“…A combination of early pharmacological and multidisciplinary team interventions aim to alter the infl ammatory process, reduce symptoms and enhance self-management (Hilliquin and Menkes, 1994). At diagnosis, people with RA may experience not only a range of physical problems, such as pain, disability and fatigue, but also associated emotional consequences, including depressive symptoms and anxiety (Ramjeet et al, 2005;Scott et al, 2005;Smedstad et al, 1996;Van der Heide et al, 1994). Unpredictability disrupts life plans, increasing psychological distress and helplessness, and roles and relationships come under stress (Newman et al, 1996;Ryan, 1996).…”