Mental Health and Arthritis

We all know that a healthy mind resides in a healthy body. Diseases of the body negatively affect mental well-being. One among them, arthritis is a condition associated with joint inflammation, manifesting as joint pain, swelling, and stiffness, and sometimes with deformity of the joint.

Arthritis of various types whether the infamous rheumatoid arthritis or lesser known Lupus arthritis when left untreated or uncontrolled for long brings with them various mental illnesses most notably Depression and Anxiety.

In various studies it is found that one among five persons suffering from arthritis may be suffering from one or more mental illnesses.

Many  studies have confirmed this finding, showing that anxiety disorders are more common in people with arthritis. Researchers say that patients with psychiatric disorders are not at a higher risk of arthritis, but instead, arthritis makes the person more prone to developing mood disorders over time.

Common Symptoms of Psychological Ill-health

The symptoms of anxiety in these patients may include restlessness, lack of concentration, worry or irritability, poor sleep quality. Depressive symptoms may  include sadness low self-worth, guilt loss of pleasure, physical problems such as headache, cramps, fatigue or digestive problems and in severe cases suicidal tendencies.

Now there may be one question why those suffering from arthritis are more prone to develop depression and anxiety symptoms. Basically arthritis is a disease of joints generally involving more than one joints . This multiple joint involvement leads to  limitation of movement and functional impairment for that person. The inability to do things that are valuable to the individual predisposes to the development of depression since such activities are often part of one’s identity, self-esteem, and life meaning or a source of deep pleasure.

The previous mental make-up of the person also contributes to the reaction to arthritic pain and disability. Individuals who believe that they are helpless or who foresee catastrophic consequences (“It’s terrible and I think it’s never going to get any better,” or “I keep thinking about how badly I want it to stop,”) are more prone to developing depression and distress. Their mood is affected by how they perceive pain and joint symptoms. In general, such individuals feel more severe pain and disability, respond worse to pain treatment, pay more attention to their pain at the cost of other things, and are more emotionally susceptible to affective disorders like depression. Helplessness is one belief that can keep a patient from coping well with arthritis. This is associated with passive coping instead, relying on others for all activities and avoiding doing things on one’s own because one is “helpless”, or turning to medication for pain relief.

For instance, being unable to write, for a writer, is far more than the loss of a job or financial security, important as that may be. Similarly, being unable to provide for one’s family may be the most disabling part of arthritis for a hardworking man who has been the breadwinner for decades.

Because anxiety is often perceived as normal, people don’t always seek mental health services for it. Left untreated, anxiety can lead to greater problems. In fact, chronic anxiety can increase someone’s risk of developing Depression

Their mood is affected by how they perceive pain and joint symptoms. In general, such individuals feel more severe pain and disability, respond worse to pain treatment, pay more attention to their pain at the cost of other things, and are more emotionally susceptible to affective disorders like depression.

Helplessness is one belief that can keep a patient from coping well with arthritis. This is associated with passive coping instead, relying on others for all activities and avoiding doing things on one’s own because one is “helpless”, or turning to medication for pain relief.

This is associated with more disability and depression, triggering a vicious spiral downwards into mood disturbance. Active coping, on the other hand, helps patients with arthritis to adjust better to their condition both physically and emotionally.

Depression may contribute to worse outcomes following the development of arthritis because the depressed patient has more active inflammation, is functioning at a lower level, is less likely to take medication regularly, or to cooperate with treatment, leading to other illnesses. Thus, both exaggerate the effect of the other, leading to frustrations in self-management and management by healthcare providers.

In addition to the psychological explanations for the mental disorders associated with arthritis, the inflammatory cytokines, or cell signaling molecules, that are released by the body, may disrupt neurotransmission through serotonin-producing cells, causing depression

How to prevent and cope with mental illnesses in arthritis

There are several ways in which people cope with painful conditions, including distracting oneself from the pain, ignoring the pain, praying and hoping for pain relief or the ability to bear the pain, catastrophizing, or becoming more active.

In general, individuals try to consciously cope with or suppress pain using intellectual and emotional pathways. Resilient people are among the most capable when it comes to meeting stress positively, as they instinctively choose the appropriate coping strategy, and control themselves accordingly.

One way to learn a healthy mental attitude towards life is to take a “wellness” approach. Instead of thinking of themselves as sick and designing their day to relieve their pain and disability, such people design it around what they can do, all the ways they can enjoy life, different approaches to health including diet and exercise, and social interaction with other people. This also includes taking medication properly, learning to relieve stress, and taking time out to relax.

Avoiding crutches like alcohol, drug abuse and overusing pain medications, is very important. Similarly, taking to bed and focusing on pain are counterproductive reactions. Changing such habits is hard but rewarding. It can be achieved by substituting a favorite and rewarding activity for the pain crutch, whatever it is, with the support of close friends or family, or of those who have gone down this path already. Communication with doctors is also key, to help establish control and to make use of available methods and technologies, to optimize pain control and improve the quality of life.

Person with arthritis may have been on many drugs already. If symptoms of mental illness are mild or moderate these can be managed by life style changes, taking healthy diet, joining a support group, yoga and relaxation exercises. But in case of severe illness leading to impairment in daily life, then drugs should be cony as first line of treatment after consulting a psychiatrist. In treating such cases rheumatologist, psychiatrist, clinical psychologist/counsellor work in tandem as a team and keep updating each other regarding changes in condition of person.

Dr J. K. Verma, MD(Psychiatry) MBBS: GSVM Medical College Kanpur, U.P. MD: K.G.M.U. Lucknow, U.P. Current Designation: Associate Professor, Psychiatry Government Medical College, Ambedkar Nagar, U.P. Experience in field of Mental Health : 13 years Associated with different organizations working in field of health, Women health, Mental health and rehabilitation of persons with Mental illness