Deformity, Depression and Disability—The Chain of Events that Must be Broken

Dr. Mark James Borigini

Obviously, poorly controlled rheumatoid arthritis can lead to deformities of the joints, particularly the hands and feet. This in turn could lead to a poor self-image, which in turn could lead to feelings of inadequacy and depression. 

An article in the March, 2007 edition of "Arthritis Care and Research" focused on the dynamics of physical appearance concerns and depression and anxiety in patients with rheumatoid arthritis and lupus. 

The rheumatoid arthritis patients included both newly diagnosed and chronic rheumatoid arthritis patients. All patients completed surveys which sought to answer questions regarding how they viewed various aspects of health, in addition to questions regarding psychological distress (related to perceived self-image) and how patients cope with everyday life. A joint examination was performed for the rheumatoid arthritis patients.

Not surprisingly, all groups studied showed greater psychological distress. 53% of lupus patients reported feeling that the disease made them unattractive. On the other hand, 30% of chronic rheumatoid arthritis patients and 34% of newly diagnosed rheumatoid arthritis patients felt this way. 

Further, it was found that appearance and physical disability could predict depression in patients with rheumatoid arthritis. Appearance concerns are related to rheumatic disease, as up to 53% of patients surveyed reported that they felt unattractive due to physical changes brought about by their disease. 

It was already known that there is a high degree of depression in both rheumatoid arthritis and lupus patients; and the more distress there is in one's life, the greater the impact on daily functioning and overall quality of life. When doctors know what causes distress, psychological therapy can be tailored to allow patients to cope with these stressors.

It is known that depression can lead to disability, so it is in the best interest of doctor and patient to take measures to lessen the distressing impact of rheumatoid arthritis on mood. Hopefully, by helping patients conquer appearance concerns, there will be less depression. 

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