Depression in rheumatoid arthritis: aetiology and treatment

Abstract

Previous reviews of psychological factors in arthritis have emphasized the methodological weaknesses of many studies, especially those attempting to measure personality after years of disabling disease. A number of recent studies have used reliable measures, and there is a growing consensus that the prevalence of depression is similar to patients with other medical conditions and that social stress and lack of social support are closely related to depression. The aetiology of such depression includes factors such as recrudescence of arthritis, physical disability, social problems consequent upon such disability and lack of social support. Treatment of the depression involves its recognition, adequate doses of antidepressants and psychological help to overcome marital or family problems and any co-existing phobias. Such treatment may reduce pain, improve functioning and mood, yet be regarded by the patient as ‘improved confidence’. This illustrates the importance of somatization in this population.