A diagnosis of rheumatoid arthritis is a profound, life-changing event. An incurable, autoimmune disease, RA causes widespread inflammation throughout the body, with resulting chronic pain, fatigue that can be overwhelming and potentially crippling disfigurement of the joints.
RA requires treatment with powerful medications that suppress the immune system to prevent it from attacking the body’s healthy tissue. These medications, which include disease-modifying anti-rheumatic drugs like methotrexate, biologics such as Enbrel and Aricept and corticosteroids like prednisone, have greatly improved the outlook for most people with RA. However, treatment is lifelong, and the medications themselves can have serious side effects. In addition, not everyone responds well to treatment, and disease flares are common, even when RA is well-controlled.
In short, if you have been diagnosed with RA, your life is forever changed. If affects your relationships with friends and family, may impact your ability to work, can rob you of some of your independence and may adversely affect your social life.
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A 2016 Polish study examined multiple reports in the medical literature of the social implications of rheumatic diseases, including RA. The reports overwhelmingly indicated that these diseases significantly affect a person’s ability to function within society, cause mood problems and decrease overall quality of life. This was especially true for people with long-standing, active disease.
One study conducted in Poland found that only 38 percent of individuals with RA were satisfied with their lives, while another Polish-German study of people with RA reported that 95 percent of Polish patients and 62 percent of German patients felt excluded from social life.
Younger people were more likely to speak about the damaging influence of RA on their functioning within society than people older than 65. They specifically mentioned that RA negatively impacted their social life and ability to participate in outdoor sports.
Most studies found that RA has a similar adverse effect on both men and women. However, women with RA were more likely than men to need help from relatives or friends with domestic responsibilities and personal hygiene as well as with shopping, handling heavy objects, managing transportation or opening jars. And a Spanish study indicated that women with less education rated their quality of life as poorer than their more educated counterparts.
Another study reported that rheumatic diseases limit educational possibilities and decrease the chances for promotion even among persons who are professionally active.
These changes in daily living often lead to depression.
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“Depression is a common condition with RA, with a prevalence rate of approximately 16.8 percent. This is significantly higher than the prevalence rate of approximately 5 percent found in the general population,” says Lauren Holleb, a psychologist and assistant professor in the College of Science and Humanities at Husson University in Bangor, Maine.
“Complications for those with both depression and RA include decreased quality of life, negative impact on daily functioning, deterioration of relationships with family and friends, increased risk of economic hardship, increased medical costs and greater risk for poor health. Specifically, RA patients with comorbid depression are at increased risk for cardiovascular disease and heart attacks, loss of work productivity, disability and mortality,” Holleb says.
Suicide appears to be an increased risk factor for women with RA. A 13-year study of all suicides in Finland found that of the people who committed suicide in that period and who did not have RA, 17 percent were women. Among those committing suicide who did have RA, 53 percent were women. The men who committed suicide had been diagnosed with RA for less time and had fewer hospital admissions than females.
Clearly, RA is not just a disease that affects one’s physical health. Rather, it can have far-reaching — even deadly — implications on a person’s ability to function within the family and other social and work-related settings.
These research findings underscore the importance of routine mental health assessment and intervention as part of routine care for RA patients. According to the 2016 Polish study, early diagnosis of social and mental health issues and implementation of effective treatment are essential for patients to maintain professional and social activity, which is critically important in decreasing the negative social implications of RA.
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Despite this fact, “mental health and [the] emotional impact of [RA] are rarely brought up by physicians,” says Adena Batterman, a licensed clinical social worker and the senior manager of inflammatory arthritis support and education at the Hospital for Special Surgery in New York.
However, according to Batterman, “Studies show that patients would welcome the opportunity to discuss [these issues] if given the opening.”
But patients should not wait for their physicians to bring up the subject. “People with RA who feel they might be experiencing signs or symptoms of depression, anxiety and changes in mood should know that reporting these symptoms to their health care provider is as important as discussing joint pain and fatigue,” Batterman stresses.
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Rheumatoid Arthritis Has Far-Reaching Social Implications originally appeared on usnews.com
