Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review

Abstract

Over 60% of rheumatoid arthritis (RA) patients achieve a good response after 12 months of treatment when following the European league against rheumatism (EULAR) guidelines for treatment. However, almost half of patients still suffer from moderate to severe disease activity despite this. In addition, mental health problems may remain despite reduced measures of inflammation systemically and within joints. Depression is two times more common in RA patients than in the general population, and intriguingly a bi-directional relationship with RA has been shown in cross-sectional studies. Chronic inflammation impairs the physiological responses to stress including effective coping behaviours, resulting in depression, which leads to a worse long-term outcome in RA. In RA patients, the pain score is not always solely related to inflammatory arthritis and immunological disease activity by Bąk et al.

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

“…It seems that there are unrevealed factors that could be considered accountable for the decreased frequency of COVID-19 infection in those from upper Egypt compared to those from the capital and northern cities, such as the hot weather, less vibrant lifestyle and moderate challenging circumstances. RA patients are more prone to have anxiety, depression and cognitive impairment [ 2 ].…”

“…Rheumatoid arthritis (RA) is the most common inflammatory arthritis [ 1 ] that can cause damage to the joints. It can also present with extra-articular manifestations, affecting other major organs [ 2 ]. Infections are the most important comorbidities associated with increased morbidity and mortality [ 1 ].…”

Impact of coronavirus disease 2019 (COVID-19) pandemic on attitude, behavior, and mental health of patients with rheumatic diseases

“…The limitations of our study were the inability to assess the same patients' psychological status just before the hit of coronavirus, an unexpected event, which would have been more informative about the direct impact of COVID-19 pandemic isolated from the effect of their chronic illnesses which had been also accused to affect mental health [30,31]. The finding that mental health status was more affected by their belief of "being at risk" of infection was a clear indicator of the impact of COVID-19 pandemic.…”

Over-the-counter naproxen in rheumatology practice: scope and therapeutic benefits

“…Однако боль -субъективное ощущение, интенсивность которого определяется не только выраженностью воспаления и тяжестью повреждения ткани, но и длительностью страдания, функциональными нарушениями, психологическим статусом, воспитанием, социальными проблемами и др. [4,5]. Поэтому переживание боли и оценка ее выраженности могут быть примерно одинаковыми как при ревматоидном артрите (РА), для которого типичны активное системное воспаление и клиническая картина полиартрита, так и при остеоартрите (ОА), который характеризуется локальной низкоинтенсивной воспалительной реакцией и поражением суставов в виде моно-или олигоартрита.…”

“…Даже эффективное подавление иммунного воспаления и достижение клинико-лабораторной ремиссии не обеспечивают полного устранения боли и обусловленных ею психологических проблем, таких как депрессия и тревожность. С одной стороны, это определяется сложным, многоплановым патогенезом хронической боли при РЗ, включающим механизмы центральной сенситизации и нейропластические процессы, с другой -функциональными нарушениями и дегенеративными процессами (фиброз, неоангиогенез, гетеротопическая оссификация), которые развиваются вследствие аутоиммунной агрессии и приводят к формированию «вторичного» ОА и стойким биомеханическим нарушениям [4,5,7]. Так, K. Michaud и соавт.…”