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Psychological effects of living
with rheumatoid arthritis
NS771 Ryan S (2014) Psychological effects of living with rheumatoid arthritis.
Nursing Standard. 29, 13, 52-59. Date of submission: August 11 2014; date of acceptance: September 12 2014.
Abstract
Aims and intended learning outcomes
Keywords
This article describes the psychological effects
of living with rheumatoid arthritis, including
reaction to diagnosis, anxiety and depression,
body image, and the effects on work and
family. It aims to increase understanding of
the psychological implications of living with
rheumatoid arthritis, and outline the nurse’s
role in helping patients to manage symptoms
and maintain psychological wellbeing. After
reading this article and completing the time out
activities, you should be able to:
Identify common emotional reactions to a
diagnosis of rheumatoid arthritis.
Recognise the main factors associated
with depression.
Understand the nurse’s role in helping a
person with depression.
Be aware of the effect rheumatoid arthritis
can have on social function, work and family.
Outline the nurse’s role in managing fatigue.
Anxiety, body image, depression, family role, fatigue, nursing role, pain,
psychological wellbeing, rheumatoid arthritis, self-efficacy, work
Rheumatoid arthritis
Rheumatoid arthritis is a long-term inflammatory condition that can
affect physical, psychological and social function. The condition is not
curable – although drug therapy can be used to reduce inflammation
– and patients often experience daily symptoms of joint pain and
stiffness, fatigue and functional limitations. Patients may also experience
psychological challenges. This article focuses on the psychological
implications of living with rheumatoid arthritis, including reaction to
diagnosis, anxiety and depression, body image, sexuality, self-esteem and
social role. It aims to explore the role of the nurse in addressing these
psychological challenges to optimise the physical and psychological
status of each patient.
Author
Sarah Ryan
Nurse consultant, rheumatology, Haywood Hospital, Staffordshire and
Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, England.
Correspondence to: [email protected]
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52 november 26 :: vol 29 no 13 :: 2014
Rheumatoid arthritis is a common long-term
inflammatory condition that can affect
physical, psychological and social wellbeing.
Since there is no cure, patients require help
and support from healthcare professionals
to manage the symptoms, which can affect
their everyday function. Rheumatoid arthritis
is a systemic, autoimmune, inflammatory
condition of the moveable (synovial) joints
of the body. It is estimated to affect 580,000
people in England (House of Commons
Committee of Public Accounts 2010),
with women affected more commonly than
men (Symmons et al 2002). Its core symptoms
© NURSING STANDARD / RCN PUBLISHING
present as joint pain, stiffness and swelling
as well as fatigue. It can affect physical,
psychological and social functioning.
Joint deformity can also occur if the
inflammatory process is not controlled.
Symptoms are not always confined to the
joints. Rheumatoid arthritis can cause
extra-articular manifestations, including
subcutaneous nodules, anaemia, pericarditis
and pleural effusions.
The cause of rheumatoid arthritis is
unknown. A family history of rheumatoid
arthritis increases the likelihood of the
condition. It appears that exposure to an
as-yet-unidentified antigen, in a genetically
predisposed individual, can initiate an
autoimmune response that leads to joint
inflammation. The synovial lining of the joint
capsule becomes inflamed and congested
with T lymphocytes, B cells, macrophages
and plasma cells. This inflammatory response
causes proliferation of the synovial membrane,
which erodes the bone. This results in
altered joint function and, ultimately, joint
deformity (Hameed and Akil 2010). There is
no single diagnostic test for rheumatoid
arthritis, but there are diagnostic criteria to
identify patients with the condition (Box 1)
(Aletaha et al 2010).
The aim of treatment is to suppress the
activity (inflammation) of rheumatoid arthritis
and to optimise patients’ physical, psychological
and social functioning. Disease-modifying
anti-rheumatic drugs and biologic agents,
which inhibit cytokines, are used to suppress
the inflammation and reduce the likelihood
of deformities (Box 2). Non-pharmacological
interventions are also invaluable in helping
patients manage their symptoms on a daily
basis; they include exercise, strategies for
coping with pain and fatigue, pacing activities,
and joint protection.
Psychological wellbeing
The World Health Organization (WHO)
(2003) refers to psychological wellbeing as
a state in which every individual realises
his or her own potential, can cope with the
usual stresses of life, can work productively
and is able to make a contribution to his or
her community. There are many ways in
which being diagnosed with a long-term
condition such as rheumatoid arthritis can
challenge wellbeing. First, the individual
may need to re-evaluate his or her current
and future goals, including whether they
© NURSING STANDARD / RCN PUBLISHING
can continue in their preferred employment.
Second, the unpredictability of symptoms
and the presence of pain and fatigue may lead
to daily plans having to be changed. Third,
the treatment of rheumatoid arthritis contains
aspects of uncertainty – a patient might
commence the recommended drug treatment
but find it is not effective and additional
medication needs to be started.
It is not surprising, therefore, that patients
with rheumatoid arthritis experience a host of
psychological reactions that can range from the
shock of diagnosis and initial helplessness, to a
sense of being in control. A sense of control can
be achieved when patients realise they have the
knowledge and behavioural skills to cope with
the effects of the condition (Bandura 1977).
Complete time out activity 1
Reaction to diagnosis
Rheumatoid arthritis has an insidious onset.
The patient may feel well one day and may
wake the next day to find that joints have
become swollen, painful and stiff to move and
that these symptoms are accompanied by an
overwhelming feeling of tiredness. There is no
time for the patient to prepare to cope because
1 Write a list of the
factors that contribute
to maintaining your
own sense of wellbeing.
How might the factors
you have identified
alter if you were
diagnosed with a
long-term condition?
BOX 1
Diagnostic criteria for rheumatoid arthritis
A definite diagnosis of rheumatoid arthritis requires:
 Confirmed presence of synovitis in at least one joint.
 Absence of an alternative diagnosis that better explains the symptoms.
Achievement of a score of 6 or greater (from a possible 10)
from the following:
 Number and sites of involved joints including hands and feet
(score range 0-5).
 Serological abnormalities: highly positive rheumatoid factor (RF) or highly
positive anti-cyclic citrullinated peptide antibody (anti-CCP) (score range 0-3).
 Evaluated acute phase response (raised C-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR)) (score range 0-1).
 Symptoms lasting more than six weeks (score range of 0-1).
(Aletaha et al 2010)
BOX 2
Disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents
DMARDs:
 Azathioprine
 Ciclosporin
 Cyclophosphamide
 Hydroxychloroquine
 Leflunomide
 Methotrexate
 Mycophenolate mofetil
 Penicillamine
 Sulfasalazine
Biologic agents:
 Abatacept
 Adalimumab
 Certolizumab pegol
 Etanercept
 Golimumab
 Infliximab
 Rituximab
 Tocilizumab
november 26 :: vol 29 no 13 :: 2014 53
CPD rheumatology nursing
of the quick onset of symptoms. It can be a
bewildering process because the symptoms
might affect everyday activities and social roles
quickly. Obtaining a diagnosis for the condition
might provide patients with an initial sense
of relief, but when they learn their condition
is incurable they may experience a range of
emotions, including shock, grief, anger, denial
and depression (Hehir et al 2008).
Complete time out activity 2
The role of the nurse, following diagnosis of
rheumatoid arthritis, is to provide time and
space for the patient to discuss his or her feelings
and thoughts about the condition and to offer
emotional support while the patient attempts
to make sense of what is happening (Hehir
et al 2008). The patient may feel helpless at
this time, and will require information from
the nurse about what rheumatoid arthritis is,
what the symptoms are, the expectations for the
treatment and what can be done to minimise the
effect of symptoms while sufficient time is given
for the treatment to become effective.
Many rheumatology services have nurse-led
clinics for newly diagnosed patients, so that
patients can access regular emotional and
practical support while they come to terms
with their diagnosis. Hehir et al (2008)
identified that patients often had three main
needs after receiving a diagnosis of rheumatoid
arthritis. They required emotional time
and space to work through feelings of being
depressed and frustrated; opportunities to
discuss practicalities associated with the
treatment of rheumatoid arthritis, including
how to take medications; and advice on
self-management that explores how to manage
symptoms of rheumatoid arthritis, such as
pain and fatigue.
Depression
2 Discuss with a
colleague the role of the
nurse when a patient
is given a diagnosis of
rheumatoid arthritis.
Are there any changes
to your practice that
should be made?
Anxiety and depression are commonly
observed among patients with rheumatoid
arthritis, with a higher prevalence than that
of the general population (Isik et al 2007).
An anxious patient will be worried, tense,
and exhibiting signs of avoiding certain
behaviours, such as exercise, because of a fear
that it may aggravate pain. A patient with
symptoms of depression will often display
feelings of sadness, helplessness and loss of
feelings of pleasure and interest, sometimes to
the extent they interfere with daily functioning
(Geenen et al 2012). Other symptoms
associated with depression are listed in Box 3.
54 november 26 :: vol 29 no 13 :: 2014
Patients who perceive their rheumatoid
arthritis to have serious negative consequences
experience higher states of anxiety, whereas
patients with a greater number of symptoms
experience more severe depression (Graves
et al 2009). A large epidemiological study
demonstrated that having arthritis of any
type significantly increased the odds of
developing depression two years later (van’t
Land et al 2010). Patients with rheumatoid
arthritis who are depressed have a greater
risk of illnesses and events such as myocardial
infarction (Scherrer et al 2009), have increased
mortality (Ang et al 2005), and make greater
use of healthcare services (Joyce et al 2009).
Many factors, including pain, fatigue and
disability, can contribute to the development
of depression in rheumatoid arthritis (Dickens
et al 2002). In a large-scale study of 22,131
patients with rheumatoid arthritis, pain and
fatigue were the best predictors of self-reported
depression (Wolfe and Michaud 2009).
A survey on the emotional effect of arthritis
found that, when arthritis pain was at its worst,
68% of respondents felt depressed and 50%
felt helpless (Arthritis Care 2011). Disability
can affect mobility and limit the ability to
engage in meaningful or valued life activities,
and is associated with greater pain, fatigue
and work disability (Dickens et al 2002).
Depression may also lead to marital conflict
and reduce the size of the patient’s social
network (Nicassio 2008, Morris et al 2011).
Identifying depression
The provision of psychological support is part of
the role of rheumatology nurses, but depression
is seldom assessed routinely in outpatient
rheumatology clinics (van Eijk-Hustings
et al 2012). The apparent reluctance of
rheumatology healthcare professionals to
adopt an active role in addressing patients’
psychological needs may be attributable to
BOX 3
Symptoms associated with depression
 Loss of interest in and enjoyment of life.
 Lack of drive and motivation.
 Fatigue.
 Agitation and restlessness.
 Alteration in appetite.
 Alteration in sleep pattern.
 Loss of self-confidence.
 Feeling worse at a particular time of day,
usually mornings.
 Irritability.
 Feeling useless or inadequate.
© NURSING STANDARD / RCN PUBLISHING
time constraints, lack of resources, inadequate
professional training or the belief that other
healthcare professionals should be dealing with
psychological issues (Nicassio 2008).
Many of the symptoms of depression,
including fatigue, sleep disturbance, weight loss
and loss of appetite, can arise from physical
manifestations of rheumatoid arthritis, as well
as from depression. If the patient is not screened
for depression, an erroneous assumption might
be made that such symptoms are related to
heightened disease activity. The healthcare
professional may then use pharmacological
measures to control the perceived increase
in disease activity – an intervention that
is unlikely to help the patient with mood
symptoms. A count of four out of ten
depressive symptoms, present for at least two
weeks, with each symptom present every day,
is required for a formal diagnosis of depression
under the ICD-10 classification system (WHO
2010). The National Institute for Health and
Care Excellence (NICE) (2009) recommends
that healthcare professionals do not rely solely
on a depressive symptom count when assessing
a patient with a chronic physical health
problem who may have depression. This is
because depressive symptoms below this formal
threshold for diagnosis may still be distressing
and disabling. NICE (2009) recommends that
healthcare professionals take into account
the degree of functional impairment and/or
disability associated with the possible
depression and the duration of the episode.
A brief self-report instrument, such as the
Patient Health Questionnaire (also known as
PHQ9), can be completed in a few minutes and
has high specificity and sensitivity for detecting
depressive disorders (Gilbody et al 2007).
The presence of depressive symptoms can
also influence treatment outcomes adversely,
which provides another reason to identify
and treat depression. Patients with persistent
depression who were prescribed anti-tumour
necrosis factor (anti-TNF) therapy had
significantly smaller reductions in disease
activity compared with patients without
persistent depression who were given the same
agents (Hider et al 2009).
Complete time out activity 3
Treatments for psychological distress
The importance of addressing psychological
needs is acknowledged in the NICE (2009)
treatment guidelines, which state that people
with chronic physical health problems should
© NURSING STANDARD / RCN PUBLISHING
be offered psychological interventions such as
relaxation, stress management and cognitive
coping skills to help them adjust to living with
their condition. The nurse’s role is to assess
the patient for the presence of depressive
symptoms and to offer psychological support
if these symptoms are identified. The skills
that patients with rheumatoid arthritis value
in a nurse include empathy, the ability to listen
and the ability to understand the effects of
the condition from the individual’s viewpoint
(Ryan et al 2013). If the nurse does not have
appropriate knowledge and skills in this area,
then he or she can direct the patient to relevant
services – for example, in the voluntary sector
through charities such as MIND – and alert the
patient’s GP to the patient’s mood status.
Cognitive behavioural therapy (CBT)
is recommended as a first-line treatment for
mild-to-moderate anxiety and depression
(NICE 2009). CBT focuses on how our
thoughts (cognitions) can influence our
actions. For example, if an individual believes
that engaging in exercise will increase pain,
he or she is unlikely to undertake any such
exercise. The nurse should spend time with
the patient exploring the factors that have
influenced his or her belief that exercise will
increase pain, as well as past experiences of
exercise. The nurse should explain the benefits
that exercise can bring and demonstrate
specific exercises to the patient. If the patient
is willing to explore exercise as a treatment
option, the nurse might refer the patient to
a physiotherapist for supervised exercise to
provide motivation and feedback. CBT has
been shown to reduce depressive symptoms,
anxiety and the effects of disability in patients
with rheumatoid arthritis (Sharpe et al 2003).
Meditation, biofeedback and relaxation have
also been shown to be safe and effective means
of reducing psychological distress. Patients
attending a meditation-based course designed
to increase clarity, calm and wellbeing reported
a reduction in stress levels (Pradhan et al 2007).
In biofeedback, the patient is made aware of the
effect that stress can have on wellbeing. He or
she may then be able to identify and control
triggers of stress, limiting the effect of potential
stressors in future.
There is insufficient evidence to support
the routine prescription of antidepressants in
patients with rheumatoid arthritis (Richards
et al 2011). NICE (2009) does not recommend
the routine use of antidepressants to treat mild
depression in patients with a chronic physical
health problem, because the benefit-to-risk
3 What services are
available in your area
to help patients with
anxiety and depression.
Consider producing
a leaflet or poster to
display this information
on the ward.
november 26 :: vol 29 no 13 :: 2014 55
CPD rheumatology nursing
ratio is poor. NICE (2009) recommends that
antidepressants should be considered for
patients with a history of moderate or severe
depression, or with mild depression that
persists over time.
Pain and fatigue
4 Using the
concept of pacing,
what advice would you
give to a patient who
was swimming once
a week for one hour,
and who is experiencing
increased joint pain and
fatigue two days
after swimming?
5 List all the ways
in which rheumatoid
arthritis might affect
body image. Write
down some questions
that would enable
an exploration of the
potential effect of
rheumatoid arthritis
on body image during a
patient assessment.
Pain and fatigue in patients with rheumatoid
arthritis can affect psychological wellbeing
(Walsh and McWilliams 2014). Patients need
advice on managing these symptoms, since a
reduction in their pain and fatigue is likely to
improve their mood status too. Pacing is one
coping strategy that can help an individual to
manage pain and fatigue effectively. Pacing
involves reviewing the patient’s daily routine
and ensuring periods of rest and activity are
spread evenly throughout the day. Planning
activities over a week, rather than carrying out
too many activities in one day, can help patients
conserve energy and reduce pain, as well as
giving individuals a sense of control over
their situation.
Complete time out activity 4
Patients can find it useful to keep a diary of
their activities, and recording times in the day
when their pain and/or fatigue is heightened.
Such a diary can identify associations
between their activities and their symptoms.
An example of this might be doing three hours
of continuous housework and experiencing
increased pain and fatigue the next day.
This realisation might then lead to patients
modifying their behaviour, for example by
altering their routine so that they do one hour
of housework daily over three days. This in
turn might reduce the likelihood of increased
pain and fatigue the next day.
A group CBT self-management programme
for fatigue in rheumatoid arthritis, which
included goal setting, exploring the associations
between cognitions and behaviour, how to
engage in exercise and implement energy
conservation, demonstrated a reduction in the
BOX 4
Strategies to manage pain
 Using splints for inflamed joints, such as a wrist splint.
 Using hot and cold applications, such as heat or ice packs.
 Taking prescribed analgesia on a regular basis.
 Completing stretching and strengthening exercises.
 Minimising exposure to stress.
 Performing relaxation techniques, such as deep-breathing exercises,
meditation, and tensing and relaxing muscles.
 Pacing activities – balancing exercises with rest.
56 november 26 :: vol 29 no 13 :: 2014
effects of fatigue as well as a beneficial effect
on depression and feelings of helplessness
(Hewlett et al 2011).
Regular maintained exercise, employing
the principles of pacing, can help patients with
rheumatoid arthritis to manage joint stiffness
and pain, fatigue and muscle weakness,
and maintain joint function. Swimming,
walking and cycling are recommended forms
of exercise for maintaining joint health
because they have low impact on the joints.
Other methods of pain management are
shown in Box 4.
Body image and sexuality
Concerns about body image, including worry
about physical changes to the joints such as
swelling and deformity, are heightened in
people with rheumatoid arthritis, and are
associated with a poor quality of life (Jorge
et al 2010). Other factors that can have a
negative effect on body image and sexuality
include self-esteem, physical function,
the degree of early morning stiffness and
low mood (Josefsson and Gard 2010).
Approximately 30% of patients report that
arthritis makes them feel less attractive.
These feelings are associated with high levels
of depression and might lead to patients
using avoiding and concealing behaviours to
reduce noticeability (Monaghan et al 2007).
The hands, feet and knees were the body areas
most frequently reported as causing distress
(McBain et al 2013).
Complete time out activity 5
Patients’ body image should be addressed in
the nursing assessment, so that any negative
thoughts or concerns about body image can be
identified. Patients often report feeling clumsy
or slow in movement because of perceptions
of heaviness in their limbs, or they find that
fatigue affects their speed of movement.
The nurse can demonstrate exercises to help
with stiffness and to improve joint movement.
The patient may often feel that being able to
do something beneficial means taking some
control of the condition, which can improve
self-esteem. Patients with rheumatoid arthritis
who have persistent negative body perceptions
may benefit from referral to a psychologist.
If inflammatory changes are occurring in the
hands, the nurse may also refer the patient to
the occupational therapist for advice on hand
exercises and for splinting. Providing advice
on choosing suitable supportive footwear
© NURSING STANDARD / RCN PUBLISHING
may avoid the need for bespoke surgical shoes
that reinforce the sense of altered body image
in some patients. A surgical opinion may be
required if there are structural changes in
the hands and feet; surgical treatment may
be required to relieve symptoms of pain or to
correct deformity.
The presence of joint pain and stiffness,
fatigue and concerns about body image may
all have a negative effect on sexuality. Female
patients with rheumatoid arthritis report
that their reduced range of movement and
muscle strength makes it difficult to find a
comfortable position during sexual intercourse
(Josefsson and Gard 2010). The nurse should
discuss with patients whether their condition
is affecting their sexuality and may propose
self-management techniques such as planning
when sexual intercourse will occur, pacing
activities to conserve energy, having a hot bath
to relax the joints, taking analgesia or using a
pillow to support painful joints.
Self-efficacy
Symptoms of rheumatoid arthritis can be
influenced by psychosocial factors such as
self-efficacy: the belief in one’s ability to carry
out a specific behaviour with a desired outcome
(Bandura 1977). For example, whether an
individual engages in a specific behaviour such
as exercise to reduce joint stiffness, will be
influenced by the individual’s conviction that he
or she has the ability to carry out the exercises.
It also depends on the value placed on the
intended outcome, in this case, a reduction in
joint stiffness. When advocating behavioural
change, it is useful to ask patients questions
such as: ‘how confident are you at carrying out
the exercises we have just discussed on a score
of 1 to 10?’ If the patient responds with a score
of less than 7, it is unlikely he or she will carry
out the exercises. The nurse should then explore
what action is necessary to increase the score to
more than 7, or whether another intervention
would be more beneficial.
Self-management programmes with an
emphasis on learning behavioural skills,
such as exercise, relaxation, joint protection
and pacing activities, have been shown to
increase self-efficacy (Barlow et al 2009).
A Cochrane review of 31 patient education
programmes concluded that programmes
that offered only information and counselling
had no additional benefits over usual care
(Riemsma et al 2003). However, programmes
that included behavioural skills had a
© NURSING STANDARD / RCN PUBLISHING
significant but short-term benefit (less than
12 months) on physical function and
psychological status in patients with
rheumatoid arthritis, providing an additional
benefit to routine care (Riemsma et al 2003).
Effects on partners
A diagnosis of a long-term condition such as
rheumatoid arthritis has the potential to
affect not only individuals with the condition
but also partners, resulting in emotions
such as anger, guilt, helplessness, feelings
of loss, and worry and fear of the future
(Matheson et al 2010). Participants in one
study described the frustration of seeing
partners in pain and being unable to help as
well as having to forego enjoyable activities
(Matheson et al 2010). Another study
identified significant financial, physical
and psychological strain on spouses (Jacobi
et al 2003). Partners employed coping
strategies such as maintaining a positive
outlook and planning short recreational
activities (Mann and Dieppe 2006).
Many couples developed a sense of shared
ownership of the illness over time (Mann
and Dieppe 2006). Most partners wished to
be involved in every aspect of care and to be
recognised by healthcare professionals as an
essential source of support for the patient.
They also identified the need for partner
support groups (Matheson et al 2010).
Effects on work
Patients often express concerns at the time of
their diagnosis about their ability to work.
The unpredictability of their symptoms can
make it difficult to remain in occupations that
have a fixed starting time. Joint stiffness can
be heightened in the morning, and patients
might find they have to get up two or three
hours before starting work to enable their
joint stiffness to ease. Occupations and
employers that endorse flexitime can make
it easier for an individual to manage their
symptoms. Part-time work, if available and
financially viable, can provide the patient
with the opportunity for rest periods
throughout the week.
It can be challenging for people with
rheumatoid arthritis to remain in physically
demanding work, such as that involving
manual labour, where there is daily stress
and repetitive strain on joints and muscles.
Patients with continual pain, fatigue,
november 26 :: vol 29 no 13 :: 2014 57
CPD rheumatology nursing
functional disability or high levels of disease
activity often have to leave the workforce
(McWilliams et al 2013). Factors that
would increase the likelihood of remaining
in employment, as identified by patients
with rheumatoid arthritis, were increased
flexibility from their employer and urgent
access to the rheumatology team when
their condition became active (National
Rheumatoid Arthritis Society 2007).
If a patient is experiencing difficulties in his
or her current employment, then the nurse
can refer to the local vocational rehabilitation
officer, so that the patient can access
information about possible modifications to
work environments or about training schemes
leading to alternative employment.
Complete time out activity 6
Social support
6 List the effects
rheumatoid arthritis
might have on the family
and consider how the
family can support
the person with
the condition.
7 Now that you have
completed the article,
you might like to write
a reflective account.
Guidelines to help you
are on page 62.
Social support is a major factor of wellbeing
with many functions (Box 5). A diagnosis of
rheumatoid arthritis can be a strain on the
whole family. Roles within the family unit
many have to change and not every family
member may be receptive to enforced changes.
For example, a mother with rheumatoid
arthritis may find it difficult to join in
physical activities with her children because
of physical discomfort in her joints. The nurse
can encourage the patient to discuss how to
manage the condition with family members
so that they feel included in all decisions and
BOX 5
Functions of social support
 Emotional support.
 Encouraging communication of feelings.
 Expressing positive effect.
 Physical assistance with everyday tasks.
 Providing information and advice.
 Providing material aid.
 Recreational activity and social commitments.
 Sexual wellbeing.
 Validating beliefs, emotions and actions.
BOX 6
Support organisations for patients
 National Rheumatoid Arthritis Society (www.nras.org.uk)
Has information for patients and healthcare professionals on all aspects
of rheumatoid arthritis and a telephone helpline.
 Arthritis Research UK (www.arthritisresearchuk.org)
Produces patient information leaflets on rheumatoid arthritis.
 Arthritis Care (www.arthritiscare.org.uk)
Has a range of information on coping with the effects of rheumatoid
arthritis. There is also a telephone helpline for patients.
58 november 26 :: vol 29 no 13 :: 2014
role changes can be negotiated and agreed
within the family unit. For example, instead
of engaging in physical activities with her
children, the mother could spend time with
her children, taking them to the cinema or
going out for a meal.
Problems are likely to occur when the
person with rheumatoid arthritis feels guilty
that the condition is causing changes in the
family, and stops communicating or sharing
the management of the condition with the
family. It can be rewarding to involve the
family in many aspects of management,
such as swimming to help maintain joint
mobility and reduce joint stiffness, as well
as creating a fun occasion for the family.
Explaining that having periods of rest
balanced with periods of activity will help
to reduce pain and fatigue. It should also
help the family to understand that rest
is an important part of coping with the
condition and avoid them perceiving rest
as a negative activity. Being married is
not in itself associated with better health
in rheumatoid arthritis, but being in a
well-adjusted or non-distressed marriage is
linked with less pain and better functioning
(Reese et al 2010).
For some patients, support groups can
remove the potential for isolation as well as
providing information and contacts. The three
main support organisations offering resources
for people with rheumatoid arthritis are
shown in Box 6.
Conclusion
A diagnosis of rheumatoid arthritis may
affect many aspects of psychological
wellbeing including mood, body image
and social function. Physical symptoms of
rheumatoid arthritis such as pain, fatigue
and loss of function can also adversely affect
wellbeing. The nurse can support patients
from the time of diagnosis throughout their
care and management. By helping patients to
manage their pain and fatigue, and optimise
psychosocial functioning, the nurse can
help patients improve their physical and
psychological wellbeing. Recognising
when the patient is anxious or depressed
and referring him or her to the appropriate
service enables the individual to access
appropriate psychological support, as well as
improving his or her response to treatment for
rheumatoid arthritis NS
Complete time out activity 7
© NURSING STANDARD / RCN PUBLISHING
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