The Mental Side of Arthritis: Challenges & Strategies

The Chicken or the Egg of Arthritis and Mental Health

Researchers at Arthritis Research Canada found that people with inflammatory arthritis are significantly more likely to struggle with depression and anxiety, especially around the time of diagnosis, and in the five years following. They are also more likely to seek care for mental health issues, particularly in the year before and after diagnosis. And, they often do not receive adequate treatment for their mental health.

Researchers specifically found that 41% of individuals with inflammatory arthritis and depression are not receiving the mental health care they need – in the form of medications and/or psychological treatment. For individuals with inflammatory arthritis and anxiety, that number was 47%.

“Despite the substantial risk of depression and anxiety in inflammatory arthritis, there is limited understanding about the diagnosis and treatment for these psychiatric disorders, which is why this research is so important,” said Dr. Alyssa Howren, who is currently a Postdoctoral Fellow at Stanford University and conducted this study while she was a Research Trainee at Arthritis Research Canada.

Altogether, the study found that 6,951 people who have inflammatory arthritis experienced depression, and 3,701 had anxiety. When evaluating the specific types of mental health care, researchers found that 51% of people with inflammatory arthritis received adequate pharmacotherapy in the form of antidepressants for their depression. And 20% received adequate psychological treatment, such as counselling, for depression. The findings were similar for those struggling with anxiety.

Arthritis & Mental Health Connection: Why it Matters

Recognizing that people living with inflammatory arthritis are at a higher risk of depression and anxiety, especially around the time of diagnosis, can allow clinicians to offer timely mental health support and interventions and ultimately improve overall quality of life.

For patients, being aware of this link can encourage them to seek help for mental health concerns and to communicate openly with healthcare providers.

While Arthritis Research Canada’s study found that the use of mental health care was similar to the general population, it is important to note that people living with inflammatory types of arthritis – like rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis – are at risk for other complications when mental health remains untreated. For example, having depression can lead to delayed arthritis remission, as well as increased risk of death and hospitalization.

Mental Health Challenges I Face with Arthritis

Dealing with chronic pain and fatigue has taken a toll on my mental well-being. Some days, the pain and exhaustion feel overwhelming and lead to frustration and a sense of helplessness. 

Managing a chronic disease like rheumatoid arthritis also creates added stress, and juggling medical appointments, medications, and constant uncertainty often leaves me feeling burnt out.

I worry about the progression of my disease and how it might affect my future. I live with guilt when I let someone down because my arthritis gets in the way of plans, or like a burden when I need extra help to complete tasks.

These mental health challenges make managing rheumatoid arthritis even more difficult and affect my motivation, confidence and overall quality of life.

Finding Adequate Mental Health Support Can Be Costly

Unfortunately, mental health support is not accessible for many Canadians living with arthritis. Support was offered at the beginning of my diagnosis through a social worker at a local arthritis clinic. However, the longer I live with arthritis, help seems to be harder and more expensive to obtain.

This is true for the state of mental healthcare in Canada in general. According to 2022 data, “over five million Canadians (18%) aged 15 and older met the diagnostic criteria for a mood, anxiety or substance use disorder.” However, more than 1 in 3 (36.6%) of those individuals reported unmet or partially met health and mental health care needs.”

While my initial rheumatoid arthritis diagnosis threw me into a very dark place, addressing my mental health helped. The reality is that rheumatoid arthritis is still a chronic illness, and the long journey remains challenging. Loss, grief, anger, stress, and frustration are continuous emotions I experience because my disease is progressive, impacting my life continuously and not just at one point in time. 

As the research study discussed above stresses, it is essential to make mental health services more accessible in Canada.

“Expansion of publicly funded health care systems to include services from mental health professionals, such as psychologists and licensed counsellors, is ideal, yet remains an arduous task,” Howren said. “We need to consider ways to increase the accessibility of mental health treatments for rheumatology patients in particular.”

She listed examples, such as supported self-management, peer support groups, and inflammatory arthritis-specific programs, like a self-guided, online cognitive behavioural therapy intervention for rheumatoid arthritis, which has been demonstrated to reduce depression and anxiety symptoms after three months.

Tips for Managing Mental Health with Arthritis

Over the years, I have learned that it’s important to address both the physical and emotional aspects of rheumatoid arthritis. Here are some resources and tools that work for me:

Education and Awareness:

• Understand Your Mental Health: Understanding anxiety and depression can help you manage them better and identify triggers, much like living with an autoimmune disease.
• Stay Informed: Keep up with new research and treatments for arthritis, anxiety and depression.

Support, Therapy and Counselling:

• Consult a Mental Health Professional: Psychiatrists, psychologists, social workers, and counsellors can provide specialized care.
• Access Community Resources: Local mental health centers and organizations offer support and resources, including some online.
• Cognitive Behavioural Therapy (CBT): Helps identify and change negative thought patterns and behaviours. I find this therapy to be quite beneficial when I feel my emotions spiralling down. 
• Acceptance and Commitment Therapy (ACT): Encourages acceptance of emotions and focuses on living a values-driven life.
• Talk Therapy: Provides a safe space to discuss feelings and develop coping strategies.
• Join Support Groups: Sharing experiences with others who understand can be comforting and validating. As an arthritis support group host, I understand how beneficial support groups can be for everyone involved. 
• Connect with Loved Ones: Spending time with family and friends can provide emotional support.

Stress Management:

• Time Management: Organize your time to reduce stress and increase productivity.
• Limit Stressors: Identifying and minimizing sources of stress can benefit mental health and arthritis management.
• Set Realistic Goals: Break tasks into manageable steps to avoid feeling overwhelmed.

Lifestyle:

• Regular Exercise: Physical activity can reduce arthritis pain and stiffness, improve joint function, boost overall mood and lower anxiety.
• Healthy Nutrition: Eating a balanced diet rich in anti-inflammatory foods can help manage arthritis symptoms and positively impact mental health.
• Adequate Sleep: Ensuring sufficient, restful sleep is crucial for both mental health and arthritis symptoms. When I don’t sleep well, I don’t feel well. 

Mindfulness and Relaxation Techniques:

• Mindfulness Meditation: Reduces stress and improves pain management in arthritis patients by promoting relaxation and a positive mindset.
• Deep Breathing Exercises and Progressive Muscle Relaxation: Alleviate anxiety and arthritis-related pain by reducing muscle tension and promoting relaxation.
• Journaling: Write down thoughts and feelings to process emotions.
• Creative Outlets: Engage in art, music, or other creative activities to express yourself.
• Engage in Hobbies: Participate in activities that bring you joy and a sense of accomplishment.
• Practice Self-Compassion: Be kind to yourself and acknowledge your efforts.

I was diagnosed with arthritis at age 29. However, it can strike at any time. Over six million Canadians currently live with different types of arthritis and are at a higher risk of experiencing anxiety and depression. I continue to weather the ups and downs of this life-long chronic disease, and it’s not easy. But help is available.

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