People living with rheumatoid arthritis not only grapple with physical symptoms and impaired ability to perform ordinary tasks, they also have higher reported rates of anxiety and depression, according to a 2012 study led by researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta. 

The study, which was published in the medical journal Arthritis Care & Research in April, looked at rates of anxiety and depression among U.S. patients with arthritis as a whole, not just RA. Researchers used the emotional well-being questions from the Arthritis Impact Measurement Scales, a respected measurement tool, to determine rates of mood disorders. Among 1,793 adults age 45 or older with doctor-diagnosed arthritis or rheumatic conditions, 31 percent had anxiety and 18 percent had depression, notes Louise Murphy, PhD, the epidemiologist who led the study.

“This is not a surprise to people with arthritis,” says Murphy. It’s hard to pinpoint the exact cause of anxiety or depression, but RA pain and inflammation can cause life-disrupting problems. “People with arthritis experience a higher degree of work limitation once symptoms start, and that is a huge source of anxiety. If a person becomes unable to work, then the path is clear.”

What remains unclear: Whether RA’s physical symptoms cause increased anxiety and depression, or if depression is just another RA symptom sparked by systemic, chronic inflammation. Regardless, health care professionals can do more to identify anxiety and depression in RA patients and either treat the conditions, or refer the patient to a mental health professional for counseling and treatment, says Murphy.

She and her colleagues at CDC recommend a three-pronged approach to the problem: Encourage more health-care professionals to identify and diagnose anxiety or depression in patients with RA, either treat the disorder with medications or refer the patient for mental-health counseling, and encourage the patient to get more physical activity to improve physical function and boost mood. She also recommends people with RA who have mood disorders enroll in an arthritis self-management course to learn coping skills, and to talk with others experiencing the same issues.

Half the patients in the study who reported anxiety or depression were not seeking treatment for these conditions, says Murphy. “Maybe they are apprehensive about talking about it. But they’re not alone, and it would be helpful if they were talking about it, and knowing that there are things they can do about it.”

Losing Valued Activities

RA destroying one’s ability to perform “valued life activities” may contribute to depression, says Mary Margaretten, MD, a rheumatologist at the University of California at San Francisco (UCSF). “Like no longer being able to pick up your children at school because you have trouble driving,” she explains. “It’s not surprising that the inability to do those things makes a person feel sad or depressed.”

As part of UCSF’s Rheumatoid Arthritis Cohort, Dr. Margaretten has studied patients with RA and collected data on their symptoms. She and other researchers are now looking into possible causes of depression and how it may be better addressed by health-care professionals. Patients may be talking about their physical symptoms but not bringing up emotions, she says.