RA Patients Looking to Rheumatologists for Emotional Support


Many RA patients specifically want help from their rheumatology teams in coping with pain and fatigue, new studies show. The issue important in disability most often goes unaddressed.

Dures E, Almeida C, Caesley J, et al., Patient preferences for psychological support in inflammatory arthritis: a multicentre survey.Ann Rheum Dis. (2014) Sep 26.  doi: 10.1136/annrheumdis-2014-205636. [Epub ahead of print]

Bacconnier LK, Rincheval N, Flipo RN, et al., Psychological distress over time in early rheumatoid arthritis: results from a Longitudinal study in an early arthritis cohort. Rheumatology. (2014) October  doi:10.1093/rheumatology/keu371. [Online Sept 28 2014]

Almost half of rheumatoid arthritis (RA) patients suffer psychological distress early in their illness and would like emotional support from their rheumatologists. But fewer than one in four are ever asked about it, according to recent studies from Europe.

Both research teams question whether rheumatology teams have the capacity to address this important problem, but suggest that patients should at least be asked about it.

Psychological distress is common during the first three years after an RA diagnosis, to judge from an ongoing longitudinal study of 641 patients in a multi-center French database. At baseline, 46.9% of patients reported  on the 5-item Mental Health Inventory.

A little over one-quarter of the patients (women in their late 50s diagnosed with RA within the previous 4 months) continued to report emotional distress at 3 years.

In this study, those most likely to need emotional help are poorly educated employed women with poor functional status. The most significant predictor of continued distress over 3 years was a high score on the Health Assessment Questionnaire Disability Index (HAQ-DI).    

These findings are in line with other studies that show that many patients with early RA report depression and anxiety.

A study from Britain finds that a substantial number of patients living with inflammatory arthritis (IA) would like psychological support for their distress, but that they rarely have an opportunity to speak with doctors about how the disease is affecting their lives.

Questionnaire data for 1,210 IA patients at six hospitals in Britain, (like the French study, predominantly women around age 59) finds that 46% would like to have discussed the psychological impact of their disease. About half of the group were never asked about it.

Most patients (82%) wanted support for managing pain and fatigue, and over half wanted help in coping with low mood, anxiety, stress and the effect of their IA on family and work.

Most patients said they’d prefer this support from their rheumatology team. But they would be willing to take part in a self-management coping clinic or counseling, given the opportunity.

The British researchers say their study highlights a gap between demand and supply for psychological support among IA patients. They also wonder whether the doctors, nurses and other providers on rheumatology teams “have the skills or resources to meet patients’ needs.”

The authors of the French study contend that “psychological evaluation should be an important part of RA care because of its major impact on disease course and burden.”


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