Psychosomatic Features, Compliance and Complementary Therapies in Rheumatoid Arthritis

Abstract

: This review highlights the issue of psychosomatic conditions in rheumatoid arthritis, paying a special attention to new researches and trends in this field. Emerging concepts in all the major parts of the problem are covered consecutively, from the impact of chronic musculoskeletal pain on emotional state to disease influence over quality of life, socio-psychological, and interpersonal relationships. Chronic pain is closely related to emotional responses and coping ability, with pronounced positive effect of psychotherapeutic interventions, family and social support on it. Psychosexual disorders, anxiety, depression also commonly coexist with rheumatoid arthritis, leading to further decrease of quality of life, low compliance, and high suicide risk. Influence of psychosomatic conditions on overall treatment effect is usually underestimated by rheumatologists and general practitioners. Psychosomatic considerations are of great importance for up-to-date management of rheumatoid arthritis, as they strongly influence quality of life, compliance, and thereby disease outcomes. Two major approaches of psychological rehabilitation exist, both coping with pain through regulation of emotion and psychotherapeutic intervention, which not only helps patients in coping with the disease, but also aimed at improving the overall adaptation of the patient. It includes techniques of relaxation, cognitive-behavioral therapy, and biofeedback therapy. Current data about efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review.

An Overview on Causes of Nonadherence in the Treatment of Rheumatoid Arthritis: Its Effect on Mortality and Ways to Improve Adherence

“…An additional factor to be considered in the development of AEs is the treatment for other comorbid diseases in addition to RA. When multiple medications are prescribed, the risk of medication interactions increases along with the risk of AEs [ 28 ]. One study saw that when MTX was combined with frequent corticosteroid use, tolerance to MTX dropped significantly (odds ratio = 2.73; 95% confidence interval, 1.06 to 7.06; p = 0.038) [ 29 ].…”

“…When AEs become too severe or frequent, the patient-perceived risk-benefit declines leading to skipped doses or abandonment of the medication altogether [ 5 , 29 ]. Even chronic fatigue, a common AE reported from those on multi-pharmacologic treatment regimen, was reported to cause such a detrimental emotional impact that eventually lead to nonadherence [ 5 , 28 ].…”

Schmerzmedikamente bei Nierenpatienten

“…Man sollte nicht die Beseitigung, sondern die Erträglichkeit der Schmerzen zum Behandlungsziel machen. Moderne Schmerztherapie will also keine Schmerzfreiheit erreichen, sondern die Patienten dabei unterstützen, trotz Schmerzen ihre Lebensqualität zu verbessern [3].…”

Clinical and psychological characteristics associated with negative beliefs and concerns about treatment necessity in rheumatic diseases

“…Rheumatic diseases require often complex and long-term therapy in order to prevent exacerbations, control pain and improve the quality of life of patients. As in other chronic diseases 1 , it is extremely challenging to achieve compliance with pharmacological treatment in order to prevent progression of the disease and hospitalizations 2 – 4 . Compliance can be influenced by several factors as pain, disease duration, comorbidities, disability and individual beliefs about illness and medication 5 – 7 .…”