As well as several reports relating diseases and mood, mental status has also been reported to affect immuno-regulatory systems. Chronic depression or chronic stress conditions lead to immuno-suppressive status and imbalance in corticotrophin-releasing hormone, which induces cancer and hyperthyroidism. It has been reported that depressive states induce suppression of mitogenic reaction in lymphocytes, decreases the number and activity of natural killer cells and decreases the production of interferon." Sadamoto, Ogawa, Ogura and Saito, 2006) the work of Gray (nd) entitled: "What Feature of Rheumatoid Arthritis are Hard to Cope with Psychologically and What Strategies Might be Helpful in Coping?" identifies the features of RA which are hard to psychologically cope with and explores the relationships between those features and negative psychological outcomes. The following figure shows the percentages of the disease symptoms and how the ability of those with RA are affected in coping. Figure 1

How Severely Individuals with RA are Affected

Source: Gray (nd)

Gray states that: "...regardless of the degree of severity, different patients will be more or less disabled by their disease depending on their expectations and tasks they wish to partake in. Any small change in the hand or wrist could be catastrophic for a pianist for example, but may not bother someone else who does not require the same levels of precision in hand movements." (nd) Therefore, it is critical when considering the psychological coping of the different variations of the severity of RA that one be "clear about difference between restriction, resulting disability and consequent handicap." (Gray, nd) Dickens et al. (2002) conducted a meta-analysis, which shows that in 13%-19%Q of RA depression is existent, which is approximately three times the normal population range. ADL in RA is affected by joint pain (Heiburg and Kvein, 2002) the study of Minnock et al. (2003) conducted a survey of a group of women with RA using the Arthritis Impact Measurement Scales 2 (AIMS2) and state findings that the primary factor associated with a reduction in ADL was pain. Functional impairment is also a result of RA and Heiburg and Kvein state findings that 45% of the participants state that hand and finger functioning was most affected in their ADL while 33% state that walking and bending was...

Crosby (1991) reports that 80% of RA patients report fatigue as the primary affect on their ADL with RA.
BIBLIOGRAPHY

Crosby LJ. Factors which contribute to fatigue associated with rheumatoid arthritis. J Adv Nurs 1991;16:974 -- 81.

Dickens C, McGowan L, Clark-Carter D, Creed F: Depression in Rheumatoid Arthritis: A Systematic Review of the Literature With Meta-Analysis. Psychosomatic Medicine 64:52 -- 60 (2002)

Disability/Condition: Rheumatoid Arthritis and Exercise (2007) NCPAD. Online available at: http://www.ncpad.org/disability/fact_sheet.php?sheet=131&view=all

Gray, H. (nd) What Features of Rheumatoid Arthritis Are Hard to Cope With Psycholgocially and What Strategies Might Be Helpful in Coping. Online available at: http://www.waht.nhs.uk/nsacademy/mdemo/Documents/previous_projects_and_posters/3%20psych%20features%20of%20ra.doc

Hakkinen, a., Sokka, T., & Kotaniemi, a., et al. (1999). Dynamic Strength Training in Patients with Early Rheumatoid Arthritis Increases Muscle Strength but Not Bone Density. The Journal of Rheumatology, 26, 1257-1263.

Heiburg T, Kvein T. Preferences for improved health examined in 1,024 patients with rheumatoid arthritis: Pain has highest priority. Arthritis & Rheumatism 2002 47 (4) 391-397

Minnock P. FitzGerald O. Bresnihan B: Women with established rheumatoid arthritis perceive pain as the predominant impairment of health status. Rheumatology. 42(8):995-1000, 2003.

Nieman, D.C. (2000). Exercise Soothes Arthritis Joint Effects. ACSM's Health and Fitness Journal, 4, 20-27.

Sadamoto, Kiyomi; Ogawa, Takehiko; Ogura, Takehisa; and Saito, Eizo (2006) Impact of Mood on the Course of Disease Activity in Patients with Rheumatoid Arthritis. Asia Pacific Journal of Family Medicine Vol. 5 Issue 3. Online available at: http://www.apfmj.com/afm5_3/afm46.htm#A1

Van den Ende, C.H., Hazes, J.M., le Cessie, S., Mulder, W.J., Belfor, D.G., Breedveld, F.C., and Dijkmans, B.A. (1996). Comparison of High and Low Intensity Training in Well Controlled Rheumatoid Arthritis. Annals of the Rheumatic Diseases, 55(11), 798-805.

What is Rheumatoid Arthritis (nd) University of Virginia Health System. Online available at: http://www.healthsystem.virginia.edu/uvahealth/adult_plassurg/rheuma.cfm