title: Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways.
abstract: In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.
authors.affiliation: Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, California, 94304, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Sturgeon
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, Maryland, 21209, USA.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
authors.affiliation: Department of Psychology, Arizona State University, 950 South McAllister Avenue, Tempe, Arizona, 85287, USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Zautra
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D003071:Cognition; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D004644:Emotions; D005221:Fatigue / Q000523:psychology; D006801:Humans; D007249:Inflammation / Q000523:psychology; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000523:psychology; D010817:Physician-Patient Relations; D012559:Schizophrenia / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology