Can psychological treatment and patient education help in rheumatoid arthritis?

Patient education programs, psychological treatment and cognitive behavioral therapy may help people with rheumatoid arthritis cope in everyday life. Different measures are often combined, such as relaxation techniques, stress management and strategies to avoid using up your energy levels and to optimize planning in daily life.

Rheumatoid arthritis can cause some joints to be inflamed for longer periods of time. This leads to pain, swelling, joint stiffness and a lack of energy. The small joints in the hands, fingers and feet are often affected first. But the bigger joints, such as the joints in the knees, hips and shoulders, can become inflamed too.

The inflammations often lead to overall physical weakness. This can make people feel generally unwell, which may be accompanied by tiredness, exhaustion and loss of appetite. Rheumatoid arthritis can make activities of daily life more difficult, and limit what you can do in many areas of your life. That can affect you emotionally, resulting in anxiety and depressive moods. Some people feel increasingly helpless – they are often unable to do daily household chores or participate in social activities because of their symptoms.

Coping strategies

There are a number of different psychological and psychotherapeutic approaches designed to help people with chronic illnesses like rheumatoid arthritis deal with pain and other symptoms. The main approaches include the following:

Relaxation techniques like progressive muscle relaxation or autogenic training
Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps people to recognize patterns of thought and behavior that can make it more difficult for them to deal with their condition, and then to change them. CBT is also about offering practical support: For example, someone may practice saving up their energy and setting goals that they are able to reach despite having rheumatoid arthritis. Behavioral therapy treatments are often combined with other approaches, such as relaxation techniques. Patient education programs also often offer various approaches.

Research on psychological support for rheumatoid arthritis

Researchers at the University of Leiden in the Netherlands looked for studies on the benefits of the interventions described above. They analyzed the results of a total of 27 studies involving 1,600 people with rheumatoid arthritis.

Overall, the studies show that the interventions relieved the pain somewhat and that the participants became more physically active. They also had slightly fewer depressive symptoms. These positive effects even lasted for several months after. Work done by another group of researchers suggests that the treatments also effectively reduce exhaustion.

It seems that "self-regulating" methods were especially helpful in reducing depressive moods. These are strategies that teach people to act on their own to deal with the symptoms and feelings their condition brings about. That may include setting personal goals, pursuing them, and then tracking your success.

Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EH, Chalder T et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 2013; (8): CD008322.

Knittle K, Maes S, de Gucht V. Psychological interventions for rheumatoid arthritis: examining the role of self-regulation with a systematic review and meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 2010; 62(10): 1460-1472.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”