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Psychosocial factors and rheumatic disease

Jonathan M Silver, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD


Psychosocial factors affect patients' abilities to cope with chronic illness [1]. Among those with rheumatic disease, optimal management can only be achieved if clinicians recognize relevant psychosocial factors and utilize psychosocial interventions that influence these factors. A review of the relationships between psychosocial factors and patient adaptation in three common rheumatologic disorders: rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM), is presented in this topic review.


The major psychosocial factors that negatively influence adaptation to chronic rheumatic diseases include depression and anxiety, history of abuse and psychiatric diagnoses, exposure to stressors, and disturbance in sleep patterns. It is generally agreed that patients' beliefs about their illnesses and coping strategies may aid adaptation to rheumatic disease. However, our understanding of these positive influences is relatively meager compared with knowledge about the negative psychosocial factors noted above. We will discuss the negative factors as well as two relatively positive psychosocial factors, ie, self-efficacy and optimism. We conclude by examining the effects of psychosocial interventions on adaptation among patients with rheumatic disease.

Depression and anxiety — Depression and anxiety are negative psychological states that are frequently observed in patients with rheumatoid arthritis (RA), fibromyalgia (FM), osteoarthritis (OA), and ankylosing spondylitis (AS):

The frequency of depression and anxiety disorders diagnosed among patients with RA ranges from 14 to 42 percent [2-5]. Among female patients with RA who committed suicide, 90 percent had a depressive disorder [6].

The frequency of lifetime diagnoses of major depression and anxiety disorders in patients with FM ranges from 26 to 71 percent [7-9].

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Literature review current through: Dec 2017. | This topic last updated: Mar 23, 2017.
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