Early studies dealing with the relations between psychological factors and rheumatic diseases, particularly rheumatoid arthritis, focused on whether there were some maladaptive psychological factors that could influence the onset of the disease. Personality styles like hostility¹ or neurotic behavior² were suggested. However, this line of research was soon abandoned, simply because no consistent conclusions could be made. Instead, questions were raised about the psychological and social consequences of rheumatic diseases. It was also proposed that treatment and rehabilitation should be evaluated from the patients’ point of view, thus according to the effects it had on perceived symptoms, everyday functioning, well-being and social integration. Several instruments were also developed to catch various aspects of the subjective impact of the disease, for example the well-known HAQ.³ Since then the subjective burden of having rheumatic diseases have been extensively studied. Although some studies have found that the patients as a group show small tendencies toward increased emotional distress, it is apparent that the majority of patients do not seem to differ from that of a normal population.⁴ In that respect rheumatic patients also resemble several other patient groups with chronic diseases.⁵ One major finding was also that indicators of severity of disease had surprisingly small relations with psychological health.⁶ Such findings led in turn to an interest for the presence of psychological factors that could “buffer” the emotional impact of the disease among the patients. Constructs that were in special focus were learned helplessness, self-efficacy beliefs, cognitive distortions and coping. The introduction of these constructs have also advanced the understanding of psychological distress among RA patients, although they tend to explain only a smaller part of the variance in distress.⁷ As an alternative, other research has shown that more stable personality styles, particularly what has been labelled neuroticism, are relatively strongly associated with a broad range of subjective experiences and may act as a common factor behind several types of negative experiences, also among patients with rheumatic diseases. Thus, individuals high in negative affectivity seem to be more perceptive of physical sensations, to interpret physical symptoms as more threatening, to experience more of emotional distress regardless of the objective situation, to react more strongly to negative events and to choose and utilise less effective coping strategies.⁸ The suggestions that a stable temperamental trait seem to influence most types of self-reported data have important implications for the clinical practice, since illness status is now commonly assessed by standardised self-rating questionnaires. The extent that stable psychological traits confound such measures is an important issue to resolve. Furthermore, if patient differences in subjective wellbeing largely depend on temperamental dispositions then the efforts to change patients’ coping style, or illness would be expected to have less impact in the long run. Thus, a further important research issue to perform more persistent followup studies of psychological. It may also be crucial to identify in what respects the interventions improve psychological well-being.

References

1. Levitan HL. Patterns of hostility revealed in the fantasies and dreams of women with rheumatoid arthritis. Psychother Psychosom. 1981;35:34–43

2. Gardiner BM. Psychological aspects of rheumatoid arthritis. Psychol Med. 1980;10:159–63

3. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45

4. Hawley DJ, Wolfe F. Depression is not more common in rheumatoid arthritis: A 10-year longitudinal study of 6,153 patiens with rheumatoid disease. J Rheumatol. 1993;20:2025–30

5. Cassileth BR, Lusk EJ, Strouse TB, et al. Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups. N Engl J Med. 1984;311:506–11

6. McFarlane AC, Brooks PM. An analysis of the relationship between psychological morbidity and disease activity in rheumatoid arthritis. J Rheumatol. 1988;15:926–31

7. Persson L-O, Berglund K, Sahlberg D. Psychological factors in chronic rheumatic diseases – A review. Scand J Rheumatol. 1999;28:137–44

8. Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 1994;103:103–16