At the 2025 American College of Rheumatology (ACR) meeting, one theme echoed through dozens of studies: mental health isn’t a side issue in rheumatology—it’s central to outcomes, function, and well-being. From trauma exposure to depression screening, sleep quality, and digital therapy, researchers are showing that emotional and psychological factors shape how people experience and manage rheumatic disease just as much as inflammation or lab results.
A Joint Effort: Implementing Depression Screening in a Safety-Net Rheumatology Clinic
At a busy urban rheumatology clinic serving underserved populations, researchers introduced a workflow to screen patients with rheumatic diseases for depression using the PHQ-9 questionnaire and built protocols for follow-up care. Out of 116 eligible patients, 109 (94 %) completed screening, and 44 % screened positive for mild or greater depressive symptoms; 22 % had scores indicating moderate or severe depression and 10 reported suicidal thoughts. Through three rounds of process improvement, documentation in the electronic medical record improved from 29 % to 96 %. Clinic staff reported that the new screening process was acceptable and workable. The study shows that depression screening and referral can be implemented successfully in rheumatology settings for vulnerable patients
Adverse Childhood Experiences: Prevalence and Relationship to Disease and Mental Health Outcomes in Childhood-Onset Systemic Lupus Erythematosus (cSLE)
In this study, researchers looked at young people ages 13-19 with childhood-onset Systemic Lupus Erythematosus (cSLE) and asked how many had experienced adverse childhood experiences (ACEs) such as household dysfunction or abuse. They found that about 37% of the participants reported at least one ACE, and in most cases the ACE occurred more than a year before lupus was diagnosed. While having an ACE was not linked to worse lupus disease activity or damage itself, the ACEs were significantly connected to higher odds of a psychiatric diagnosis (such as depression or anxiety). The authors conclude that ACEs are common in this group and may affect mental-health outcomes even if they don’t clearly impact lupus severity — suggesting the need for awareness of trauma history in young rheumatology patients.
Association between Anxiety and Tender Swollen Joint Difference in Patients with Rheumatoid Arthritis
Researchers analyzed nearly 300 patients with Rheumatoid Arthritis (RA) to see if anxiety symptoms were linked to the difference between tender and swollen joint counts (called TSJD). A higher TSJD means more tender joints than swollen ones. They found that greater anxiety (measured via the PROMIS tool) was significantly associated with having a higher TSJD—meaning patients who felt more anxious tended to report more tenderness vs. swelling on exams. The study suggests that in RA care it may help to address anxiety as part of a broader pain-management strategy.
Association of disease activity with insomnia, depression, and fatigue in patients with rheumatoid arthritis: a multicenter prospective observational study
In this study of 107 patients with Rheumatoid Arthritis (RA), researchers found that insomnia and severe fatigue were extremely common (affecting over 80% of participants), while about 13% showed signs of depression. They observed that higher disease activity (as measured by standard clinical scores) was significantly associated with worse sleep, more fatigue, and greater depression symptoms. The findings suggest that when treating RA, clinicians should not only focus on joint swelling and pain, but also pay attention to sleep quality, mood and fatigue — because these factors are linked to how active the disease is and how well patients function.
Beyond Pain Severity in Psoriatic Arthritis: Pain Catastrophizing Independently Impacts Disease Burden and Quality of Life
In this qualitative study of 22 people with rheumatoid arthritis (mostly women over 50, including five from Puerto Rico), researchers used interviews to explore how physical activity, mental health, and disease management interact in daily life. Participants described feeling isolated and different from people without RA (theme: “ableism and isolationism”), grieving the loss of their former selves, and struggling with sleep quality. At the same time, they showed resilience, adapting activities and environments, valued the idea of working with a peer coach, and emphasised the need to tailor physical activity safely and meaningfully. The findings suggest that supporting RA patients involves not just telling them to “move more,” but addressing emotional loss, sleep disorders, peer support, and accessible exercise strategies.
Depression and Mental Health Service Gaps in Autoimmune Disease: Insights from a Simulated BRFSS Dataset
Using a simulated version of the U.S. Behavioral Risk Factor Surveillance System (BRFSS) dataset, researchers looked at adults with autoimmune diseases to see how common depression is and how often mental-health services are accessed. They found that depression rates are significantly higher in people with autoimmune conditions, but many of these individuals are not receiving adequate mental-health care or support. The findings point to a clear gap: it’s not enough to recognize that depression is more likely in this population — rheumatology and allied-health teams need to proactively screen, refer, and ensure access to mental-health services as part of comprehensive autoimmune care.
Digital Psychological Support for Inflammatory Rheumatic Diseases: A Randomized Clinical Trial
This trial enrolled 102 adults (mostly women) with inflammatory rheumatic diseases such as Rheumatoid Arthritis, Psoriatic Arthritis or Systemic Lupus Erythematosus who were experiencing psychological distress and reduced quality of life. Participants were randomized into two groups: one received a self-guided, web-based psychological intervention rooted in cognitive behavioral therapy, and the other continued with usual care. After three months, the intervention group showed significantly larger reductions in psychological distress (anxiety/depression symptoms) and greater improvements in quality of life, compared with the control group. The findings support the potential of digital psychological tools as safe, scalable support for people with rheumatic diseases who often face mental-health struggles
Rheumatoid arthritis (RA) patients who screen positive for anxiety, depression, and/or fibromyalgia are more likely to report problems with sleeping, memory, and/or social activities than to have an abnormal rheumatoid factor or ACPA
In this research involving 173 patients with rheumatoid arthritis, those who screened positive for anxiety, depression, or fibromyalgia reported very high rates of non-joint symptoms: more than 70% had trouble with thinking, memory, sleep, or unusual fatigue. In contrast, fewer than half of those without those mental-health/fibromyalgia screens reported the same issues. Interestingly, these non-inflammatory symptoms were more common than the presence of abnormal antibodies like rheumatoid factor (RF) or ACPA. The findings suggest that when RA patients report fatigue, brain fog, or poor sleep, it may signal underlying anxiety, depression or fibromyalgia — and that tackling those issues is crucial for full care, not just focusing on joints.
Perceived Dignity in Patients With Rheumatic Disease
The study looked at how people with rheumatic diseases (mostly women, average age ~31) feel about their own dignity — meaning how much they value themselves, feel respected, and maintain a sense of independence and support in their lives despite illness. Using a questionnaire (the Patient Dignity Inventory) 16.7% of participants scored in the “impaired dignity” range. The areas where people scored highest (i.e., felt more distress) were “Loss of meaning in life” and “Discomfort/uncertainty,” with fewer issues reported in “Loss of social support.” The authors conclude that a reduced sense of dignity can impact how patients view themselves and their well-being, and suggest that healthcare systems should pay attention to dignity-related concerns (not just symptoms) to improve quality of life.
Impact of Stress, Anxiety, and Depression on Fatigue as moderated by Resilience and Exposure to Trauma in Rheumatology Patients
In this study of 132 adults with rheumatic diseases (such as rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, or lupus), researchers explored how stress, anxiety and depression relate to fatigue, and whether personal resilience or past trauma exposure make a difference. They found that depression was the strongest direct predictor of fatigue, anxiety had a smaller effect, and stress mainly worked indirectly. Though they thought resilience might buffer (weaken) the effect of trauma or distress on fatigue, that protective effect didn’t show up significantly in this sample. The takeaway: in rheumatology care, fatigue isn’t just a symptom of the disease — it’s closely linked to mental-health distress, and understanding a patient’s trauma history and psychological resilience may help tailor more effective support.
Abuse in Rheumatic Diseases: Associations with Depression, Disability, and Psychosocial Risk Factors
In a group of people living with rheumatic diseases, researchers found that past exposure to abuse or hostile environments was significantly linked to worse outcomes — including higher rates of depression, more disability in daily life, and greater psychosocial risk factors like less social support or coping resources. The study underscores that abuse (whether emotional, physical or other) is not just a historical footnote but actively influences mental-health and functional outcomes in rheumatic disease, making it important for care teams to ask about trauma history and provide supportive interventions.
Confirmatory Factor Analysis of the Plutchik Suicide Risk Scale in Patients with Rheumatoid Arthritis
Researchers evaluated whether the Plutchik Suicide Risk Scale (a questionnaire used to assess suicide risk) works reliably in adults with rheumatoid arthritis. Using a statistical method called confirmatory factor analysis (which tests whether the survey’s questions cluster together as expected), they found that the scale is a valid and stable tool in this patient group. In other words, the Plutchik scale appears appropriate for use in RA patients, helping clinicians identify suicide risk with confidence.
Steroid Psychosis and Neuropsychiatric Symptoms induced by Corticosteroid Injection in Rheumatology Patients
Researchers reviewed 5,487 musculoskeletal corticosteroid injections in a rheumatology clinic and found that about 4% (221 injections in 24 patients) were followed by psychiatric or neuropsychiatric symptoms (such as anxiety, vasomotor symptoms, paranoia and hallucinations) within seven days of injection. Most of the affected patients had a pre-existing anxiety or depression history. All symptoms typically resolved within three days. The findings highlight that even joint injections, which are generally considered low-risk for systemic effects, can trigger mental-health complications in a small subset of patients—especially those with prior psychiatric issues.
Evaluation of Adverse Childhood Experiences in Systemic Sclerosis: Prevalence and Patient Characteristics
In this study, adult patients with systemic sclerosis (SSc) were asked about adverse childhood experiences (ACEs) — such as abuse, neglect, or household dysfunction — and researchers examined how common these were and which patient-groups reported more. They found that a notable proportion of SSc patients reported one or more ACEs. These early-life stressors were more common in certain demographic groups (for example, by age, disease subtype, or socio-economic status) though the study did not establish whether the ACEs directly affected SSc severity or organ damage. The authors conclude that ACEs are a relevant, yet under-recognised, part of the patient experience in SSc and suggest that rheumatology clinics might benefit from asking about trauma history to provide more holistic care.
Relationship Between Sleep Quality and Psychiatric Symptoms in Autoimmune Rheumatic Diseases
In a study of 176 adults with autoimmune rheumatic diseases (mostly women, median age ~46), researchers found that over half (58 %) reported poor sleep quality. Those with poor sleep were much more likely than good sleepers to also report anxiety (27.5 % vs a much lower rate) and depression (9.8 % vs lower) and to have serious fatigue. The study showed that poor sleep in this group is strongly linked to worse mood, higher anxiety, more fatigue — suggesting that clinicians should ask about and address sleep as part of overall care for autoimmune rheumatic diseases.
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