Arthritis and Mental Health: The Often Overlooked Connection

Arthritis is a painful condition that causes swelling, stiffness and discomfort in and around the joints. Millions of people in the UK are affected by arthritis or similar conditions. In addition to causing pain and discomfort, having arthritis can take a toll on a person mentally and emotionally. 

The connection between physical pain and mental health is often overlooked but should not be minimised, and studies have shown a significant intersection between the two. Looking after our physical health can improve our mental wellbeing. Additionally, people who suffer from poor mental health are thought to be at a greater risk of developing a chronic physical condition. 

As it is a chronic, long-term condition (meaning there is no cure for arthritis at present), it is important that people who suffer from arthritis find ways to manage and cope with pain to reduce the impact it has on their lives and their health, both mental and physical.

About Arthritis

Arthritis is a common condition that affects up to 10 million people in the UK. It can cause pain, discomfort and mobility issues.

There are two main types of arthritis:

• Osteoarthritis
• Rheumatoid arthritis

Osteoarthritis is the most common type of arthritis. It most commonly affects older people (middle-aged or above) and women are more often affected than men. Those with a family history of arthritis are also more at risk of developing the condition. 

In its early stages, osteoarthritis affects the smooth cartilage lining of the joint. This can restrict movement and cause pain and swelling.

As it progresses, the tendon and ligaments are forced to work harder due to thinning cartilage. This can cause increased swelling and tiny bony spurs called osteophytes start to form. 

When a significant amount of cartilage is worn down, the lack of material between the bones causes friction as bones rub against one another where they meet at the joint. This can cause them to become misshapen and bones may move out of their usual position.

Joints most commonly affected by arthritis include:

• Hands
• Knees
• Ankles
• Spine
• Hips

Although it is more often associated with the older generation, people of any age can develop arthritis. Younger people sometimes develop the condition as the result of an injury to their joint.

Rheumatoid arthritis is a less common condition than osteoarthritis although it still affects around 400,00 people in the UK. Women and smokers are more likely to be affected. It is a long-term, chronic auto-immune condition. An auto-immune condition happens when the immune system malfunctions and begins to attack the body’s own cells, tissues or organs in error. 

If you have rheumatoid arthritis, your body will start to attack the cells that line the joints. This can make them become swollen and painful. It results in damage to the joints, cartilage and bone over time. 

Arthritis sufferers are likely to experience unpleasant physical problems that may come and go. The unpredictability of symptoms may add to the emotional impact that having arthritis may inflict on our mental health or wellbeing. 

Mental Health and Arthritis

Arthritic conditions can cause people to experience pain, discomfort and restricted movement. The physical symptoms of arthritis are obvious and widely reported; however, it is also important to acknowledge the often overlooked connection between arthritis and mental health. 

People with arthritis can experience symptoms of mental health problems at a higher rate than the general population for a range of reasons, such as:

• Low mood, sadness and depression due to constantly feeling uncomfortable or in pain
• Experiencing isolation due to difficulty getting out and about (this may be especially problematic in older people, rural populations or marginalised societies)
• Lack of understanding from others
• Possibility of developing feelings of social anxiety or generalised anxiety due to periods of being housebound
• Time off work and economic activity that can lead to stress, worry and financial pressure
• Some studies suggest that poor mental health can actively lower pain thresholds

Additional risk factors that may make it more likely for an arthritis sufferer to develop mental health problems include:

• Age factors, for example the older generation may be less open to speak about mental health or to admit that they are struggling
• Age, location and socio-economic factors that increase social isolation and decrease access to appropriate resources
• Poverty or housing issues
• People experiencing unpleasant side effects from medication
• Patients who have feelings of worry or overwhelm due to waiting for medical appointments, test results and trying to find the right treatment
• People who struggle to deal with stress or adapt to change
• A lack of available resources to understand the connection between arthritic pain and mental health
• Side effects from medication

The Link Between Pain and Mental Health

We know that osteoarthritis and rheumatoid arthritis are conditions that can cause significant pain to people. Some other common issues that are known to cause regular bouts of pain in the bones, joints or muscles include:

• Juvenile arthritis
• Gout
• Fibromyalgia
• Ankylosing spondylitis

Studies have shown that there is a link between mental health and physical pain. Mental health problems can make people perceive their pain to be worse and suffering from chronic pain can also exacerbate mental health problems. 

Painful, long-term conditions like arthritis can put an emotional strain on people and their families. Learning to self-manage pain and take advantage of any resources that are available to you (including medicine, therapy or other management techniques) can help people to improve their quality of life.  

Depression and Anxiety in Arthritis

It is understandable that having a painful, recurring and sometimes debilitating condition such as arthritis can make people feel emotionally vulnerable. They may feel down, upset, irritable or angry at times. These feelings may be a reaction to the pain itself, a sense of unfairness – ‘why is this happing to me’ – or because they are forced to limit activities or cancel plans due to pain and swelling. These are normal and completely valid feelings to have; however, there is also a link between arthritis and diagnosable mental health conditions, such as depression and anxiety. 

Very recent statistics suggest that at least one in six people are experiencing a ‘common mental health condition’ such as depression or anxiety. Symptoms of depression or anxiety go beyond normal feelings of being sad, low or annoyed, and need addressing by a healthcare professional. If you are experiencing issues with your mental health, you should make an appointment to speak to your GP and if you feel able to, also reach out to your immediate support network. 

People can experience depression that ranges from mild to severe. Depression is more than just being in a bad mood or having a bad day. Not everyone experiences depression in the same way, but it can typically be described as:

• A persistent low mood or sense of unhappiness
• Feelings of being down, sad and hopeless
• Losing interest in things or activities you once enjoyed

Severe depression can make people want to harm themselves or feel suicidal.

Sometimes, depression can also show physical symptoms which include tiredness, aches and pains, nausea or lack of appetite.

In addition to depression, sometimes people with arthritis suffer from anxiety. Depression and anxiety are the most common mental health problems that people in the general population (as well as those with arthritis) suffer from; however, they are very different conditions. If depression can be viewed as a loss of interest in general life, anxiety is more like a hyper-awareness of everything. A clinician may diagnose a person who is exhibiting symptoms of anxiety as having generalised anxiety disorder (GAD).

Symptoms include:

• A constant feeling or dread that something is going to go wrong
• Feeling stressed, panicked or on edge
• Restlessness and difficulty concentrating
• Irritability

Anxiety can also produce physical symptoms including sweating, increased heart rate/palpitations, trembling, dizziness, nausea and shallow breathing.

Sleep plays a key role in our health. Tiredness can have a significant effect on our mental and physical wellbeing. Being in pain can also affect the quality of sleep you are able to get, including struggling to get to sleep and having problems staying asleep. Arthritis pain can disrupt our sleep routine, worsening our mood and making us feel low, down or emotional because we are overtired. 

Loneliness and isolation can also have an effect on us emotionally. People can have arthritis at any age, though arthritis will often affect older people. It is known that the older generation already suffers disproportionately from loneliness. As bouts of arthritis can make it hard to move around or get out of the house, it is not surprising that this isolation can add additional feelings of loneliness, low mood or boredom which can also have an impact on mental health. 

A wide range of different methods and treatment options are available to manage both chronic pain and any mental health problems that are linked to it. This includes medical interventions, therapy and self-help strategies. Many people find a combination approach works well for them.

Coping Strategies

When we are struggling mentally or physically it is crucial that we find coping strategies that make us feel better. 

It is important to find ways to manage the symptoms of your arthritis, including pain and discomfort. Treatments for arthritic conditions include:

• Over the counter medicine including painkillers
• Prescribed medicine such as opioid painkillers, corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs)
• Diet and lifestyle changes
• Physiotherapy
• Surgery

Some arthritis sufferers also turn to psychotherapy or alternative therapies to complement their treatment, such as:

• Meditation or mindfulness
• Yoga
• Aromatherapy
• Massage
• Hydrotherapy

If arthritis is affecting your mental health, it is vital that you get support with your emotional and mental struggles as well as treatment for the physical symptoms of the condition. You can do this by making an initial appointment with your GP to talk through your treatment options. Depending on your circumstances, you may opt for NHS treatment or go down a private healthcare route. 

Treatment options to help with mental health issues include:

• Talking therapies such as cognitive behavioural therapy (CBT)
• Medication such as antidepressants
• Alternative therapies (including mindfulness, meditation and aromatherapy)

There is a growing amount of evidence that cognitive behaviour therapy (CBT) in particular can help with chronic pain. CBT is a goal orientated form of talking therapy that aims to identify negative thought patterns and reframe our thoughts to help us to become more empowered. A structured course of CBT can help patients develop long-term resilience, which is useful if you have a chronic condition. 

CBT techniques can help people to re-evaluate their attitudes to pain and take back some control over their: 

• Thoughts
• Feelings
• Attitudes
• Behaviours

Cognitive behavioural therapy has also been shown to be a helpful tool to help people deal with mental health problems, such as depression and anxiety. Additionally, CBT can be delivered in person or online which may be helpful to people with mobility constraints. 

In addition to using medication, therapy or alternative medicine, our lifestyle can play a vital role in looking after both our bodies and minds. We can all make small changes to our lifestyles that will help to boost our mental wellbeing, as well as improve our physical health, such as:

• Maintaining a healthy weight / losing weight if needed
• Getting enough high-quality sleep
• Staying hydrated
• Eating a healthy balanced diet (including fruits, vegetables, healthy fats and lean proteins)
• Making sure to exercise regularly

When you are living with a physical or mental condition it is likely that you will have good days and bad days. Try to be kind to yourself and find a combination of treatments that work for you. Outcomes are usually better for people who have built a strong support network of family, friends and clinicians around them. 

The link between arthritis pain and an increased risk of poor mental health is real, therefore it is important to acknowledge your feelings. Never feel that you have to suffer in silence as a variety of help for both your mental and physical struggles is available.