & Drake, C. L. The interplay between daily affect and sleep: a 2-week study of young women. J. Sleep Res. 23, 636–645 (2014).
Finan, P., Quartana, P. & Smith, M. The effects of sleep continuity disruption on positive mood and sleep architecture in healthy adults. Sleep 38, 1735–1742 (2015).
Alex J. Zautra deceased June 2016. Dr Zautra was an accomplished researcher and academic, and a devoted mentor. This work was supported by grants from the NIH: NIDA 3T32DA035165-02S1 to J.A.S.; NIH K23 DA035915 and NIH P30 NR014131 to P.H.F.; and NIA R01 AG 026006 to A.J.Z.
The authors declare no competing financial interests.
- Cognitive styles
Relatively stable patterns of cognitive interpretation of events that have implications for behaviour and mood, such as an increased tendency towards catastrophic appraisal of pain or health, or optimistic views of oneself, health, or future function.
- Insecure attachment
A stable cognitive and behavioural style of forming and maintaining meaningful social relationships, characterized by high levels of anxiety and hypervigilance to cues about whether an individual is loved by significant others to whom he or she is attached.
- Therapeutic alliance
The relationship between a patient and his or her clinical provider (e.g. physician or psychologist), which has implications for treatment adherence and treatment outcomes, and might evolve over time.
About this article
Cite this article
Sturgeon, J., Finan, P. & Zautra, A. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol 12, 532–542 (2016). https://doi.org/10.1038/nrrheum.2016.112
This article is cited by
A nationwide study of the risks of major mental disorders among the offspring of parents with rheumatoid arthritis
Scientific Reports (2022)
The effect of flaxseed with or without anti-inflammatory diet in patients with rheumatoid arthritis, a randomized controlled trial
European Journal of Nutrition (2022)
Differential inflammation-mediated function of prokineticin 2 in the synovial fibroblasts of patients with rheumatoid arthritis compared with osteoarthritis
Scientific Reports (2021)
Current Pain and Headache Reports (2021)
Interleukin 6, interleukin 17, disease-related and contextual factor association with depression, and its severity in patients with rheumatoid arthritis
Clinical Rheumatology (2021)