WHAT IS ARTHRITIS?
Arthritis is a general term that refers to diseases that involve inflammation of the joints. In all, there are more than 100 different forms of arthritis that range from mild forms such as tendonitis or bursitis to systemic chronic diseases such as rheumatoid arthritis, psoriatic arthritis, lupus erythematosus, gout and scleroderma.
There are currently more than 4 million Canadians living with arthritis. Many of these are autoimmune disorders in which a person’s immune system attacks joints and other organs within the body. Osteoarthritis, the most common form of arthritis, is not autoimmune but tends to be age and injury related.
It occurs as a result of damage to cartilage and affects about 1 in 10 Canadians. No drugs are available to change the course of this disease but if it is severe enough joint replacement surgery is often done.
On the other hand, rheumatoid arthritis and other forms of autoimmune arthritis are now treated with drugs that suppress the immune system. Early treatment with these medications leads to joint damage and disability in the long run.
HOW CAN PSYCHOLOGY HELP?
Psychological adjustment to their illness can be a significant challenge for many people with arthritis. For example, about 20% of those with rheumatoid arthritis are clinically depressed.
This high rate of depression is perhaps not surprising when one considers the impact that the disease can have on a person’s ability to participate in life and the significant pain that often accompanies joint damage.
In addition, significant flare-ups of symptoms are common and unpredictable. These changes can influence the individual’s ability to work as well as family and social relationships.
We now know that people who: feel able to control their pain and adopt active coping strategies, have a sense of self-efficacy and feel less helpless, have less pain, less depression, and less disability.
Recent evidence also suggests that psychological functioning and mood are even linked to the disease process. For example, mortality rates are higher over time for those who have both rheumatoid arthritis and depression. Stressful events, particularly interpersonal stressors can increase symptoms of arthritis.
Psychologists have played the leading role in developing treatments that improve coping, decrease pain and decrease disability in persons with arthritis. Psychologists who work with arthritis patients are trained to understand these diseases, their psychological impact and the treatments that can help them adjust better.
Cognitive-behavioural therapy and other psychological treatments that help individuals cope with their disease are an important adjunct to medical treatments. Although it is best to prevent psychological problems in the first place, psychologist can also provide treatment for the depression, anxiety, relationship problems and pain that can occur.
ARE PSYCHOLOGICAL INTERVENTIONS EFFECTIVE?
Dozens of randomized controlled trials, the gold standard for evaluating health care interventions, have now been reported for psychological treatments in arthritis. These studies suggest that psychological treatments are effective in helping patients cope with their disease and reduce its impact.
Psychological treatments have enjoyed sufficient success that they have become an integral element of Arthritis Self-Management (ASMP) Programs that are sponsored by the Arthritis Society across Canada and have been adopted the world over.
WHERE DO I GO FOR MORE INFORMATION?
The following websites provide useful information on arthritis care:
You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, visit http://www.cpa.ca/public/provincialandterritorialassociations. The Canadian Register of Health Service Providers in Psychology also has a listing service and can be reached through http://www.crhspp.ca.
This fact sheet has been prepared for the Canadian Psychological Association by Dr. Warren Nielson, St. Joseph's Health Care, London, ON.
January 2009
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