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Rheumatoid Arthritis: Keeping a Positive Outlook

Realistic optimism fuels the body's immune system and triggers natural painkillers.

How Depression Makes Arthritis Pain Worse

People who are depressed are more sensitive to pain, Raison says. Existing pain can become more intense -- and new aches and pains can develop.

"There's a lot that's come to light on this in the past few years," he tells WebMD. "People who are medically healthy can experience moderate to severe pain when they are depressed. People with depression can actually feel pain that is comparable to people who have active rheumatoid arthritis."

That's because depression puts other brain chemicals out of whack -- those that affect how the body functions, Raison explains. Both the emotional and physical symptoms of depression involve nerve pathways into the brain and spinal cord. Two brain chemicals involved in regulating mood -- serotonin and norepinephrine -- also keep the body running smoothly. They help regulate our sleep, our sex drive, and they help keep aches and pains from dominating our attention.

If those brain chemicals are out of whack, so is the body. We get more headaches, back and muscle pains, joint pain, and digestive problems. We feel exhausted and don't sleep well.

"If you're depressed, you really need to see a doctor," says Raison. "If you need an antidepressant, you need to stay on it long enough that it starts working. The vast majority of people don't take it long enough to get a benefit. They often quit taking it after the first month." Many people don't realize that it may take up to eight weeks before they feel the full effects, says Raison.

Getting treated for depression truly can help relieve pain, Raison tells WebMD. "If we can treat people for depression, their pain will get better," he says.

Make Optimism a Goal When You Have Rheumatoid Arthritis

Good coping skills are an important part of this picture, Raison says. "You can get a good mental 'loop' going. Start by doing everything possible to keep your physical body in the best physical functioning possible. Treat your pain aggressively and early on. If you don't have pain, you are less likely to be anxious and depressed."

With rheumatoid arthritis, the unpredictability of the disease is the biggest problem, says psychiatrist Nadine Kaslow, PhD, a professor of psychiatry and behavioral sciences at Emory University and chief psychologist at the Grady Health System, both in Atlanta.

"It's important to figure out what you can control -- in other areas of your life and in your illness," Kaslow tells WebMD. "We know that the more people take control of treatment and activity level, the better they can cope."

Tips for Staying Positive When You Have Rheumatoid Arthritis

Kaslow and Raison offer these tips for staying positive when you have rheumatoid arthritis:

Get adequate sleep. "The sleep-deprived person has more pain," says Raison.

  • Exercise as much as you can. "There is much research showing that exercise is great for improving mood, decreasing anxiety, treating depression," Raison tells WebMD. "Regular ongoing exercise produces long-term changes in the nervous system that promote well-being." Exercise is also a great treatment for rheumatoid arthritis. It helps relieve pain and prevent disability.

  • Practice mind-body exercises. Yoga and meditation are excellent for this, says Raison, "but these are best done under guidance of an expert."

  • Nurture supportive relationships. "Research shows that material possessions and status don't make people happy," says Raison. "It's clear that happiness comes from nurturing relationships that are supportive and that have as little conflict as possible. Our bonds are a very powerful source. They are essential for health and for working out internal conflicts."

  • Get counseling if you need it. "Or find a truly wise confidante," suggests Raison. "People who have one person they can talk to are known to live longer. It doesn't have to be a health care professional. But if you can talk to someone about your emotional baggage, it can help your physical pain, too."

  • Put the disease into perspective. "Don't let it run your life," says Kaslow. "When you need to focus on it, focus on it. But find ways to quit focusing on it."

  • Do things that you enjoy. "It's absolutely important to take inventory of those people and activities that bring pleasure, and build those into your life," says Raison. "If you love foreign movies, make an effort to see a foreign movie once a week. Look for those things that give you relaxation and satisfaction, and nurture them. They are beneficial for developing an optimistic, realistic, hopeful attitude."

  • Learn to relax. "Relaxation training is a process that involves deep breathing and systematically tensing and releasing different muscle groups," Kaslow explains. "Once you're relaxed, create a very positive mental image. You're laying on the beach, with the sand under you, the ocean air flowing over you. Or place yourself in the mountains, or in a gathering with friends -- anything that is peaceful, calming. Stay in that very comforting place for awhile."

  • Learn more about the disease. Join a support group. Read information from reliable sources. "Learn as much as you can about what you've got," says Kaslow. "That alone will help you feel more in control, better able to make decisions."

  • Talk to your doctor. "Good communication with your health care team is important," says Kaslow. "When you have flare-ups, you'll know what to do. It's called collaborative family health care. You and the members of your social support network work with your medical team to help you maintain your positive mental outlook."

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Reviewed on March 24, 2008

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