The role of psychosocial factor in rhematoid arthritis and ankylosing spondylitis

The article is devoted to the study of the psychosomatic characteristics of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The study has been divided into 3 stages. The purpose of the first stage was to study the leading personality traits and prevailing types of attitude towards the disease in patients with RA and AS. The purpose of the second stage was to study the role of the social factor in RA patients based on the family pattern, to identify the relationship of intra-family problems with the duration and degree of the disease activity, the level of education. The third stage was aimed to demonstrate the effectiveness of biobehavioral therapy for the correction of pain in patients with RA. Material and methods. The contingent study consisted of patients with a reliable diagnosis of rheumatoid RA and AS, stage 1 – 26 patients (20 men, 6 women), stage 2 – 14 patients (11 women, 3 men), stage 3 – 46 women with RA. The patients underwent clinical, laboratory, X-ray examination. Psychological questionnaires and the Health Assessment Questionnaire (HAQ) were used. Results.: Hypochondria, increased anxiety, emotional immaturity, men’s behavioral characteristics in women have been revealed at the first stage of the study. In men with RA, the leading features are hypochondria, emotional immaturity. Types of attitude to the disease in women were: ergopathic 79 %, harmonious 37 %, neurasthenic 32 %; in men: ergopathic 57 %. The significant intercorrelation between the disease duration in women and the ergopathic and harmonious type of attitude toward the disease was found. The second stage of the study allowed the RA group to identify alienation, unwillingness and inability to independently solve family problems. According to the results of the third stage of the study, it was found that the patient’s acquired ability to control the alpha rhythm voluntarily allowed them to control the intensity of the pain syndrome and reduce the need for taking high doses of NSAIDs. A reduction of feelings of helplessness, hopelessness has been achieved. Conclusions. The study revealed psychological and social problems in patients with RA and AS, substantiating an interdisciplinary approach in the management of the patients with the rheumatologist and psychotherapist participation. Modern possibilities of psychotherapy can reduce the pharmacological burden in the treatment process.

1. Dissanayake R.K., Bertouch J.V. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review. Int. J. Rheum. Dis. 2010; 13 (4): 324–334. doi: 10.1111/j.1756-185X.2010.01563.x

2. Lindberg N.E., Lindberg E., Psychotherapy in rheumatoid arthritis – a parallel-process study of psychic state and course of rheumatic disease. Rheumatology. 1996; 55 (1): 28–39.

3. Kremleva O.V. Psychotherapy in the rehabilitation of patients with rheumatoid arthritis (biopsychosocial approach): abstract of thesis … doct. med. sciences. Saint-Petersburg, 2007. [In Russian].

4. Astin J.A., Beckner W., Soeken K., Hochberg M.C., Berman B. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum. 2002; 47 (3): 291–302. doi: 10.1002/art.10416

5. Andrianova I.A., Amirdzhanova V.N., Zhor­nyak A.P., Krichevskaya O.A. Quality of life complex assesment in patients with rheumatoid arthritis (results of the first level of multicentral study of life quality in rheumatoid arthritis). Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2006; 44 (2): 11–17. [In Russian]

6. Grekhov R.A., Suleymanova G.P., Kharchenko S.A., Аdamovich E.I. Psychophsiology basics of application biofeedback. Vestnik Volgogradskogo gosudarstvennogo universiteta. Seriya 11. Estestvennye nauki = Science Journal of Volgograd State University. Natural Sciences. 2015; 3 (13): 87–95. [In Russian]. doi: 10.15688/jvolsu11.2015.3.9

7. Grekhov R.A. Psychosomatic relationships and internal picture of disease in patients with rheumatoid arthritis: abstract of thesis … doct. med. sciences. Volgograd, 2010. [In Russian].

8. Lisitsina T.A., Veltishev D.Yu., Gerasimov A.N., Seravina O.F., Kovalevskaya O.B., Zeltan A.E., Novikov A.A., Alexandrova E.N., Tallerov A.V., Kovalenko A.P., Durnev A.D., Krasnov V.N., Nasonov E.L. Perception of pain in rheumatoid arthritis: relation to inflammation to psychic disorders, functional status and quality of life. Klinicheskaya medicina = Clinical Medicine. 2013; (3): 54–61. [In Russian].

9. Rheumatology: clinical guidelines. Ed. E.L. Naso­nov. 2nd ed. Moscow: GEOTAR-Media, 2010. 708 p. [In Russian].

10. Bradley L.A. Psychosocial factors and disease outcomes in rheumatoid arthritis: old problems, new solutions and future agenda. Arthritis Rheum. 1989; 32: 1611–1614. doi: 10.1002/anr.1780321220

11. Savelieva M.I. Rheumatoid arthritis: psychosomatic relationship and internal picture of disease: abstract of thesis … cand. psychol. sciences. Yaroslavl, 1995. [In Russian].

12. Sinclair V.G. Predictors of pain catastrophi­zing in women with rheumatoid arthritis. Arch. Psychiatr. Nurs. 2001; 15 (6): 279–288. doi: 10.1053/apnu.2001.28686

13. Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. J. Pain Res. 2016; 9: 137–146. doi: 10.2147/JPR.S83653

14. Shabanova N.A., Shubina O.S., Ukolova L.A., Tov N.L. Biobehavioral therapy of rheumatoid arthritis. Byulleten’ sibirskoy meditsiny = Bulletin of Siberian Medicine. 2013; (3): 135–140. [In Russian]. doi: 10.20538/1682-0363-2013-2-135-140

15. Korshunov N.I., Kurygin A.G., Rechkina E.V., Filatova Yu.S., Yaltseva N.V. Rheumatoid arthritis as a psychosomatic disease. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2015; 53 (5): 469–471. doi: dx.doi.org/10.14412/1995-4484-2015469-471

16. Kriganovsky N.S., Balabanova R.M. Rheumatoid arthritis in context of psychological problems. Terapevticheskiy archive =Therapeutic Archive. 2000; (5): 79–82. [In Russian].

17. Shubina O.S., Melnikov M.Ye., Veretelnikov I.A. Investigation of alpha-wave frequency characteristics in the patients with chronic tension headache and its modification during electromyographic-temperature training. Byulleten’ sibirskoy meditsiny = Bulletin of Siberian medicine. 2010; (2): 42–46. [In Russian].

18. Erdes Sh.F., Bochkova A.G., Dubinina T.V., Lapshina S.A., Myasoutova L.I., Rumyantseva O.A., Salikhov I.G. Project of working classification of ankylosing spondilytis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013; 51 (6): 604–608. [In Russian]. doi: 10.14412/1995-4484-2013-604-8

19. Aletaha D., Neogi T., Silman A.J., Funovits J., Felson D.T., Bingham C.O., Birnbaum N.S., Burmester G.R., Bykerk V.P., Cohen M.D., Combe B., Costenbader K.H., Dougados M., Emery P., Ferraccioli G., Hazes J.M.W., Hobbs K., Huizinga T.W.J., Kavanaugh A., Kay J., Kvien T.K., Laing T., Mease P., Ménard H.A., Moreland L.W., Naden R.L., Pincus T., Smolen J.S., Stanislawska-Biernat E., Symmons D., Tak P.P., Upchurch K.S., Vencovský J., Wolfe F., Hawker G. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann. Rheum. Dis. 2010; 69: 1580–1588. doi: 10.1002/art.27584

20. Eidemiller E.G., Justitskis V. Psychology and psychotherapy of family. Saint-Petersburg: Piter, 2009. 672 p.

21. Olyunin Yu.A. Evaluation of the activity and effectiveness of the treatment of rheumatoid arthritis. In: International indices for assessing the activity, functional status and quality of life of patients with rheumatic diseases. Moscow: Publishing group of Association of Russian rheumatologists, 2007; 3–12. [In Russian].

22. Raigorodskiy D.Ya. Practical Psychodiagnostic. Moscow: Bakhrakh-M, 2011. 664 р.