Bad State of Mind Worsens Rheumatoid Arthritis


Anxiety and depression, often under-recognized and undertreated, may contribute to poorer outcomes.

Comorbid anxiety and depression are common in patients who have rheumatoid arthritis but often are under-recognized and undertreated, contributing to worse outcomes, according to the authors of a recent study.

Annabelle Machin and colleagues in the United Kingdom pointed out that mental health is a frequently overlooked medical problem in patients with rheumatoid arthritis and other chronic health conditions. Rates of depression and anxiety in patients with rheumatoid arthritis have been reported as high as 39% and 20%, respectively, they noted.

The authors explored patients’ perspectives of anxiety and depression in rheumatoid arthritis and preferences for disclosure and management of mood problems and presented their findings in a recent British Journal of General Practice article.

The study

The investigators established a nurse-led rheumatoid arthritis clinic that provided annual reviews for patients. Patients were interviewed and their perspectives explored; 171 patients were ultimately included in the study.

The results

Study subjects reported the following:

• They believed that rheumatoid arthritis negatively affected their mood.

• Some believed their mood had an impact on their rheumatoid arthritis flare-ups.

• Some recognized a link between their mood and their rheumatoid arthritis only when it was brought up by a clinician.

• They felt embarrassed to talk about their mental health.

• Several felt anxiety over appointments with their general practitioner that prevented them from seeking help for mental health problems.

• Some described their general practitioners as intimidating.

• When they felt at ease with their general practitioners, they were more likely to open up about mental health issues.

• Preference for drug therapy versus behavioral therapy for mood disturbances was mixed.

Implications for physicians

• Rheumatologists should ask their patients with rheumatoid arthritis about their mood, because patients may not volunteer information on their own.

• The physical manifestations of rheumatoid arthritis should not be the sole focus of diagnosis and treatment plans discounting the patient’s mental health.

• General practitioners should strive to recognize barriers to patients talking about their mental health issues and to be more approachable, less time constrained, and more empathetic to mood problems.

• General practitioners should make referrals to improve access to psychological therapies for patients who have rheumatoid arthritis and anxiety or depression.

• Nurse-led care teams may improve outcomes for patients as well as costs when managing multiple comorbidities, such as rheumatoid arthritis and mental health conditions.

“Prior experiences can lead patients with RA and comorbid anxiety and depression to feel they lack candidacy for care,” the authors concluded. “Provision of equal priority to mental and physical health problems by GPs and improved continuity of care could help disclosure of mood concerns. Facilitation of access to psychological therapies could improve outcomes for both mental and physical health problems.”


The Scientific Foundation Board of the Royal College of Practitioners provided funding for this study.


Machin A, Hider S, Dale N, Chew-Graham C. “Improving recognition of anxiety and depression in rheumatoid arthritis: a qualitative study in a community clinic.” Br J Gen Pract. 2017;67(661):e531-e537. doi: 10.3399/bjgp17X691877. Epub 2017 Jul 17.

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