How Rheumatoid Arthritis Affects Mental Health

Links, Common Conditions, and Recognizing the Early Signs

Rheumatoid arthritis (RA) causes many physical symptoms, including pain and inflammation. Living with RA also means you might experience mental health issues related to the effects of your disease. Mental health refers to your emotional and psychological well-being.

If you live with RA, you should prioritize your mental health as much as you do your physical health. It is also important to be aware of the links between RA and some common mental health disorders. Keep reading to learn about these links, the ways in which RA affects your mental health, and how to recognize early signs of mental illness. 

Depression
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Mental Health Defined

Your mental health generally includes your emotional, psychological, and social wellbeing. It helps you to manage stress, relate to others, and to make decisions. It will affect how you think, feel, and behave. Mental health is important throughout your entire life—from childhood to adolescence and through adulthood. 

Throughout your life, it is possible to experience mental health problems or a mental illness. These problems may cause major changes to your thoughts, emotions, and behaviors. Examples of mental health disorders are depression, anxiety, and bipolar disease, among others.

Mental health issues can also cause distress and problems that affect your social life, job, and personal relationships. Factors attributable to mental illness include biological factors, such as genes and brain chemistry, life experiences like trauma, and a family history of mental illness.

Mental health concerns affect almost everyone from time to time. But when mental health concerns cause ongoing signs and symptoms, they might cause stress and affect your ability to function. Fortunately, for most people, the symptoms of mental illness can be managed with medication and talk therapy.

Mental Illness Risk Higher in RA

A study published in 2018 in the journal Arthritis Care & Research found people with RA were more likely to experience depression, an anxiety disorder, or bipolar disorder during their lifetimes when compared to others without RA. Here, researchers in Canada studied more than 60,000 people, 10,206 of which had RA. 

Among study participants, the incidence of depression was 45% higher in the RA group. For anxiety, the RA group was at a 25% higher incidence, and bipolar disorder was 20% more common in the people with RA. People with RA also had episodes of depression and anxiety that were more frequent and lengthier than they were for people without RA

Research also shows that even though the coexistence of mental health is known, doctors don’t always screen people with RA. This can lead to untreated mental health conditions.

A study reported in 2017 by the British Journal of General Practice found people with RA might begin to think their depression or anxiety symptoms are normal. They might also think their doctors place more emphasis on treating physical symptoms and pay little attention to symptoms that might indicate mental health problems.

Depression and anxiety seem to affect large numbers of people with RA. A study reported in 2017 in the journal Rheumatology and Therapy found around 30% of people with RA develop depression within five years of their diagnosis.

People with RA may also experience anxiety at a rate of 20% according to the previously mentioned British Journal of General Practice study. That study shows the depression rate for people with RA to be slightly higher at 39%.

Why RA Affects Your Mental Health 

RA doesn’t share the same physical symptoms of depression and anxiety. But living with more than one condition can bring about a variety of challenges. And there are different reasons why RA and mood disorders might be connected, including chronic stress, inflammation, and RA pain.

Chronic Stress

Fighting pain and a chronic health problem is a lot to handle. And the connection between chronic stress and RA has been well-documented. A 2010 analysis of studies published in the journal Arthritis Research & Therapy found stress makes RA worse and mental health disorders are common with RA and other rheumatic diseases.

Another study, this one from 2013, found stressful events often proceeded an RA diagnosis. In addition, higher stress was associated with a less positive outlook for RA, and people with RA were more sensitive to certain types of stress.

Inflammation 

Researchers speculate chronic inflammation might contribute to other conditions beyond RA, including mood disorders. That means that people with inflammatory biomarkers in their bodies are more likely to develop depression. Some of these same biomarkers also contribute to worsening RA symptoms.

Pain

Depression and RA pain seem to go hand in hand. Chronic pain might lead to depression and feeling depressed can worsen the pain. 

In a study reported in 2016 by BMC Musculoskeletal Disorders, researchers asked 56 people with RA to complete a questionnaire about their depression and anxiety levels. A year later, the researchers followed up with the study participants and found a strong connection between the number of sore joints and how study participants were feeling overall.

The study participants felt worse emotionally the more significant they considered their pain to be. The study’s authors thought that depression and anxiety could worsen the perception of pain experienced.

They also felt it was possible that feeling depressed and anxious could cause people to not keep up with good health behaviors and treatments, which would worsen the effects of RA. 

Recognize the Early Signs

If you have RA and you are worried about your mental health, it is a good idea to bring your concerns to your doctor. They can assess you to determine if you might be experiencing symptoms of anxiety, depression, bipolar disorder, or another condition.

Signs of depression might include:

  • Low mood, feelings of sadness, irritability, and anger
  • Reduced energy levels
  • Loss of interest or enjoyment in activities you once enjoyed
  • Concentration troubles
  • Unusual fatigue
  • Sleep problems, including sleeping too much or not being able to fall asleep
  • Feelings of guilt or worthlessness
  • Thoughts of self-harm or suicide

Signs of anxiety might include:

  • Feeling nervous, tense, or restless
  • Feeling a sense of impending danger, doom, or panic
  • An increased heart rate
  • Hyperventilation: rapid breathing
  • Sweating
  • Trembling
  • Feeling weak or tired
  • Concentration troubles
  • Sleep problems
  • Gastrointestinal (GI) problems
  • Constant worry
  • An urge to avoid things that trigger anxious feelings

The signs and symptoms of bipolar disorder are divided into two categories: mania and depression. 

Mania symptoms might include:

  • Feeling overly happy for long periods
  • Not needing too much sleep
  • Talking fast and having racing thoughts
  • Feeling impulsive and restless
  • Becoming easily distracted
  • Feeling overconfident
  • Engaging in risky behaviors, including gambling away savings, going on big spending sprees, or having impulsive sex

Depression symptoms of bipolar disorder might include:

  • Feeling sad or hopeless for extended periods
  • Withdrawing from family and friends
  • Loss of interest in activities once enjoyed
  • Significant appetite changes
  • Chronic fatigue and lack of energy
  • Constant worry and concentration troubles
  • Thoughts of suicide or death

A Word From Verywell

It is possible that you might be nervous about bringing up mental health concerns to your doctor, or you are worried they might dismiss you. But it is important that you speak up, so your doctor can help you to find the right resources to manage mental health issues and your overall well-being.

Whether you speak to your doctor, a mental health professional, or join an RA support group, you have a lot of options for prioritizing your mental health. And treating RA and managing the challenges it brings, like mental health concerns, is key to living a full life with and despite RA. 

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Article Sources
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Additional Reading
  • National Institutes of Mental Health. Anxiety. Updated July
    2018.


  • National Institutes of Mental Health. Bipolar
    disorder
    .
    Updated January 2020.


  • National Institutes of Mental Health. Depression. Updated
    February 2018.