Physical and Mental Implications of Rheumatoid Arthritis

 

Physical and Mental Implications of Rheumatoid Arthritis

     Imagine that every minute, of everyday, you suffered from excruciating pain.  While it may be hard to imagine, this is in fact what life with Rheumatoid Arthritis (RA) is like.  RA is classified as an autoimmune disorder, which means that the person’s immune system does not work properly.   Symptoms for RA include: pain, inflammation and stiffness of the joints, and ultimate disability.  Although RA is three times more likely to be present in women than in men (Swann, 2011), the criteria for diagnosis is the same.  The criterion for RA includes Synovitis in at least one joint and the absence of a better diagnosis.  In addition to being an incurable disease, symptoms progressively get worse over time.  In order to fully understand RA, it is important to dissect how the disease impacts the patient physically and psychologically.

Causes

     So that one may fully understand RA, it is important to understand the causes of the disease.  Within the article, Understanding Rheumatoid Arthritis: causes and treatment, written by Julie Swann, discusses the causes of RA.  According to Swann, “RA primarily causes inflammation of the synovial membrane, which lines a joint capsule” (Swann, 2011).  Like many other articles, this particular article stresses the debilitating swelling of the joints as the primary impact of the disease.  Although swelling is the body’s defense against infection, RA patients bodies dysfunction, and cause uninfected areas to swell.

     In writing the article, Swann’s main purpose was to illustrate the many different ideas as to the cause of RA.  Although there are many varying opinions, some of the causes include: immune system dysfunction, hormones, smoking, and a virus.  Although all of the different opinions are valid, RA caused by a virus tends to be the one I agree with.  “Some patients with RA” according to Swann “have been exposed to a bacterium called Proteus mirabilis” (Swann, 2011).  Although the virus was not responsible for the patient having RA, because there is strong proof that the disease is genetic, it can be responsible for the onset of the symptoms.  

Treatment and Side Effects

     Once the doctors have diagnosed the patient with RA, the next step is to determine what treatment is best suited for the individual.  The article, Treat-to-target: A Tailored Treatment Approach to Rheumatoid Arthritis, written by Deborah Palmer and Yasser El Miedany, delves into the different treatments available for RA.  According to Palmer and Miedany, “An important goal of RA management is to maximally reduce disease activity and thereby mitigate the accumulation of irreversible joint damage” (Palmer & Miedany, 2012).   In addition to the importance of treatment, they stressed the importance of seeking medical treatment as soon as the symptoms begin.

      Similar to a multitude of chronic diseases, there are multiple treatments available for RA.  The authors describe two ways in which doctors treat RA symptoms.  The two ways are: drugs that limit joint damage and those that control pain (Palmer & Miedany, 2012).  Some of the medicines prescribed are anti-rheumatic drugs, corticosteroids, and non-steroidal anti-inflammatory drugs. 

     Even though the treatments for RA have been proven to be remarkably successful in slowing down the progression of RA, there is still no cure for the disease.  Along with positive aspects of the treatments, the drugs come with a substantial amount of side effects.  A good example of negative side effects accompanies the RA drug Abatacept.  According to Palmer and Miedany, “Recent data on several safety issues, including the risk of tuberculosis infection, suppression of response to immunization and risk of malignancy, suggest that these are relatively low in patients treated with Abatacept, in comparison to incidences reported with other biologic therapy agents…” (Palmer & Miedany, 2012).  Although the risk is low, there is still a risk, and doctors will insist on regular blood work in order to ensure the patient is staying healthy.

Psychological Well-Being

    In addition to dealing with the physical symptoms, RA patients are also prone to having psychological problems.  The article, Psychological Well-Being in Rheumatoid Arthritis: A Review of the Literature, author Lynda Getting thoroughly describes the risk of depression and anxiety associated with RA. 

     Within the article, Getting uses previous studies in order to illustrate the prevalence of depression and anxiety disorders with RA patients. According to Getting, “In a telephone interview survey carried out in Australia, significantly more adults with arthritis reported a mental health condition (14.9% versus 12.0%; p=0.004) and were at a medium or high risk for anxiety or depression (39.0% versus 31.0%; p<0.001) than those without the condition” (Getting, 2010).  The presence of daily pain and suffering in the patients’ lives, is psychologically hard to deal with, and without proper treatment, can significantly diminish their lives happiness.

     Along with the patients’ psychological health, the authors also stress the impact of RA on the families and caregivers.  Within the article, Getting states, “Many families and partners of patients with RA also carry a substantial psychological burden- this can go unrecognized, leaving them with little support in managing the impact of the disease” (Getting, 2010).   It is important the person in charge of taking care of the patient is not over looked. 

      The article gives many different ways in which depression and anxiety can be treated.  “Treatments include cognitive behavioral therapy (CBT), mediation and relaxation, biofeedback, patient education and exercise” (Getting, 2010).   For those patients suffering from depression or anxiety, it is vital to all those involved that they are educated on the disease.  For this purpose, there are many organizations that provide information on the subject.  A couple examples are the National Rheumatoid Arthritis Society and the Arthritis Research Campaign. 

Individual Case Study

     In order to reach the conclusion that there is a prevalence of depression and anxiety with those suffering from RA; psychologists have performed many different studies. One such study, performed by Kemal Nas, Psychological status is associated with health related quality of life in patients with rheumatoid arthritis, attempted to determine if RA patients are prone to depression and anxiety. 

     Using the Hospital Anxiety and Depression Scale (HADS), the researchers assessed four hundred and seventy nine patients suffering from RA.  The scale used eight domains in order to determine the percentage of patients suffering from psychological problems. “The eight domains (subscales) of the SF-36 scored on a scale of 0-100 are: physical functioning (PF), health problems resulting in limitations of physical activities; role physical (RP), physical disability resulting in limitations of usual role activities; bodily pain (BP), daily activities influenced by pain; general health (GH), self-perception of general health; virtuosity (VT), overall energy level or lack thereof; role-emotional (RE), emotional problems resulting in limitations of usual role activities; mental health (MH), psychological well-being and stress; and social function (SF)” (Nas, 2011). 

       After administering the test, it showed that, “Three hundred seventeen patients (75%) with > 7 score were grouped as having higher risk for depression and 104 patients (25%) without risk for depression” (Nas, 2011).   The results proved their hypothesis that there is indeed a correlation between those people who suffer from RA, and the increased risk for depression and anxiety.

Mental Health Testing

     With the results of mental health testing holding so much weight in the diagnosis of depression and anxiety, researchers felt it necessary determine how one test correlates with the other.  In one such study, Depression and Anxiety in Patients with Rheumatoid Arthritis: Prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the Hospital, Anxiety and Depression Scale (HADS), written by Tanya Covic, Steven R. Cumming, Julie F. Pallant, Nick Manolios, Paul Emery, Philip G. Conaghan, and Alan Tennant, commenced the project in order to determine the similarity between the two tests.

     In determining if a patient suffers from depression and anxiety, doctors administer one of several tests.  The two tests that this article discusses are the Depression, Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS).   The study determined that, “The HADS Depression ‘probable’ cut point and the DASS Depression ‘severe’ and ‘extremely severe’ cut point gave levels of prevalence e for depression of a similar magnitude, and are closely located on the underlying metric” (Covic, 2012).   Although the two tests vary in several ways, the researchers determined that both test a similar enough that they are both viable ways of determining depression and anxiety in patients with RA.

     While opinions may vary as to which cause and treatment is best for Rheumatoid Arthritis, it is important to remember the patient is a human being.  It is very likely that the patient will be forced to make many drastic life changes, due to the psychological and physical aspects of the disease.  Although there is not cure for the disease, there are many medications that have been created to stop the progression, and ease the patients suffering.   According to the research, the most important thing a patient can do is seek immediate help from a rheumatologist and other medical experts.

 

 

Reference

Covic, Tanya, Cumming, Steven R., et al. (2012) Depression and anxiety in patients with  

rheumatoid arthritis: Prevalence rates based on a comparison of the depression, anxiety    

and stress scale (DASS) and the hospital, anxiety and depression scale (HADS).  BMC      

Psychiatry, vol 12.  Retrieved from http://www.biomedcentral.com/1471-244x/12/6.

Getting, Lynda (2010). Psychological well-being in rheumatoid arthritis: A review of the  

literature. Wiley Interscience, vol 8.  Retrieved from http://www.interscience.wiley.com

Nas, Kemal et al (2011) Psychological status is associated with health related quality of life in            

 patients with rheumatoid arthritis.  Journal of Back and Muscularskeletal

Rehabilitation, vol 24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21558614

Palmer, Deborah and Miedany, Yasser El. (2012) Treat-to-target: A tailored treatment approach

            to rheumatoid arthritis. British Journal of Nursing, vol 22 (6).

Swann, Julie. (2011) Understanding rheumatoid arthritis: Causes and treatment.  British

            Journal of Healthcare Assistants, vol 5(01).

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