Psychiatric disorder and illness behaviour in rheumatoid arthritis

A detailed physical and psychiatric assessment of 80 patients with definite or classical rheumatoid arthritis was performed using diagnostic criteria for psychiatric disorder appropriate for those with physical illness. Seventeen (21%) patients had depression or anxiety severe enough to warrant treatment. The presence of pychiatric disorders was not related to the duration of the arthritis nor to 11 other indicators of its severity with the exception of grip strength (p less than 0.002) and Fries Functional grade (p less than 0.005). It was significantly related to the presence of social stress (p less than 0.05) and lack of social support (p less than 0.005). Those with psychiatric symptoms scored higher on an illness behaviour scale, indicating that they perceived their illness as very severe. These also worried excessively about it and failed to be reassured by the doctor. Such illness behaviour was displayed by some patients who had severe arthritis but lacked social support. In others the complaints were unfounded because their arthritis was mild. They also experienced much social stress and lacked social support. We conclude that psychiatric illness occurs in rheumatoid arthritis with similar frequency to that of other general medical patients. It is principally related to social stress and lack of support rather than severity of arthritis, and may lead to abnormal illness behaviour. Since lack of social support appears of prime importance in determining disability, its assessment is essential for the rehabilitation of the disabled patient with RA.