Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

Abstract

This paper presents a comprehensive review of research relating psychological domains with response to therapy in patients with rheumatoid arthritis. A holistic approach to the disease was adopted by incorporating not only disease activity but also dimensions of the impact of disease on patients' lives. Psychological distress, including depression and anxiety, is common among patients with rheumatoid arthritis and has a significant negative impact on response to therapy and on patients' abilities to cope with chronic illness. Evidence regarding the influence of positive psychological dimensions such as acceptance, optimism, and adaptive coping strategies is scarce. The mechanisms involved in these interactions are incompletely understood, although changes in neuro-endocrine-immune pathways, which are common to depression and rheumatoid arthritis, seem to play a central role. Indirect psychological influences on therapeutic efficacy and long-term effectiveness include a myriad of factors such as adherence, placebo effects, cognition, coping strategies, and family and social support. Data suggest that recognition and appropriate management of psychological distress may improve response to treatment and significantly reduce disease burden.

Discontinuation rate of sulfasalazine, leflunomide and methotrexate due to adverse events in a real-life setting (NOR-DMARD)

“…Rheumatologists treating RA can influence patients with milder MTX-associated AEs to continue the treatment more often owing to the higher MTX adoption rate and the fact that it is usually used as concomitant treatment with most biologic DMARDs (bDMARDs). Psychosocial factors can play an essential role in AE acceptance [ 16 ], which can also be the case in our study. Patient education regarding treatment benefits, risks and procedures can increase compliance and improve outcomes [ 17 ].…”

Psychological stress in rheumatoid arthritis: a systematic scoping review

“…On the other hand, various studies have shown that rheumatoid arthritis has a considerable impact on patients' mental health (46). Furthermore, psychological comorbidities such as depression and anxiety are not only associated with a reduced probability of achieving disease remission (12,(47)(48)(49), but it has also been shown that patients in remission often still report unmet needs in terms of mental health (3,50,51). However, the concept of psychological stress refers to more than mood disturbances or psychiatric conditions.…”

Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study

“…Psychological factors play a substantial role in patients with RA, affecting both physical and mental wellbeing as well as their disease course. 8 So far, characterization of psychological factors and determination of their predictive value for treatment response has not been performed in depth. Particularly, expectations have so far been analysed only as a whole and specific aspects of expectations have not yet been assessed separately.…”

“…It is generally accepted that the psychosocial state impacts parameters such as disease activity and health-related quality of life (HrQoL) at baseline, but also longitudinally. 8–10 As such, an association of anxiety, coping with pain and fatigue at baseline with disease activity after 3–12 months was reported. 11 Other analyses focused on illness perceptions in patients with RA and found a significant impact of illness perceptions on physical and mental HrQoL at baseline.…”