Background Pain and fatigue have been linked to negative mental and physical outcome in Rheumatoid Arthritis (RA), but this link may be mediated by psychological processes.

Objectives To examine whether the link of RA symptoms to well-being is mediated by the process of psychological adjustment, defined as Disease Self-Efficacy (belief in certain abilities), Disease Acceptance (the ability to accommodate disease-generated stressors), and General Self-Discrepancy (the distance between the actual and ideal self-concepts).

Methods Patients:140 random, consenting hospital outpatients with RA. Instruments: (a) Somatic symptoms: Visual Analogue Scales for pain and fatigue; (b) Mental Health: Hospital Anxiety and Depression Scale (HAD); (c) Physical Function: Health Assessment Questionnaire (HAQ); (d) Psychological Adjustment: Arthritis Self-Efficacy Scale (ASES), Acceptance of Illness Scale (AIS), and Self-Discrepancy Scale (SDS). Statistics: correlation, hierarchical multiple regression.

Results Regression strategies to detect mediators indicated that: Disease Acceptance and Self-Efficacy For Other Symptoms mediated the relationship between Fatigue and Depression (beta reducing from 0.28, p < 0.01, to 0.02, n.s.); Self-Efficacy for Other Symptoms also mediated the relationship between Pain and Depression (beta reducing from 0.23, p < 0.05, to 0.11, n.s.); and Self-Efficacy for Pain mediated the relationship between Pain and Physical Function (beta reducing from 0.21, p < 0.05, to 0.08, n.s.).

Conclusion Disease Acceptance and Self-Efficacy as measures of Psychological Adjustment mediate the relationship of somatic symptoms with mental health and physical function in RA. They may be appropriate targets for intervention in patients with RA.