Psychosocial aspects of rheumatic disease: the developing biopsychosocial framework

Recent findings suggest that biologic, psychologic, and social variables interact to determine an individual's response to rheumatic disease. Data indicate that specific coping responses and quality of social support modulate the psychosocial impact of the disease. Additional current developments are 1) an increased emphasis on patients' input regarding health care delivery; 2) the development of alternative methods of information dissemination; 3) identification of nonadherence to treatment regimens as an obstacle to clinical trials and to improving outcome; and 4) a trend toward the use of psychosocial assessment tools with established psychometric properties for rheumatic disease populations. A major challenge is the identification of mechanisms by which psychosocial variables interact with biologic processes.