Well-being In Rheumatoid Arthritis Research Articles

The Relationship between Proinflammatory Cytokines, Trait Mindfulness, and Psychological Well-Being in Rheumatoid Arthritis

Background: Rheumatoid arthritis(RA) is an autoimmune disease in which the body’s immune systemstarts attacking its own cells especially, joints. Individuals with RA are 3 times more susceptible todepression and anxiety. Mindfulness-based interventions have been found efficacious in decreasingdepressive symptoms and increasing psychological well-being(PWB) in this population, but therelationship between trait mindfulness and PWB with proinflammatory cytokines implicated in RA hasnot been explored to date. Background: Rheumatoid arthritis(RA) is an autoimmune disease in which the body’s immune systemstarts attacking its own cells especially, joints. Individuals with RA are 3 times more susceptible todepression and anxiety. Mindfulness-based interventions have been found efficacious in decreasingdepressive symptoms and increasing psychological well-being(PWB) in this population, but therelationship between trait mindfulness and PWB with proinflammatory cytokines implicated in RA hasnot been explored to date.Objective: This study aimed to understand the relationship between proinflammatory cytokines, traitmindfulness, and psychological well-being in rheumatoid arthritis patients.Method: The study consisted of a total of 16 individuals from the 45-75 years age group who havebeen diagnosed with RA, taking treatment from Kasturba Medical College, Manipal. Proinflammatorycytokines in saliva, IL-6 and TNF levels were measured using an ELISA kit, and scales wereadministered to measure trait mindfulness, psychological well-being, and functioning. Descriptiveanalysis was done to study the relationship between the variables.Results: A significant increase in IL-6 levels were observed in the present study, while TNF- levelswere within normal limits. 50% of the participants reported severe impairment and 75% reporteddepressive symptoms. These results provided evidence of a strong correlation between IL-6 levelsand depression. There was a strong positive correlation between trait mindfulness and psychologicalwell-being, . Trait mindfulness however had a moderately negative correlation withdepressive symptoms and disability. Moreover, the relationship between psychological well-being anddepressive symptoms and disability was not significant. The relationship between depressive symptomsand disability was highly significant, Discussion and Conclusion: People with RA experience difficulty carrying out everyday tasks andtend to suffer from depression. However, people who score high on Mindfulness and PWB experienceless depression and face less interference in their daily activities. Thus, interventions that promotemindfulness practice and psychological well-being may prove to be effective in decreasing depressivesymptoms in RA patients as well as proinflammatory cytokines.

Different types of physical activity are positively associated with indicators of mental health and psychological wellbeing in rheumatoid arthritis during COVID-19

Nationwide lockdowns during SARS-CoV-2 (COVID-19) can compromise mental health and psychological wellbeing and limit opportunities for physical activity (PA), particularly in clinical populations, such as people with rheumatoid arthritis (RA), who are considered at risk for COVID-19 complications. This study aimed to investigate associations between PA and sedentary time (ST) with indicators of mental health and wellbeing in RA during COVID-19 lockdown, and examine the moderation effects of self-isolating. 345 RA patients completed an online questionnaire measuring PA (NIH-AARP Diet and Health Study Questionnaire), ST (International Physical Activity Questionnaire-Short Form), pain (McGill Pain Questionnaire and Visual Analogue Scale), fatigue (Multidimensional Fatigue Inventory), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), and vitality (Subjective Vitality Scale) during the United Kingdom COVID-19 lockdown. Associations between PA and ST with mental health and wellbeing were examined using hierarchical multiple linear regressions. Light PA (LPA) was significantly negatively associated with mental fatigue (β = − .11), depressive symptoms (β = − .14), and positively with vitality (β = .13). Walking was negatively related to physical fatigue (β = − .11) and depressive symptoms (β = − .12) and positively with vitality (β = .15). Exercise was negatively associated with physical (β = − .19) and general (β = − .12) fatigue and depressive symptoms (β = − .09). ST was positively associated with physical fatigue (β = .19). Moderation analyses showed that LPA was related to lower mental fatigue and better vitality in people not self-isolating, and walking with lower physical fatigue in people self-isolating. These findings show the importance of encouraging PA for people with RA during a lockdown period for mental health and wellbeing.

Mental Health and Psychological Wellbeing in Rheumatoid Arthritis during COVID-19 - Can Physical Activity Help?

In response to the COVID-19 pandemic, many countries have adopted community containment to manage COVID-19. These measures to reduce human contact, such as social distancing, are deemed necessary to contain the spread of the virus and protect those at increased risk of developing complications following infection with COVID-19. People with rheumatoid arthritis (RA) are advised to adhere to even more stringent restrictions compared to the general population, and avoid any social contact with people outside their household. This social isolation combined with the anxiety and stress associated with the pandemic, is likely to particularly have an impact on mental health and psychological wellbeing in people with RA. Increasing physical activity and reducing sedentary behaviour can improve mental health and psychological wellbeing in RA. However, COVID-19 restrictions make it more difficult for people with RA to be physically active and facilitate a more sedentary lifestyle. Therefore, guidance is necessary for people with RA to adopt a healthy lifestyle within the constraints of COVID-19 restrictions to support their mental health and psychological wellbeing during and after the COVID-19 pandemic.

Are Illness Perceptions Associated With Disease Activity or Psychological Well-Being in Rheumatoid Arthritis? A Study With the Evidence of Confirmatory Factor Analysis.

This study aims to assess the factor structure of the Turkish Revised Illness Perception Questionnaire (IPQ-R) in patients with rheumatoid arthritis (RA) and the relationship of illness perceptions with disease activity and psychological well-being. One hundred and fifty RA patients (8 males, 142 females; mean age 51.1±12.7 years; range 21 to 81 years) were included in the study. Confirmatory factor analysis was used to test the factor structure of the IPQ-R. Pain was assessed by visual analog scale, disease activity by Disease Activity Score 28, depression by Beck Depression Inventory, global life satisfaction by the Satisfaction with Life Scale, and illness perception by the IPQ-R. Three items (items 12, 18, 19) were deleted because of poor factor loadings. The modified 35-item model showed good reliability and discriminant validity. Beck Depression Inventory scores were correlated with identity, consequences, and emotional representations subscales positively (p<0.001); and with illness coherence subscale negatively (p<0.05). There were positive correlations between Satisfaction with Life Scale scores, and treatment control and illness coherence subscales (p<0.05). Satisfaction with Life Scale scores were negatively correlated with identity, emotional representation, and timeline acute/chronic subscales (p<0.05), and consequences subscale (p<0.001). Disease Activity Score 28 was not correlated with IPQ-R domains (p>0.05). The Turkish IPQ-R appears to be a useful clinical assessment tool to evaluate RA-related illness perceptions. RA healthcare should include psychological intervention to strengthen patients' beliefs about their RA regardless of disease activity.

Autonomy support, light physical activity and psychological well-being in Rheumatoid Arthritis: A cross-sectional study

BackgroundParticipation in physical activity may improve psychological well-being among people with Rheumatoid Arthritis (RA). This study examined the implications of autonomy support for physical activity, on objectively assessed light physical activity (LPA) engagement, and in turn, psychological well-being in RA. In addition, the role of lower-limb functional disability in these associations was investigated. MethodsRA patients (n = 50) completed questionnaires assessing 1) autonomy support for physical activity [from a patient-specified important other], 2) functional disability to ‘rise’ and ‘walk’ (functional disabilityRW), 3) depressive symptoms, and 4) subjective vitality. Levels of LPA [100–2019 counts/minute], were calculated from 7 days of accelerometry. ResultsPath analysis supported a model (χ2 (2) = 2.44, p = 0.30, CFI = 0.99, SRMR = 0.05, RMSEA = 0.07) in which important other autonomy support for physical activity significantly and positively predicted LPA engagement. In turn, LPA was significantly and positively associated with subjective vitality, and significantly and negatively linked to depressive symptoms. These associations were observed independently of adverse direct relationships between functional disabilityRW with depressive symptoms and subjective vitality. ConclusionsImportant other autonomy support for physical activity may hold positive consequences for LPA engagement and related psychological well-being in RA, independent of the negative effects of lower-limb functional disability.

SP0095 Coping as Integral to Understanding and Assessing Health and Well-Being in Rheumatoid Arthritis. Pragmatist, Fighter or Minimiser? Possible Trajectories of Newly Diagnosed Patients

Individuals vary significantly in how they adjust to their arthritis and this is not always explained by the level of disease activity but by their ability to cope. Coping was...

The Interaction of Physical Function and Emotional Well-being in Rheumatoid Arthritis—What is the Impact on Disease Activity and Coping?

To evaluate the impact of the interaction of physical function and emotional well-being on disease-related parameters and coping with rheumatoid arthritis. A cross-sectional survey among 177 RA patients included demographic and disease-related variables as well as the following patient-reported outcome measures: Health Assessment Questionnaire-Disability Index (HAQ-DI) (physical function), Mental Component Summary Scale of the SF-36 (MCSS) for emotional well-being, Rheumatoid Arthritis Disease Activity Index (RADAI), and Coping with Rheumatoid Arthritis Questionnaire (C-RAQ). Based on HAQ-DI and MCSS, six categories representing various levels of physical and emotional impairment were formed. Multivariate analysis of variance and a subsequent discriminant analysis were used to evaluate whether demographic and disease-related variables and coping strategies differed between these categories. Patients with moderate to high impairment of physical function and emotional well-being reported significantly higher disease activity and a more frequent use of distancing and active problem solving coping strategies than patients with low-level impairment (p<0.001-0.043). Furthermore, these patients reported experiencing significantly higher levels of helplessness (p<0.001-0.032). Results from the discriminant analysis highlighted a combination of disease activity and helplessness to differentiate best between patients with either low or high impairment of physical function and emotional well-being (p<0.001). Aside from perceived disease activity, helplessness, and distancing as well as active problem solving allowed for a good discrimination between the different levels of impairment of physical function and emotional well-being. Encouraging and educating patients on how to cognitively reframe their current situation might play a key role in reducing the level of helplessness resulting from impairments of physical function and emotional well-being.

Spiritual Well-Being in Patients With Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, long-term, and non-life-threatening disease. Individuals with RA face various daily pressures that include physical symptoms as well as feelings of helplessness, dependency, threats to self-respect, interference with social activities, disruptions of family ties, and difficulties in continuing to work. Quality of life reflects a patient's spiritual well-being and can be used as an important indicator of adaptation to RA. The aim of this study was to describe the status of spiritual well-being in RA patients. This study used meta-synthesis with Sandelowski and Barroso's qualitative meta-summary technique. A comprehensive search of Academic Search Complete, CINAHL, MEDLINE, PsycARTICA LES, and SocINDEX using relevant keywords identified primary research studies that have previously explored spiritual well-being in patients with RA. Each study was systematically evaluated on the basis of the following inclusion criteria: (a) clear descriptions of research purposes and qualitative research, sampling strategies and techniques used; (b) statement of sample size and sample variables; (c) description of data analysis methods used; and (d) quality of research finding presentation. A total of 675 articles, published between 1995 and 2009, were found. Ten met the inclusion criteria. The results revealed four consistent themes related to RA patients' spiritual well-being, namely, living with the disease, reclaiming control, reframing the situation, and bolstering courage. Multifaceted resources should be used to give patients spiritual support. These resources should include establishing cognition-based education programs that provide information about the disease and programs that offer strong support for patient groups. Curricula should address how to plan family education courses. Spiritual well-being as presented in this study should be integrated into quality-of-life evaluations of RA patients and provide an evaluation tool able to assess the effectiveness of various interventions.

Psychological well‐being in rheumatoid arthritis: a review of the literature

The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition.

Well-being in Rheumatoid Arthritis: The Effects of Disease Duration and Psychosocial Factors

This study examined the multivariate relationships of psychosocial factors with well-being in rheumatoid arthritis (RA). Fifty-five patients with early RA (<six months), 52 with intermediate RA (one-seven years) and 47 with established RA (>seven years) completed questionnaires on psychosocial factors and psychological and physical well-being. Illness perceptions related to worse depression and life satisfaction (especially in early RA) and to longer morning stiffness (especially in intermediate RA). Optimism related to lower pain in early and intermediate RA. Social support related to lower fatigue in established RA. Indications for interventions targeted by disease duration are discussed.

The impact of pain on psychological well-being in rheumatoid arthritis: the mediating effects of self-esteem and adjustment to disease

The aim of this study was to determine whether self-esteem and adjustment to disease can mediate the association between pain and psychological well-being in patients with Rheumatoid Arthritis (RA). Coefficients of correlation, multiple linear regressions and Structural Equation Model (SEM) were employed in order to examine the direct and indirect relationships between pain, self-esteem, adjustment to disease and psychological well-being in a sample of 160 recently-diagnosed RA-patients. The outcomes of the analyses indicate that self-esteem and adjustment to disease are important links between pain and psychological well-being. Moreover, the results suggest the increasing importance of personality variables in mediating the relationship between pain and psychological well-being as the disease advances. The findings provide evidence for considerations that psychosocial interventions, focused on increasing the self-esteem and improving the adjustment to disease, may reduce the impact of pain on patients’ psychological well-being and quality of life in general.

Effectiveness of rehabilitation with musculoskeletal diseases

Multidisciplinary treatment focusing on impairments, activities and participation are an important component within the therapeutic regimen in musculoskeletal conditions. In Germany, for more than 95% of the patients multidisciplinary treatment is provided as inpatient rehabilitation. According to the results of a study from the Netherlands, inpatient rehabilitation is superior to usual care in terms of decreasing disease activity and improving emotional well-being in rheumatoid arthritis. Another randomized, controlled study gives evidence that rehabilitation is more effective as compared to usual care in ankylosing spondylitis. In patients suffering from fibromyalgia, after inpatient rehabilitation, symptoms improve significantly and this is true even one year after discharge. The results of a quality management project financed by the German health insurance and including several thousand patients with musculoskeletal diseases show an improvement in physical and emotional dimensions of health status at discharge and after a six month follow-up. Recent studies comparing inpatient with outpatient rehabilitation in patients with musculoskeletal diseases provide information that both forms are equally effective. Taking into account the high number of inpatient rehabilitation procedures in Germany, more outcomes research is required urgently.

Psychological Well-Being in Rheumatoid Arthritis: Relationship to ‘Disease’ Variables and Affective Disturbance

Background: Resilience is likely to be important in understanding psychological responses to chronic physical illnesses. This study aimed to examine one measure of resilience – Ryff’s operationalized measure of psychological well-being (PWB) – in rheumatoid arthritis. It was hypothesized that PWB would be influenced by age and gender in the same way as in community samples, and that the absence of current mood disorder would be associated with high PWB. Methods: Rheumatology clinic outpatients (n = 104) were assessed for pain, disease activity, disability, depression and anxiety. PWB was assessed using Ryff’s six-subscale model. The measured variables were used in a logistic regression analysis to model the absence of clinically important mood disorder. Results: The expected variations in PWB according to age and gender were largely absent, with the overall findings suggesting that chronic illness in general, rather than arthritis in particular, affects PWB. Significant bivariate correlations were found between depression and pain, disease activity, disability and all six PWB subscales. However, in the regression analysis, only the PWB environmental mastery subscale and self-rated disability made significant contributions to the absence of mood disturbance, and their inclusion in the regression model correctly classified 81% of the total sample. Conclusions: These results require replication in a longitudinal study, but indicate the potential value of using PWB among people with rheumatoid arthritis to screen for individuals who may be particularly vulnerable to developing depression. It might be appropriate to target such people with focused psychological interventions.

Regulation of Cytokines, Cytokine Inhibitors, and Acute-Phase Proteins Following Anti-TNF-α Therapy in Rheumatoid Arthritis

AbstractTreatment with a chimeric mAb to TNF-α has been shown to suppress inflammation and improve patient well-being in rheumatoid arthritis (RA), but the mechanisms of action of such treatment have not been fully explored. Here we show that in vivo administration of anti-TNF-α Ab, using a longitudinal analysis, results in the rapid down-regulation of a spectrum of cytokines, cytokine inhibitors, and acute-phase proteins. Marked diurnal variation in the serum levels of some of these were detected. These results were consistent with the concept of a cytokine-dependent cytokine cascade, and the degree of clinical benefit noted after anti-TNF-α therapy is probably due to the reduction in many proinflammatory mediators apart from TNF-α, such as IL-6, which reached normal levels within 24 h. Serum levels of cytokine inhibitors such as soluble p75 and p55 TNFR were reduced as was IL-1 receptor antagonist. Reductions in acute-phase proteins occurred after serum IL-6 fell and included serum amyloid A, haptoglobin, and fibrinogen. The latter reduction could be of importance, as it is a risk factor for atherosclerosis, which is augmented in RA patients.

Social support, social disability, and psychological well-being in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well-being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well-being. The focus of the present study is on the main effect versus the buffering effect of social support. Data on 54 RA patients were gathered by means of a 2-hr interview at the patient's home. Receiving more daily emotional support positively related to greater psychological well-being; whereas problem-oriented emotional support negatively related to some aspects of psychological well-being. People receiving more social companionship turned out to be less depressed. The assumption was confirmed that social support has a major effect on psychological well-being. A buffering effect of social support was not demonstrated.

Social relationships and psychological well-being in rheumatoid arthritis

This study examines the social relationships of a sample of 158 patients attending a hospital rheumatology clinic with rheumatoid arthritis (RA). Scores of the sample were compared with those of other samples on the Interview Schedule for Social Interaction (ISSI). In addition the effects of severity of disease activity and of disability upon social relationships were examined. Diffuse social relationships such as with friends and acquaintances, rather than more intimate ones appear to be more affected in individuals with RA. Psychological well-being was assessed by means of two measures. The more favourably patients scored for social relationships, the more favourable were their scores for psychological well-being using both scores. More diffuse social relationships were more strongly correlated with psychological well-being than were the scores for more intimate relationships. Despite the strong effects of social relationships upon well- being, no buffering action on the effects of disability upon well-being were found.