Rheumatoid arthritis: Psychological factors in the etiology, course, and treatment

Study of the therapeutic effects of proximal intercessory prayer (STEPP) on auditory and visual impairments in rural Mozambique

BACKGROUND

Proximal intercessory prayer (PIP) is a common complementary and alternative medicine (CAM) therapy, but clinical effects are poorly understood, partly because studies have focused on distant intercessory prayer (DIP).

METHODS

This prospective study used an audiometer (Earscan(R) 3) and vision charts (40 cm, 6 m "Illiterate E") to evaluate 24 consecutive Mozambican subjects (19 males/5 females) reporting impaired hearing (14) and/or vision (11) who subsequently received PIP interventions.

RESULTS

We measured significant improvements in auditory (P <0.003) and visual (P <0.02) function across both tested populations.

CONCLUSIONS

Rural Mozambican subjects exhibited improved audition and/or visual acuity subsequent to PIP. The magnitude of measured effects exceeds that reported in previous suggestion and hypnosis studies. Future study seems warranted to assess whether PIP may be a useful adjunct to standard medical care for certain patients with auditory and/or visual impairments, especially in contexts where access to conventional treatment is limited.

Interpersonal workplace stressors and well-being: a multi-wave study of employees with and without arthritis

The within-person influence of interpersonal stressors on affective well-being and physical well-being was investigated for 109 women with and without arthritis. Participants were interviewed on a weekly basis for 12 consecutive weeks, and the prospective data were analyzed by using hierarchical linear modeling. Overall, interpersonal workplace stressors independently predicted both well-being outcomes. Interpersonal stressors outside the workplace were related to negative affect but not to arthritis symptoms. Compared with healthy controls, arthritis patients' ratings of negative affect were equally reactive to workplace stressors. Neuroticism did not moderate stressor reactivity for either dependent variable but did predict mean levels of negative affect. The data support the hypothesis that the psychosocial environment of the workplace contributes unique effects on well-being.

Psychological wellbeing of patients with rheumatoid arthritis

The impetus for this multiphased project was the realization that rheumatoid arthritis (RA) is not only physically debilitating, but also a cause of severe psychological distress which is often unacknowledged. A small sample of patients (n=15) was interviewed to identify their main area of psychological distress caused by RA, and data were analysed thematically. These themes formed the basis of a questionnaire that was distributed to a random sample of inpatients and outpatients with RA. This larger sample (n=140) prioritised the areas of distress that were identified by the interviewed sample of patients. This led to the development of an education programme for nurses. The authors describe the impetus for the project, the activities and processes associated with data collection, and the development and evaluation of the education programme.

A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity

This study examined the efficacy of a cognitive and behavioural intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty-three participants with a diagnosis of classical or definite rheumatoid arthritis, who were seropositive and had less than 2 years of disease history were recruited into the trial. All participants received routine medical management during the study, although half were randomly allocated to receive an adjunctive psychological intervention. All pre- and post-treatment assessments were conducted blind to the allocation. Analyses were conducted of treatment completers and also by intention-to-treat. Significant differences were found between the groups at both post-treatment and 6-month follow-up in depressive symptoms. While the CBT group showed a reduction in depressive symptoms, the same symptoms increased in the Standard group. At outcome but not follow-up, the CBT group also showed reduction in C-reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6-month follow-up compared with the Standard group, indicating physical improvements above those achieved with standard care. These results indicate that cognitive-behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical morbidity

A naturalistic evaluation of cortisol secretion in persons with fibromyalgia and rheumatoid arthritis

OBJECTIVE

To compare cortisol levels, diurnal cycles of cortisol, and reactivity of cortisol to psychological stress in fibromyalgia (FM) and rheumatoid arthritis (RA) patients in their natural environment, and to examine the effect on results of accounting for differences among the groups in psychological stress and other lifestyle and psychosocial variables.

METHODS

Participants were 21 FM patients, 18 RA patients, and 22 healthy controls. Participants engaged in normal daily activities were signaled with a preprogrammed wristwatch alarm to complete a diary (assessing psychosocial- and lifestyle-related variables) or provide a saliva sample (for cortisol assessment). Participants were signaled to provide 6 diary reports and 6 saliva samples on each of two days. Reports of sleep quality and sleep duration were also made upon awakening.

RESULTS

FM and RA patients had higher average cortisol levels than controls; however, there were no differences between the groups in diurnal cycles of cortisol or reactivity to psychological stress. While the groups differed on stress measures, surprisingly, the patient groups reported less stress. Furthermore, statistically accounting for psychosocial- and lifestyle-related differences between the groups did not change the cortisol findings.

CONCLUSION

The results provide additional evidence of hypothalamic-pituitary-adrenal axis disturbance in FM and RA patients. While such elevations are consistent with other studies of chronically stressed groups, the elevations in cortisol in this study did not appear to be due to ongoing daily stress, and there was no evidence of disturbed cortisol reactivity to acute stressors.

Prayer and spirituality

Many patients with arthritis are strongly influenced by religious beliefs and often participate in religious healing activities such as prayer and worship attendance. Scientific studies demonstrate, and most patients confirm, that faith and involvement in religious healing activities can be helpful in preventing and treating illness, recovering from surgery, reducing pain, and improving quality of life. To improve the care of patients, clinicians should develop a patient-centered, spiritually sensitive form of medical practice in which religious issues are addressed gently and appropriately with dignity, respect, and integrity.

Perceived stressors and coping strategies among individuals with rheumatoid arthritis

The purpose of this study was to identify the stressors perceived by individuals with rheumatoid arthritis (RA) and to describe coping strategies used to cope with illness-related stressors and their perceived effectiveness. Data were collected from 53 patients attending a rheumatology clinic. Results revealed that pain was the predominantly perceived stressor followed by limitation in mobility, difficulties in carrying out activities of daily living, helplessness, dependency on others, threat to self-esteem, interference in social activity, interference in family relationships, difficulties performing at work, and discomfort of the treatment. Subjects used optimistic and confrontive coping strategies more frequently than other coping strategies and optimistic coping strategies were perceived to be most effective. Point biserial correlation revealed a number of significant relationships between specific stressors and use of coping strategies: interference in family relationships and use of evasive coping strategies (r = 0.27, P < 0.05), and threat to self-esteem and use of both evasive (r = 0.45, P < 0.01) and emotive (r = 0.28, P < 0.01) coping strategies. Similarly, a number of significant relationships were found between specific stressors and the effectiveness of the coping strategies: interference in family relationships and the effectiveness of both evasive (r = 0.31, P < 0.05) and emotive (r = 0.38, P < 0.01) coping strategies, and threat to self-esteem and the effectiveness of emotive coping (r = 0.29, P < 0.05).

The physiological impact of arthritis: prevalence of depression

Attempts to estimate the prevalence of depression in people with arthritis are complicated by conceptual, definitional, and measurement problems and inconsistencies. Following a description of these methodologic problems, recent studies of depressive disorders and depressive symptoms in clinical and community samples are reviewed. The review suggests that although most people with rheumatic diseases do not experience them, depressive disorders and symptoms are probably more prevalent among people with rheumatic diseases than among people with no chronic diseases. This somewhat increased prevalence is probably no greater than that found in other serious chronic diseases, however. Additional research is needed.

Quality of life 3. Rheumatoid arthritis

It has increasingly been recognized that for the evaluation of interventions in patients with rheumatoid arthritis not only physician-oriented variables, like laboratory or radiographic assessments but also patient-oriented variables such as quality of life are of importance. Many different arthritis-specific quality of life instruments have been developed in recent years using different or no definition at all about the concept 'quality of life'. In this review a generally accepted definition of quality of life, existing of three components, is presented. The interrelationship between quality of life and all the different variables used in assessing disease activity in rheumatoid arthritis is discussed.

A comparison of pain perceptions in women with fibromyalgia and rheumatoid arthritis: relationship to depression and pain extent

Two studies were conducted to characterize the pain of fibromyalgia syndrome (FMS); to compare it to rheumatoid arthritis (RA) pain; and to examine the relationships between depression, pain extent, and pain description. Two methods of administering the McGill Pain Questionnaire (MPQ) were used. When the MPQ was administered in the standard manner, FMS pain could not be distinguished from RA pain. When participants were allowed to select as many words from an adapted MPQ as they wished, significant differences in word choice emerged. Depression and pain extent were major predictors of group differences in the evaluation of pain. However, depression scores contributed only 50% of the explanation for the differences in pain extent, with group membership contributing the other 50%. These findings suggest that the character and extent of pain in FMS are at least partially due to peripheral sensory components and not simply centrally controlled pain amplification secondary to depression.

RSI revisited: evidence for psychological and physiological differences from an age, sex and occupation matched control group

The present study sought to examine psychological characteristics and function of primary afferent nociceptive mechanisms, as indexed by capsaicin-induced flare responses, in subjects suffering from RSI (n = 72) and in pain free control volunteers (n = 69). After completing a battery of psychological tests including the McGill Pain Questionnaire, Visual Analogue Scale and Word Descriptor Scale for pain, the Profile of Mood States, Illness Behaviour Questionnaire and Multidimensional Health Locus of Control, the neurogenic flare response was assessed on the right and left forearms and across the trapezius at the shoulder. When compared to controls RSI subjects displayed higher levels of mood disturbance and some abnormal patterns of illness behaviour. A reduction in flare size was observed in the pain affected limb of RSI subjects, but an increased response occurred in sites reported as unaffected by clinical pain. Multiple regression analysis revealed that the severity of clinical pain was strongly associated with the magnitude of reduction in flare size. Collectively, these findings provide objective evidence of altered nociceptor mechanisms in RSI subjects, and are consistent with the view that this chronic pain syndrome involves somatic pathophysiology. However, a strong conviction regarding the somatic basis of their symptoms, and a denial of psychological factors may have contributed to the more severe affective disturbance and greater subjective emphasis on the presence of pain.

Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy

The present study examined catastrophizing in rheumatoid arthritis (RA) patients. Subjects were 223 RA patients who were participants in a longitudinal study. Each patient completed the Catastrophizing scale of the Coping Strategies Questionnaire (CSQ) on 2 occasions separated by 6 months (time 1, time 2). The Catastrophizing scale is designed to measure negative self-statements, castastrophizing thoughts and ideation (sample items = 'I worry all the time about whether it will end,' 'It is awful and I feel that it overwhelms me'). Data analysis revealed that the Catastrophizing scale was internally reliable (alpha = 0.91) and had high test-retest reliability (r = 0.81) over a 6 month period. Correlational analyses revealed that catastrophizing recorded at time 1 was related to pain intensity ratings, functional impairment on the Arthritis Impact Measurement scale (AIMS), and depression at time 2. Predictive findings regarding catastrophizing while modest were obtained after controlling for initial scores on the dependent variables, demographic variables (age, sex, socioeconomic status), duration of pain, and disability support status. Taken together, these findings suggest that catastrophizing is a maladaptive coping strategy in RA patients. Further research is needed to determine whether cognitive-behavioral interventions designed to decrease catastrophizing can reduce pain and improve the physical and psychological functioning of RA patients.