Study: Cognitive Behavioral Therapy Helps Rheumatoid Arthritis Patients

Cognitive behavioral therapy (CBT) not only helps rheumatoid arthritis patients deal with their anxiety, but also appears to increase their ability to function, according to a study reported in the March issue of the journal Rheumatology.

The study involved 53 patients who had recently developed rheumatoid arthritis. Although all participants received standard care for their rheumatoid arthritis, half of them were randomly chosen to receive eight weeks of CBT.

Study author Louise Sharpe, a clinical psychologist and senior lecturer in the school of psychology at the University of Sydney in Australia, told Medical Week that CBT was successful in signficantly reducing depression, anxiety and disability and improving joint function in the treated group compared to the group that received standard care alone.

Sharpe said CBT is based on the assumption that the meaning that patients attribute to an illness, such as their fears and concerns about their future, affect the way that they cope with the illness.

"Their coping strategies then influence the symptoms of illness," said Sharpe, who noted that people who believe that rheumatoid arthritis will put them in a wheelchair are more likely to rest excessively and reduce their activity levels, which can lead to increased stiffness, muscle weakness and, ultimately, increased disability over time.

Patients who are not very concerned about their rheumatoid arthritis might cope in the opposite way and continue with activity even when joints are acutely inflamed. "This pattern can further promote physical damage and as a result increased disabiliity," she added. .

"CBT aims to foster helpful attitudes to illness through cognitive restructuring and to challenge erroneous beliefs about the illness," said Sharpe. "Hence, the aim is to facilitate patients to have a realistic, but optimistic approach."

Sharpe said the program also teaches people ways of managing activity so that they can achieve an optimal balance between rest and exercise. Stress management type strategies are also included, she added.

"As a result of CBT, patients are likely to change their behaviors that in turn improves their physical as well as psychological functioning," Sharpe said.

Sharpe said it is rare for rheumatoid arthritis patients to be referred for cognitive behavioral treatment, although patients in the United Kingdom where the study was conducted do get referred occasionally.

"We treated a consecutive group of patients and found the intervention to prevent deterioration in disability and depression," Sharpe. "Patients should be referred as early as possible to diagnosis and certainly within the first two years, which are crucial to the long-term outcome in patients with rheumatoid arthritis."

Sharpe added that patients should be referred to someone such as a clinical psychologist with expertise in this type of therapy and ideally with rheumatoid arthritis patients.

Other sources: Rheumatology 2003; 42: 435-441