In addition to the physical challenges of rheumatoid arthritis, patients must also deal with social and emotional issues. These challenges are best met when the patient has support from caring people who understand RA.

RA can complicate routine tasks at work and at home, especially during flares. Even simple activities like answering the telephone, tying one's shoes or putting on makeup may become impossible to do. One person may have difficulty taking care of children, resulting in feelings of guilt and frustration. Another may have to change careers, abandoning lifelong dreams. RA can severely challenge one's sense of personal or vocational competence. There may be a loss of independence as well as a loss of income, while financial pressures are increasing with the expenses of medications and devices. With the progression of the disease, patients may begin to perceive their bodies differently. Thus, for numerous reasons, RA patients may struggle with self-esteem.

Stress is an unavoidable part of daily modern life. Our minds and bodies respond to stress in much the same way that we respond to physical dangers. Stress stimulates the release of the same powerful hormones that enable a person to either flee to safety or defend himself in a crisis. Medically speaking, there is no longer any doubt that stress affects health. Colds, tension headaches, high blood pressure and some illnesses are influenced by stress. Exacerbations of RA also appear to be related to physical and emotional stress. Many RA patients also connect the onset of their disease with a major stressful event like a car accident or a divorce. This is difficult to prove, however, and researchers are divided on this issue.

In addition to the kinds of stress that affect us all, RA patients have additional stresses: pain, self-esteem issues, physical limitations, fear, the loss of control, fatigue, depression, etc. Thus, stress becomes something of a paradox for RA patients: on one hand, to manage the disease, they must manage stress; on the other hand, the disease itself is a major source of stress.

Learning ways to deal with stress, then, is of vital importance for people with rheumatoid arthritis. Experts say that the key is how we think about the things that cause us stress. Patients are encouraged to:

Learn how to reduce stress in their lives. This starts with identifying the things that cause them stress and taking steps to eliminate as many of these as possible.

Distinguish between things that can and cannot be changed. When things can't be changed, the patient's thinking must change. They must accept that they can only change themselves; they cannot change others.

Overcome stress by mastering relaxation techniques. Books and tapes, support groups, individual counseling, exercise, humor, breathing techniques and sometimes medication may be appropriate.

Research shows that even one bout of depression, any time before the onset of RA predisposes a person to a higher level of pain, fatigue and a sense of being disabled by the disease. After the onset of RA, the greater a person's pain, disability or tendency toward unpredictable flares, the more likely the patient is to become depressed. At any given time, about 20% of rheumatoid arthritis patients are experiencing depression.

Depression can range from mild to severe, but most depression can be relieved with medication and/or therapy. RA patients need to work with both their rheumatologist and their psychiatrist, since some drugs used to treat RA can interact with drugs used to treat depression.

People who have close, supportive relationships cope better with chronic illnesses, including rheumatoid arthritis. A patient's support can come from family, friends, RA support groups, the Internet and from those who attend the patient medically. Studies have shown that unmarried RA patients progress toward disability three times faster than married patients. Although the reason for this is not completely clear, it may have to do with the increased social support that marriage can offer. Families can also be instrumental in helping the patient keep a positive attitude and compliant with therapies such as exercise.

RA can, however, place a serious strain on the family and the marriage. Family members may become overprotective of patients, or may do things for patients that they are capable of doing for themselves. Childcare, housework and financial provision may become unbalanced, with the bulk of the responsibilities shifted onto the healthy spouse. The partner with arthritis may feel guilty and frustrated, while the healthy partner feels overburdened and resentful. The sexual relationship may become unsatisfactory as well, and especially so if the healthy partner is also afraid that sex will cause pain for the spouse.

Tension and emotional distance can result if these issues are not openly discussed. The couple needs to renegotiate their relationship around a new and different paradigm that includes adaptations for RA. A counselor's help may be needed to keep both partners self-worth intact and to devise ways for each to make a contribution that is perceived as fair by the other. According to the Well Spouse Foundation, "When one is sick, two need help." Much is at stake: 85% of marriages fail when one partner becomes chronically ill. A loving partnership with open communication can beat the odds, however! Experts recommend:

For the sake of the marriage, allow friends and family to provide physical help and emotional support and/or utilize professional help.

Discuss creative ways to maintain physical intimacy. Ask your doctor for guidance or resources that will help you.

Learn how to talk openly and supportively with one another. Talk about problems as they come up. Don't harbor resentment. Its OK to be angry--but its not OK to harm your spouse with your anger. Seek professional help if necessary.

There are several things RA patients can do to take good care of themselves emotionally:

Express your feelings. Talk about what you are thinking and feeling with others you trust. Counselors also recommend writing your deepest feelings and fears in a daily journal.

Read about RA. The more patients know about RA the more in control they feel.

Join a support group. Meeting with others who have similar problems reduces the sense of isolation. A support group provides another opportunity to share feelings, to learn about RA, and to share solutions to common problems.

Have fun. Its important to keep a sense of humor and to make time for things you find fun and relaxing.

References

First published September 1, 1999
Last updated December 16, 2002
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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