The Connection Between Rheumatoid Arthritis And Mental Problems

Introduction

Arthritis is an umbrella term for a range of inflammatory conditions affecting the bones, muscles and joints. Thereby, pain and fatigue are very common and often reported symptoms. These conditions include osteoarthritis, rheumatoid arthritis, juvenile arthritis and gout and often result in pain, stiffness and swelling and redness in affected joints. But rheumatoid arthritis is not only connected to devastating bodily ailment but also to restrictive mental problems. The aim of this study was to analyze the progress of pain and fatigue in rheumatoid arthritis and the overall relation with problematic moods (depression/anxiety), psychosocial resources (social support, self-efficacy) and burdens (social distress, problematic social support). A broad search of literature which report on the relations in demand is applied in four electronic databases. The methodological quality of the included studies was assessed and data extracted, based on pain and fatigue as primary outcomes, depression and anxiety as secondary outcomes and social burdens/resources were extracted as third outcomes. The results of adequate articles for fatigue, pain. Through the different studies, pain and fatigue seemed to fluctuate in different directions over a period of 10 years. The psychosocial resources/burdens were all related to pain/fatigue: self-efficacy and the amount of social support negatively and social distress and problematic social support positively.

Epidemiological Description

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints; characterized by inflammation of the tissue around the joints as well as in other organs of the body. RA affects women’s three times more promptly than men. In the present study the survey on RA was carried out in the Indore city (M. P.) from July 2010 to October 2010. The information obtained from doctors, patients, clinics, hospitals, book and internet was used for the survey purpose. The data obtained from them served as a basis of the study. Survey revealed that RA occurs at all stages of age but mostly developed in the age group between 40-50 years. It is uncurable disease but 15% patients can get relief especially in the case of treatment start at earlier stage; whereas 85% of patients usually take lifelong treatment. As per survey result allopathy was found choice of therapy using immunosuppressant / DMARDs (Disease modifying antirheumatic drugs) with multivitamins as preferred drug combination. Whereas NSAIDS e. g. Diclofenac, Naproxen, Aspirin etc. and corticosteroids are used as first line drugs for the symptomatic relief of joint inflammation and pain in the case of RA. Survey also concluded that awareness of patient about disease therapy like early stage of treatment, regular exercise and physiotherapy increases the beneficial effects of treatment.

There are many surveys conducted in India through which we can get sufficient amount of data on RA. In one of the survey Patel (2011) it is stated that Rheumatoid arthritis is affecting woman’s more than men i. e. it is affecting 3 times more than that of men. The survey was conducted in city of Indore (MP) from July 2010 to October 2010. The data was taken from doctors, patients, clinics, hospitals, book and internet and it was used to as a tool for study. The Survey revealed that Rheumatoid Arthritis occurs at almost every stages of age but mostly it is been developing between age of 40-50 years. It is not curable but 15% patients get relief if they start their treatment at initial stage while 85% of patients take lifelong treatment. Survey also revealed that awareness of disease therapy at early phase of treatment, regular exercises and kind of patient about disease therapy like early stage of treatment, regular exercise and physiotherapy increases the beneficial effects of treatment.

The prevalence of rheumatoid arthritis was conducted in the adult Indian population. Initially a door to door survey Malviya (2013) was conducted of a rural population in a village near Delhi by health professionals. It involved 44,551 adults (over 16 years old) as a target population. Possible cases of rheumatoid arthritis was found by using questionnaire and these cases were examined by authors who were using 1987 revised ARA criteria for the diagnosis of RA. 3393 persons were listed as possible cases of RA with a response rate of 89. 5%. Of these, 299 satisfied the revised ARA criteria for the diagnosis of RA, giving a prevalence of 0. 75%. By addressing the whole population it came out to be 7 million patients throughout India. The prevalence of RA in India is quite similar to that reported from the developed countries. It is higher than that reported from China, Indonesia, Philippines and rural Africa. North Indian population resembles genetically closer to Caucasians.

A survey Yadav (2019) was conducted using cross sectional design where 1000 patients with age above 18 were diagnosed to have rheumatoid arthritis was designed to survey at an organization. Data involved demographic details, diagnosed disease and co-morbid condition and it was found that rheumatoid arthritis and co-morbidity increases with increase in age and Body mass index. A substantial proportion of patients with rheumatic diseases (45%) were found to have co-morbidities. The most common are hypertension, hypothyroidism and diabetes mellitus in order.

The recent study Gabriel (2009) shows that mortality ratios varied from 1. 28 to 2. 8 with primary differences being due to method of diagnosis, geographic location, demographics, study design (inception versus community cohorts), thoroughness of follow up, and disease status. Population-based studies specifically examining trends in mortality over time have concluded that the excess mortality associated with RA has remained unchanged over the past two to three decades. Although some referral-based studies have reported an apparent improvement in survival, a critical review indicated that these observations are likely due to referral selection bias. Recent studies have demonstrated that RA patients have not experienced the same improvement in survival as the general population, and therefore the mortality gap between RA patients and individuals without RA has more. Recent data suggest a trend toward an increase in RA-associated mortality rates in the older population groups.

According to the Australian Institute of Health and Welfare, rheumatoid arthritis prevalence in Australia decreased from 1995 to 2001 by 28 per 1000 to 24 per 1000. Arthritis is a large contributor to illness, pain and disability in Australia. Based on data from the Australian Burden of Disease Study 2011, musculoskeletal conditions were responsible for 12% (around 521,000 disability-adjusted life years (DALY)) of the total burden of disease. According to the Australian Bureau Of Statistics (ABS), arthritis differ in geographical variation according to WHO 2003. It is more prevailing in the northern hemisphere but it is contrasting in European and Asian populations. It is higher than that reported from China, Indonesia, Philippines and rural Africa. The occurrence of arthritis in North America is between 0. 5 to 1%. The much higher prevalence of rheumatoid arthritis in Australia (compared with reported occurrence in European countries and North American populations) reflects mostly the use of disparate estimation procedures. In 2017-18, one in seven Australians (15. 0% or 3. 6 million people) had arthritis. The prevalence was higher in females than in males (17. 9% compared with 12. 1%) and has remained constant. Almost two-thirds (62. 0%) of people who had arthritis had osteoarthritis (deterioration of cartilage inside a joint). One in eight people (12. 7%) with arthritis had rheumatoid arthritis (an autoimmune disease in which the body is attacked by bacteria or viruses), and one third (32. 7%) had an unspecified form. It is possible to have more than one type of arthritis, therefore proportions add to greater than 100%.

Contributing Factors

Brazier (2018) states that many factors may affect in increase in the probability or chances to develop rheumatoid arthritis, few of them are unavoidable but one can prevent it on initial bases. There are several factors responsible for developing the rheumatoid arthritis such as genetic factors, environmental factors, hormones, age, smoking, stress, obesity, early life factors, previous infection, gut bacteria, diet. The main contributing factor is gender. As discussed Jennifer (2012) earlier rheumatoid arthritis is seen developing in females rather than males in early 50s. One in four women has been diagnoses of arthritis with about one in five men. Factors such as biomechanics, hormones, obesity contributes to possibly develop risk of arthritis.

Biomechanics such as wide hips, child birth and hypermobility are responsible for arthritis. Women when compared to men have wider hips which will affect the alignment of the knees and can cause effort on the inside portion of knee which leads to knee load and thus results in to pain and inflammation. In a study women aging from 50 to 80 had given birth to 5 to 12 children which was 2. 6 times more likely to have a knee replacement than women had birthed just one child and they have more flexibility and hypermobility which also contributes to increase risk for arthritis.

Hormones such as estrogen and testosterone play an important role in developing arthritis in women. The rate of arthritis increases after menopause, women having arthritis may develop severe symptoms during menopause. Some experts tend to believe that when the level of estrogen decreases it shoots up the risk of rheumatoid arthritis. Extra body weight is responsible to both development and progression of joint deterioation. it is obvious that when there is an extra weight on joint, the stress becomes more and it is more likely to damage and there will also be increased in wear and tear of joints. Every pound of excess weight exerts about 4 pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on his knees. The additional weight causes even more problems on already damaged joints, but it’s not just the extra weight on joints that’s causing damage. The fat itself is active tissue that creates and releases chemicals, many of which promote inflammation.

Public Health Strategies

Standards a National Public Health Agenda for osteoarthritis (2010) states that the public health strategies were developed as a national agenda by collaboration between Centres for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) in 2008 to explore ways of decreasing the burden of arthritis. There are 4 intervention strategies developed for addressing the rheumatoid arthritis which are as follows:

1. Self-management
2. Physical activity
3. Injury prevention
4. Weight management and healthy nutrition.

The initial two intervention strategy aims to focus on reduction of the symptoms and its progression for those who have disease while the other two focuses on prevention. Physical activity and weight management turns out to be major health strategy concerning to the contributing factor which discussed in earlier part. Under Ottawa charter, areas such as supportive environments strengthening community action and developing personal skills were covered by implementing physical activity guidelines, by building codes and road design standards and government policies which creates safer and healthier environment, by developing programs which is benefitted for people suffering from arthritis like Arthritis Foundation Exercise Program, Arthritis Foundation Aquatics Program, by endorsing national obesity policy, by adapting dietary guidelines.

Conclusion

It is clearly seen from the above discussion that rheumatoid arthritis is usually seen in females who are in near 50s to late 80s. The contributing factors affecting are many but the major of them is age and body weight. Regular exercises and proper diet reduces the risk of developing rheumatoid arthritis. I would recommend keeping oneself fit and healthy by keeping proper healthy food habits.

References

1. Patel, P 2011,’A survey of rheumatoid Arthritis’, Asian Journal of pharmacy and life science, vol. 1, no. 3, pp. 312-316
2. Malviya, Anand and Kapoor, Shakti and Singh, Ram and Kumar, Ashok and Pande,1993,’Prevalence of rheumatoid Arthritis in the adult population’, vol. 13, no. 4, pp. 313-400
3. Gabriel, S. E. , & Michaud, K. 2009,’ Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases’ Arthritis research & therapy, vol 11, no. 3, pp. 229
4. Australian Institute of Health and welfare (AIHW) 2005, Arthritis and musculoskeletal conditions in Australia 2005, cat. no PHE67, AIHW, Canberra
5. Australian Institute of Health and welfare (AIHW) 2016, Arthritis and musculoskeletal conditions in Australia 2016, cat. no PHE234, AIHW, Canberra
6. Australian Bureau of Statistics (ABS) 2017-18, National Health Survey: First Results, 2017-18, cat. no 4364, ABS, Canberra
7. Brazier, Y 2018,’What are 10 risk factors for rheumatoid arthritis?’, Medical news today, 16 October
8. Jennifer M, Helmick C, Teresa J, 2012, ‘A Public Health Approach to Addressing Arthritis in Older Adults: The Most Common Cause of Disability’, American Journal of Public Health, vol 102, no. 3, pp. 426-433
9. Turner, S 2019,’Why are women more prone to osteoarthritis, blog post, 16 May, viewed 28 may, 2019,
10. Standards A National Public Health Agenda for osteoarthritis 2010, Centres for disease Control and Prevention, USA