Behavioral Comorbidities in Rheumatoid Arthritis

CHECK POINTS

• Chronic stressors as well as traumatic loss can provoke depression; in turn, depression can increase sensitization to future events.

• Rheumatoid arthritis (RA) pain and depression tend to be predictive of each other and together lead to a downward spiral of functioning characterized by greater disability, increased sleep disturbance and fatigue, and heightened disease activity.

• Some studies suggest that factors other than pain may cause disordered sleep in patients with RA.

While tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%. Indeed, approximately 20% of patients with RA are found to have current major depression with potential impact on RA symptoms. In this review, we discuss the biopsychosocial pathways linking stress to behavioral comorbidities with consideration of potential common underlying inflammatory mechanisms. We also describe behavioral treatment strategies that can improve the clinical management of these patients.

Psychological Stress and RA

A broad range of illnesses has been associated with stress, including a failure in regulation of autoimmune responses, which may give rise to inflammatory conditions such as RA. Psychological stress is also thought to aggravate disease activity in RA. Stress, defined as minor hassles and life events lasting hours or days, has been associated with subsequent increases in disease activity.¹

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