Recognize Early Signs And Symptoms Of Mental Illness When You Have Ra
If you have RA and youre worried about the state of your mental health, its best to see your doctor about your concerns, says Hitchon. Experts have developed questionnaires that can assess the risk of having one of these conditions. Signs of depression can include a change in your level of interest in things you normally like to do, feeling down, having difficulty sleeping, or changes in appetite or concentration. Anxiety may be present if the level of worry you have about your life interferes with your regular activities. Hyperactivity, racing thoughts, needing less sleep, or doing things that are not usual for you, especially if they interfere or cause problems with your work or family life, may be a sign of bipolar disorder.
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Patient & Ra Disease Factors Related To Depression
Female gender and younger age have well-known associations with depression and confound the SES-depression relationship in RA . As women have a higher prevalence of RA and depression, ignoring gender will falsely increase the magnitude of other variables associated with depression. Conversely, overlooking age tends to suppress other covariate effects because age has a U-shaped relation with depression . As mentioned above, race/ethnicity is an important factor to include in measures of SES but is also a patient characteristic independently associated with depression in RA. Specifically, Asians with RA report less depression while Hispanics with RA, particularly those who are not fully acculturated to mainstream Anglo society, report more depression .
Comorbidities and pain are commonly associated with both RA and depression . Not surprisingly, pain has been indicated as a mechanism along the causal pathway for depression in those with RA . Furthermore, depression may confound self-reports of pain . Alternatively, pain in a patient with RA and comorbid depression could be diagnostic overshadowing a process where the physical symptoms of RA are misattributed to depression .
Prevalence Of Mood Disorders In Patients With Inflammatory Arthritis
It is no surprise that life with IA is more complex, unpredictable, and stressful, leaving patients to struggle with a range of emotions. People with arthritis are nearly twice as likely to develop a mood disorder, especially those under 45 years of age than people without the condition . Pooled estimates using clinical interviews suggest that one in six people with IA are experiencing major depression, and up to half will have clinically relevant symptoms of depression in psoriatic arthritis , rates could be as high as one in three patients . Furthermore, contrary to whats seen in the general population, among 47 countries and more than 200,000 participants, the odds of depression in IA appears to be higher in men than women . A similar pattern is seen with anxiety disorders, although some studies suggest the prevalence of anxiety may be even higher .
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Amplification In The Synovium
Once the generalized abnormal immune response has become established which may take several years before any symptoms occur plasma cells derived from B lymphocytes produce rheumatoid factors and ACPA of the IgG and IgM classes in large quantities. These activate macrophages through Fc receptor and complement binding, which is part of the intense inflammation in RA. Binding of an autoreactive antibody to the Fc receptors is mediated through the antibody’s N-glycans, which are altered to promote inflammation in people with RA.
This contributes to local inflammation in a joint, specifically the synovium with edema, vasodilation and entry of activated T-cells, mainly CD4 in microscopically nodular aggregates and CD8 in microscopically diffuse infiltrates. Synovial macrophages and dendritic cells function as antigen-presenting cells by expressing MHC class II molecules, which establishes the immune reaction in the tissue.
Ethics Approval And Consent To Participate
The study protocol was approved by the Kyoto University Graduate School and Faculty of Medicine, Ethics Committee, and all procedures were performed in accordance with the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards. All patients provided written informed consent prior to participating in this study.
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Assessment Tools For Mental Health In Ra Patients
In the management of chronic medical diseases such as RA, shared decision-making and patient-centred care are regarded as the optimal approach . Hence, the UK NICE guideline included psychological intervention for fatigue, low mood and social well-being in the management of RA , and the NICE clinical guideline suggested managing mental health and depression to improve RA treatment outcome . Anxiety and depression are the most common mental health conditions in RA . The OMERACT international network has been researching on the standardisation of outcome measures in RA . However, to choose the standard measurement tool to assess mental health and PROs and to include patients mood in RA annual review are still challenging for the clinicians .
What Causes Rheumatoid Arthritis Fatigue
Rheumatoid Arthritis fatigue is a weariness that rest cannot cure. It is tiredness without the benefit of the pleasure of activity. Over 90% of RA patients report fatigue as a symptom. It is counted second only to pain as the greatest difficulty of living with RA.
Unlike normal fatigue, pathological fatigue does not improve with rest. This kind of fatigue is seen in most acute and chronic inflammatory diseases, including arthritis
Where does this weariness come from? What causes us to feel precisely like Superman with Kryptonite pushed in his face? Does anybody know?
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Ra Therapies: Impacts On Fatigue Depression And Cognition
RA is treated with conventional synthetic disease-modifying anti-rheumatic drugs , biologic DMARDs, targeted synthetic DMARDs and glucocorticoids . An open-label cohort study found that bDMARDs improve depression in RA patients . Another prospective single-blinded study reported that csDMARDs and bDMARDs have a similar effect on improving depressive symptoms in RA patients .
Rheumatoid Arthritis Vs Osteoarthritis
Many people confuse rheumatoid arthritis with osteoarthritis due to their similar symptoms, but the two diseases are caused by different factors.
What is Osteoarthritis?
Whereas rheumatoid arthritis is an autoimmune disease that causes joint malfunction due to inflammation, osteoarthritis is a mechanical disease brought on by the destruction of joints through wear and tear.
Osteoarthritis is the most common form of arthritis, with approximately 27 million Americans over the age of 25 having been diagnosed with it. Osteoarthritis is also most commonly seen in people middle-aged to elderly and is the top cause of disability in those age groups, though it can also appear in younger people who have sustained joint injuries.
With osteoarthritis, the cartilage, joint lining, ligaments, and bone are all affected by deterioration and inflammation. When the cartilage begins to break down due to stress or changes in the body, the surrounding bones slowly get bigger and begin to fail.
Osteoarthritis is a slowly progressing disease and occurs in the joints of the hand, spine, hips, knees, and toes. Furthermore, risk factors of this disease most often stem from lifestyle or biological causes, such as:
- Obesity
Osteoarthritis sometimes occurs alongside rheumatoid arthritis or other disease, such as gout.
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Doctors Should Watch For Depression In Rheumatoid Arthritis Patients
People with Rheumatoid Arthritis are twice as likely to be depressed.
People with rheumatoid arthritis are twice as likely to experience depression but are unlikely to talk to a doctor about it, according to researchers at the University of North Carolina at Chapel Hill. In the study, published in Arthritis Care & Research, researchers found that almost 11 percent of RA patients had moderately severe to severe symptoms of depression, demonstrating a worrisome link between rheumatoid arthritis and depression.
The study also found that only one in five of the patients with arthritis and depression discussed it with their rheumatologists. Those who did were always the ones to bring up the topic not the physician. When it was brought up, it was often not discussed at any length.
Why not? Because when patients visit their specialists, their arthritis is understandably the main focus, says Betsy Sleath, PhD, the studys lead author. But in discussing a patients arthritis, depression is a topic rheumatologists should consider broaching.
“Chronic diseases can greatly affect a patient’s psychosocial well-being, and depression can also affect a patient’s adherence to treatment regimens,” Sleath says. “Since many arthritis patients see their rheumatologist more often then their primary-care physician, we recommend that rheumatologists take steps to screen patients for signs of depression.”
Depression Can Worsen Joint Pain
Treating mental as well as physical health may alleviate symptoms.| By Jennifer Davis and Mary Ann Dunkin
When your joints are aching and painful, heres an aggravating factor you may not have considered: your mood. Understandably, being in pain can cause you to feel depressed, but research suggests the opposite is also true: being depressed can make pain worse.
In fact, a 2011 study published in The Journal of Bone and Joint Surgery showed that for people with osteoarthritis , depression can have just as strong an effect on knee pain as physical damage.
The finding was particularly true in patients with radiographic findings of less severe mild to moderate knee osteoarthritis, says lead author Tae Kyun Kim, MD, PhD, director of the division of knee surgery and sports medicine at the Joint Reconstruction Center at Seoul National University Bundang Hospital in South Korea.
Dr. Kims research team studied data from 660 Korean men and women older than age of 65. They measured the severity of participants OA damage with X-rays, questioned patients about their pain and interviewed them to diagnose depressive disorders. As expected, those with the most joint damage reported feeling the most pain. Surprisingly, participants with mild-to-moderate knee OA who were experiencing depression also reported severe pain, even if X-rays didnt show the significant damage that typically indicates pain.
The Pain-Depression Connection
Treating Depression and Pain
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Difference Between Rheumatoid And Psoriatic Arthritis
With the passage of time, the Human body makes a slow and gradual change. The body starts to become weak, and many diseases start to happen. Such two very common conditions that happen at a certain age are Rheumatoid and Psoriatic Arthritis. They both are the type of arthritis that is basically a type of joint pain but have different symptoms and are often confused with each other.
Can Rheumatoid Arthritis Affect Mental Health
Rheumatoid arthritis contributes to stress and affects mental health, especially when its symptoms occur for a longer time. Constant joint pain and poor sleep create a vicious cycle. Each symptom worsens the others and adds to the stress the patient already feels. When a patient feels tired due to stress, they dont feel like exercising. A lack of exercise triggers pain, which makes it harder to sleep. The patient gets anxious about future disability, getting pregnant or handling the financial burden of treatment. These things only add up to more stress.
Around one out of five patients with rheumatoid arthritis has depression due to the illness. Depression, in turn, further aggravates rheumatoid arthritis and leads to a greater number of painful joints, reduced functioning and increased visits to the doctors clinic. All these further affect the patients mental health and cause more stress and depression.
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Cytokines And Rheumatoid Arthritis Fatigue
Likely, there are multiple contributing factors. Most suspicious-sounding to me are the cytokines. These are chemicals which some scientists believe cause the fatigue of colds and flu. They are the chemical messengers of the immune system. There are over 150 different kinds of these protein-based molecules.
These chemicals are used by cells as a means of communication. Cells can talk to each other through cytokines, but in people with Rheumatoid Arthritis, excess amounts of them are produced and dumped off into the bloodstream. Some theorize that cytokines cause several RA symptoms, including fatigue, anemia, sleep problems, and skeletal muscle shrinkage .
One reason that Im willing to blame the cytokines is that they are reduced by TNF blocking medications . And guess what results? Yes, usually fatigue is lessened. This is one of the reasons that fatigue is said by some to mirror disease activity or reflect inflammation levels: when medications slow inflammation, fatigue tends to improve.
The fatigue of Rheumatoid Arthritis is not caused by exertion. However, activity can aggravate it. It sounds like heads I win tails you lose. Rest is critical to surviving life with Rheumatoid Arthritis, but it will not necessarily prevent fatigue.
Specific Mental Health Concerns That May Affect People With Rheumatoid Arthritis
Rheumatoid Arthritis and Depression
Depression is one of the most common mental illnesses people with RA struggle with. Sometimes, the initial diagnosis of rheumatoid arthritis can cause a period of depression, or a particularly bad flare-up could lead to depressive symptoms. When youre coming to terms with a diagnosis, you have to go through the stages of grief. Many people report feeling sad, hopeless, guilty, or unmotivated in the weeks or months following their diagnosis. Depression can also result from stress when you have RA. The autoimmune disease reduces your bodys ability to handle stress, so you may feel the psychological effects more strongly. Without healthy coping skills for stress, you can quickly fall into a depressive episode. The pain associated with RA may contribute to depression, too. When youre dealing with inflammation and joint pain, it can sometimes feel difficult to have a good outlook on life. You might not be motivated to complete your activities of daily living, see your friends or family, or engage in your hobbies due to your chronic pain.
Rheumatoid Arthritis and Anxiety
Rheumatoid Arthritis and Mood Swings
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Living With A Chronic Disease Like Ra Causes Chronic Stress
Fighting the pain and expense of a long-term health problem can be a significant burden to carry. In fact, the rate of depression among people living with rheumatoid arthritis is estimated to be anywhere from 13 to 42 percent, according to some research. Certainly pain with RA is one factor, but we know from studies including ours that there is more depression and anxiety in people with RA even before the RA is diagnosed, says Dr. Hitchon. This suggests that other factors may link these conditions, including genetics, environmental exposures, and health habits.
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Why Depression And Anxiety Matter In Patients With Inflammatory Arthritis
From work-related stress to managing life with a chronic illness, depression and anxiety can affect anyone at any age, and they are the most common mental health problems affecting people with inflammatory arthritis . While everyone experiences episodes of sadness and low mood, clinical depression is characterized by unrelenting sadness, loss of interest in daily activities, irritability, and feelings of helplessness and hopelessness that significantly interfere with day-to-day life, lasting at least two weeks. Significant episodes of depression often involve changes in sleep, appetite and weight, difficulty concentrating, and unexplained somatic symptoms Generalized anxiety is excessive nervousness and worry about everyday problems that often is accompanied by muscle tension, exhaustion, and difficulty falling asleep. High levels of anxiety over time may lead to panic attacks causing individuals to avoid situations and progress to trouble leaving their homes .
Identifying and managing depression and anxiety are important goals, as treating emotional distress improves health and quality of life. Growing evidence shows that for IA patients with anxiety and depression, treating emotional distress may also be key to achieving good outcomes.
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Rheumatoid Arthritis Fatigue Is Related To Rheumatoid Disease Activity
In 2009, I read several abstracts and medical journals to see if anything new was being uncovered about the fatigue of RA. One experiment was done with mice to show how inflammation impacts the brain. Immune cells infiltrate the brain which, according to one reporter, causes the proverbial brain fog. More recent studies, reviewed in Fatigue in chronic inflammation a link to pain pathways, confirm that inflammatory activity is a likely source of fatigue symptoms in Rheumatoid Arthritis. Specifically, IL-1, IL-6, and TNF have been studied.
Evidence shows fatigue is clearly a symptom included in rheumatic diseases: in rheumatoid arthritis , it is an important outcome to evaluate according to OMERACT, and it has been associated with the Disease Activity Score in 28 joints and the Clinical Disease Activity Index.I dont know how the mice are coping, but Im sure hoping for answers because I am tired being tired. How did Superman ever solve his Kryptonite problem, by the way? It was blue Kryptonite.
Recognize The Early Signs
If you have RA and you are worried about your mental health, it is a good idea to bring your concerns to your healthcare provider. They can assess you to determine if you might be experiencing symptoms of anxiety, depression, bipolar disorder, or another condition.
Signs of depression might include:
- Low mood, feelings of sadness, irritability, and anger
- Reduced energy levels
- Becoming easily distracted
- Feeling overconfident
- Engaging in risky behaviors, including gambling away savings, going on big spending sprees, or having impulsive sex
Depression symptoms of bipolar disorder might include:
- Feeling sad or hopeless for extended periods
- Withdrawing from family and friends
- Loss of interest in activities once enjoyed
- Significant appetite changes
- Chronic fatigue and lack of energy
- Constant worry and concentration troubles
- Thoughts of suicide or death
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The Connection Between Ra And Mental Health
Researchers suggest that theres a bi-directional connection between rheumatoid arthritis and mental health. This means that the physical effects of rheumatoid arthritis can make your mental health symptoms worse, and poor mental health can worsen the symptoms of rheumatoid arthritis. Unfortunately, many seniors with rheumatoid arthritis feel like theyre caught in a vicious cycle. They know they need to focus on their mental and emotional well-being in order to improve their symptoms, but the presence of RA in their lives makes it difficult to overcome their mental health challenges. The main cause of this bi-directional relationship is stress, which has both physiological and mental components. Rheumatoid arthritis causes chronic inflammation, which weakens your bodys response to stress. When your body cant handle stress, it releases chemicals that change your mood. Theres a strong link between your physical and emotional health when it comes to stress management, so when your body is stressed, it takes a serious toll on your mental and emotional state.