The Psychological Impact of Psoriatic Arthritis

A series of interviews indicates that psoriatic arthritis patients lack both the information they need to understand their condition and the support they need to weather its unexpectedly severe physical and emotional toll.

British investigators conducted semi-structured interviews with 24 adults who suffer from the condition. Their questions were informed by the Common-Sense Self-Regulation Model (CS-SRM) and their 2-stage analysis of the answers combined the coding of pre-determined CS-SRM components and the identification of additional emergent themes. Constant comparison techniques allowed patterns that spanned multiple CS-SRM components to emerge inductively from the data.

The people who took part in the survey represented a wide range of the psoriatic arthritis patient population. Their ages ranged from 27 years to 71 years, and the time since the onset of their illness ranged from 4 months to 29 years. Still, 4 core themes — each related to a cluster of illness beliefs — emerged: resentment, resignation, perceived restrictions and a problems dealing with others.

“People with psoriatic arthritis experience significant disease-related distress, including suicidal ideation,” the study authors wrote in Rheumatology. “Misperceptions, ineffective coping styles (eg, avoidance/blocking) and negative emotions should be actively identified and addressed with people with psoriatic arthritis.”

Many patients spoke of severe misperceptions they formed after speaking to doctors and reading about the disease after their initial diagnosis. It was common, for example, to believe the disease could be cured or that it would go away on its own.

Patients also spoke of their current beliefs about disease progression, many of which were almost as inaccurate, though often pessimistically inaccurate. They feared exponential degeneration of their condition.

Another common theme was the perceived effect psoriatic arthritis had on relationships with other people. Patients told of their condition being either dismissed or belittled by others. They also reported that the condition made them feel less confident in dealing with others and therefore blamed the disease for failed romantic relationships and dashed career prospects.

Many participants admitted to thoughts of suicide. Others spoke of excessive drinking.

“People in our study were often diagnosed but then left with little or no support for the emotional side of their conditions,” said study co-author Christine Bundy, PhD, who studies Behavioral Medicine and Health Psychology at the University of Manchester.

“The problems that came to light in this study are all treatable. With the right help and information, people can gain more confidence and recover quality of life. The prevalence of suicidal thoughts among this group is not yet known, but where it exists, effective and timely help could make a difference.”

The study authors noted the extensive research that has already been done to develop both immediate and long-term support services for patients with conditions such as diabetes and cancer. They wrote that no comparable research had been done in patients with rheumatic diseases and argued in support of such research.

They also argued that some practices that have been shown to help patients with better-researched diseases should be tried on psoriatic arthritis patients. For example, newly diagnosed patients might automatically receive contact information for psychologists who have some experience with rheumatic diseases and their emotional impact.

Brochures and websites aimed at psoriatic arthritis patients should also be improved, not only to provide information about weathering the serious emotional impact of psoriatic arthritis but also to reduce misconceptions about physical progression of the disease.