The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

Abstract

a b s t r a c tInflammatory rheumatic diseases have a long-lasting effect on patients' physical and psychological functioning, for instance, due to disabling symptoms and unpredictable disease course. Consequently, many patients show adjustment problems such as depressed mood, which in turn can negatively influence their disease outcome. Specific biopsychosocial factors have shown to affect this outcome. For example, daily stress, cognitive-behavioral risk factors such as pain catastrophizing and avoidance, and resilience factors such as optimism and social support influence the quality of life, physical symptoms of pain and fatigue, and inflammatory markers. Psychological interventions tackling these factors can have beneficial effects on physical and psychological functioning. Recent advances in screening for patients at risk, tailored treatment, and eHealth further broaden the efficiency and scope of these interventions while simultaneously optimizing patient empowerment. This chapter describes the biopsychosocial risk and resilience factors related to disease outcome and the possible benefits of psychological treatment strategies in inflammatory rheumatic diseases.

Impact of Rheumatic Disease on Social Development in Adolescents and Young Adults

“…However those at risk need to be identified and intervention measures introduced as early as possible (7,11), as impact on behaviour and management of disease can still be profound. Therefore regular screening/discussions to assess the psychosocial burden impacting quality of life is important to personalise treatment (28). It is imperative to match the needs and preferences of the young person with the support provided (26), with HCPs providing a flexible and youth-friendly approach.…”

“…They can increase optimism and alleviate feelings of social isolation, which can assist the adoption of healthy behaviours, disease management skills (25), and acceptance of help with disease management (27). Conversely problematic unsupportive relationships lead to increased distress and disease activity (26,28), by being oppressive, underestimating the disease and not providing useful advice (29). Regardless of social network size, AYA primarily disclose their illness to family members and only to a few peers.…”

Stress and Sensitization in Chronic Pain

“…In line with this view, most studies of patients with chronic pain have reported an association between acute stressors and increased pain and physical disability (Andersson, 1999;Sturgeon, Finan, & Zautra, 2016;Van Middendorp, Lumley, Jacobs, Bijlsma, & Geenen, 2010). Also, many studies have provided evidence for a pain-augmenting association of stress and stress-vulnerability factors, such as neuroticism and a tendency to worry (Al-Allaf et al, 2002;Andersson, 1999;Davis, Luecken, & Zautra, 2005;Evers, Verhoeven, et al, 2014;Evers, Zautra, & Thieme, 2011;Geenen et al, 2006;Low & Schweinhardt, 2012;Nicol et al, 2016;Ortego et al, 2016;Raphael, Widom, & Lange, 2001;Van Middendorp & Evers, 2016). Intriguingly, a number of studies has revealed that major stressors might be associated with the development of chronic pain.…”

“…Because stress is part of life and cannot always be prevented, measuring stress-vulnerability factors (p.182) can also be useful in order to identify individuals at risk. For example, investigators may screen for neuroticism, hyper-vigilance, worrying, fearavoidance, and catastrophizing (Evers, Kraaimaat, Geenen, Jacobs, & Bijlsma, 2003;Evers, Gieler, Hasenbring, & Van Middendorp, 2014;Van Middendorp & Evers, 2016 To gain insight into the number, severity, and consequences of daily stressors, ecological momentary assessment (EMA) procedures can be used to measure acute stress (and potential consequences such as pain) levels by means of (electronic) diaries over a specific period of time, varying from several days up to a year (McIntyre et al, 2016;Shiffman, Stone, & Hufford, 2008). Technological advances such as EMA allow investigators to gauge specific thoughts, actions, and emotions that might provide detailed insight into the stress experience and its consequences.…”

AB1449-HPR Patient factors contributing to and shared decision making in starting/switching biologics spondyloarthritis

“…1 This affection includes the combination of anxiety, depression, and participation in daily living activities. It can be thought that individuals can be affected from different diseases in different ways.…”