It’s Not Just Joint Pain: Mental Health in Rheumatic Diseases
The emotional toll of rheumatic diseases can lead to anxiety, depression, and stress. Addressing mental health is crucial for improving quality of life and treatment outcomes. Open conversations and comprehensive support can help patients better manage their condition.
Why is it important to address mental health in rheumatic disease patients?
Cheryl Crow – Occupational Therapist and Person Living With a Rheumatic Disease:I asked my Instagram community this question and here’s what my friend Simran said (sharing with permission): “The mental toll of chronic illness— the anxiety, the depression, the loneliness, the fear, the grief— are also often overlooked, by physical and mental health providers alike. I get that you can’t really get it unless you’re going through it and a lot of us chronic illness patients have sort of developed a tough grin and bear it attitude, but it’s difficult, awful, overwhelming, lonely, terrifying, and so much more suffering from chronic illness. Practitioners need to be aware of that and there needs to be more emphasis on mental health support in chronic illness treatment teams. (It can also exacerbate existing mental health conditions and those should be taken into account too.)”
As a health provider, it’s important to address mental health because the “SPACE” symptoms are all interrelated (sleep, pain, affect/emotions, cognition and energy). If I only look at the “body” (eg the joints) I am missing the fact that mental factors like stress, anxiety and depression can impact joint pain along with fatigue and sleep.
As an RA patient who lives with anxiety, I think it’s critical to address mental health in the rheumatic disease population simply because patients deserve comprehensive, compassionate care. If the goal of healthcare and medicine is to improve quality of life but you’re only looking at the person’s bloodwork and imaging and not at how their disease is actually impacting their quality of life, you are falling short of your goal of truly helping them.
Lastly, it’s important to address mental health because the incidence of anxiety and depression are much higher in the rheumatic disease population than the general population. 66% of people with arthritis (any form) reported anxiety or fear in the last 7 days, according to the Arthritis Foundation’s Live Yes Insights survey. Approx 20% of people with rheumatoid arthritis also have a diagnosed anxiety disorder (citation). 33% of people with psoriatic arthritis report at least mild anxiety (citation). People with ankylosing spondylitis are more likely to have an anxiety disorder than the general population (citation).
For depression: 13-42% of people with Rheumatoid arthritis have depression (citation), 20% of people with psoriatic arthritis report at least mild depression (citation), One study showed that at least 10% of people with AS had depression, which is greater than the general population (citation), and 27% of people with chronic pain who receive care from a doctor experience clinical depression (LeFort et al, 2019).
How does mental health impact symptoms and outcomes with rheumatic diseases?
Cheryl Crow – Occupational Therapist and Person Living With a Rheumatic Disease: I think of this as a “good news, bad news” situation. Looking at the “SPACE” symptoms again, which are are all interrelated (sleep, pain, affect/emotions, cognition and energy), we can see that any challenges in emotional state can lead to challenges in all the other areas. That’s the bad news. The good news is that improvements in one area can lead to improvements in the others. We can’t look at mental health in isolation – we have to look at it in the context of the individual’s life.
How does your profession/research address mental health?
Cristina Montoya – Registered Dietitian and Person Living With a Rheumatic Disease: I support my clients in breaking free from diet culture and building a healthy relationship with food, mind and body. Patients often hear advice to ‘lose weight’ or ‘try this diet’ to reduce inflammation. While losing weight can improve pain, function, and quality of life in OA patients and reduce disease activity in certain inflammatory arthritis, it can place significant pressure on individuals. This pressure leads to extreme measures to achieve their goals, like overly restrictive diets.
In my practice, I incorporate the intuitive eating framework created by Dietitians Evelyn Tribole and Elyse Resch. Instead of focusing on food restriction to shrink the body or reduce inflammation, this approach encourages self-reflection and mindfulness. It emphasizes understanding WHAT you are eating, WHY you are eating it, and HOW it makes you feel.
As an eating disorder survivor, I’m always conscious of assessing and restoring my clients’ relationship with food. If you are hungry, eat. If you are bored, engage in an activity that brings joy beyond food (walking, listening to music, dancing, playing with the kids, calling or Zooming a friend). By bringing awareness to what and why they are eating, you can help to reduce mindless eating due to boredom, distraction or emotional reasons. It also helps to lessen guilt and disappointment when “diet doesn’t work” to alleviate arthritis symptoms.
Cheryl Crow – Occupational Therapist and Person Living With a Rheumatic Disease: Mental health is at the core of occupational therapy practice and our roots in mental health separate us from physical therapists or physiotherapists. For example, occupational therapists can work in exclusively mental health settings (like inpatient psychiatry) helping clients function better with their “jobs of daily living” (self care).
For clients with rheumatic disease who also are struggling with anxiety or depression, we can implement cognitive behavioral therapy or Acceptance and Commitment Therapy based interventions to improve the severity of their anxiety or depression. I personally find Acceptance and Commitment Therapy the most helpful (and studies show people with chronic pain prefer ACT to traditional CBT) because it focuses on first mindfulness, then committing to acting according to your values even if you have some lingering anxiety, pain or other uncomfortable sensations. Support groups are also an evidence based way to improve patient’s sense of belonging, mental health factors and quality of life.
Occupational therapists can help reorient the patient to what’s possible in their lives with rheumatoid arthritis and with anxiety rather than trying to fix or solve them, which opens up the patient to seeing possibilities they might not have seen earlier.
Mental Health Resources
The Arthritis Foundation
- The Inflammation-Mental Health Connection Webinar
- How to Prioritize Emotional Health Webinar
- Arthritis Foundation Support Groups
- Make Mental Health a Priority
Versus Arthritis
Autoimmune Association
The Arthritis Society
- Mental Health Online Learning Program
- Mental Health and Arthritis Quiz
- 5 Foods To Boost Your Mood Article
- Mental Health and Wellbeing Online Learning Program
- Strategies to Manage Your Emotional Health
- Arthritis Connections Online Support Group
Arthritis Research Canada
Arthritis National Research Foundation
Arthritis Life Cheryl
Diet and Mental Health Resources Provided by Cristina Montoya, RD
- Intuitive Eating A Revolutionary Diet Approach Website
- Mindful Eating: Improve your relationship with food Website
Mental Health References
- Depression in patients with rheumatoid arthritis: description, causes and mechanisms
- The risk for depression in patients with ankylosing spondylitis: a population-based cohort study
- Improving recognition of anxiety and depression in rheumatoid arthritis: a qualitative study in a community clinic
- Risk of Psychiatric Disorders following Ankylosing Spondylitis: A Nationwide Population-based Retrospective Cohort Study
- Centers for Disease Control and Prevention. Symptoms of Anxiety and Depression Among Adults with Arthritis
Masood A et al. Are we missing the diagnosis of depression in patients with rheumatoid arthritis at a tertiary care facility?
Patient Perspectives
- The 11 Moods of Rheumatoid Arthritis and How I’ve Learned To Cope With Them
- Mourning Your Old Life After a Rheumatoid Arthritis Diagnosis – And How to Move On
- Arthritis ‘Flare Fear’: What I Do When Flare Anxiety Makes Me Feel Trapped
- Self-Love and Self-Care: What Chronic Illness Taught Me About Both
- Top 10 Frustrations I Regularly Experience Living with Rheumatoid Arthritis
- What Stress Does to My Rheumatoid Arthritis — and How I Deal With It
- 8 Strategies for Coping with Envy and Chronic Illness
- Managing Burnout While Living with Rheumatoid Arthritis
- How I Cope With Loss From Chronic Illness
- You Can’t Get This From a Doctor: The Impact of Support Groups for Those Living With Arthritis
It’s Not Just Joint Pain: Demystifying Difficult Symptoms of Rheumatic Diseases Often Neglected
- Origin of It’s Not Just Joint Pain
- Physical Activity
- Mental Health
- Sleep
- Nutrition
- Fatigue and Cognitive Dysfunction
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