Rheumatic conditions are different from other diseases. While many diseases can be cured, rheumatic diseases require an ongoing process of adaptation to maximize each patient's ability to function and well being over a long period of time.

The chronic pain, recurring flare-ups and disabling effects on joints and the ability to cope with the demands of daily living can take an emotional toll, as well as a physical one. This toll may take the form of depression or emotional distress, stress or impact on relationships with family and friends. It may involve changes to career plans, roles and relationships with other people. Therapists or behavior psychologists may be able to help you put things in perspective. They can also help you develop coping skills, including relaxation techniques.

More than 30 years of research has shown that a patient's beliefs about illness, ability to cope with the challenges of rheumatic disease, confidence in coping abilities and support system all have an impact on health. The good news is that attitudes, coping skills and confidence can be learned to enhance physical and emotional health. The ability to cope with pain and attitude about coping ability are influenced by:

• Level of independence and reliance on others
• Resourcefulness in solving challenges
• Knowledge of the specific condition
• Coping skills
• How family, friends or support groups respond to difficulties

Ongoing pain that gets worse from time to time is a primary source of emotional distress for persons with rheumatic diseases. One study based on data from the National Institutes of Health found that over the span of their lifetimes, more than 60 percent of those with arthritis became depressed or developed a psychological or emotional disorder. This rate is higher than that found in person with cancer, diabetes or stroke.

The more pain a person has, the more likely he or she is of having depression. For many people a feeling of being powerless to do anything about the pain - or feeling that the pain will never end - makes depression or mood disturbance even more likely.

Despite the challenges that a rheumatic disease presents, much can be done to improve physical and emotional health, such as to:

• Become a partner with the doctor in managing the condition. Be sure to communicate with him or her.
• Develop a more positive attitude towards the disease and symptoms and the challenges they create
• Learn about the disease and ways of managing it
• Learn about treatment and management approaches, such as drugs or complementary medical approaches
• Manage life through good nutrition, proper exercise, getting enough rest, etc. to maintain the best health possible
• Enhance problem-solving and coping skills
• Develop role models and support group contacts to share coping strategies with
• Set goals and get feedback from others about progress and successes

A number of approaches can be used to manage the depression or emotional distress associated with chronic pain or a rheumatic condition. These include:

• Reducing stress related to the disease or its treatment or to environmental demands
• Managing your lifestyle to avoid stress, fatigue or activities that strain the joints or increase pain
• Managing your thought processes to reduce negative thinking and to give you better control. Called cognitive behavioral therapy, it also includes using imagery or distraction to create a more positive and powerful attitude toward your condition and your ability to manage it.
• Scheduling pleasant events to put you in a better mood, reward positive behaviors and reduce depression
• Learning problem-solving skills
• Applying self-management skills to help you stick with your treatment program and do those things that help keep your condition under the best possible control
• Using your condition as an opportunity for personal or spiritual growth

Some research studies are showing that during times of stress, hormones that cause the immune system to react increase. The exact way this happens is still being studied.

Taking steps to manage stress and resolve the problems that occur from having a rheumatic condition are important to optimize health, to manage pain and to increase the sense of control over life. Some important ways to manage stress include:

• Take a structured approach to identifying problems, evaluate strategies for resolving them, develop an action plan and follow up on the effectiveness of the plan
• Set reasonable boundaries on what others demand and expect from you
• Explain stressful life events and difficult symptoms to yourself in a more healthy and positive way. For example, instead of telling yourself, "I'm having a difficult time with these new job responsibilities because I have arthritis," you might think, "I'm having a difficult time with these new job responsibilities because they are new and they require skills I have not had a chance to practice yet. But I'm getting better at them every day."
• Avoid a pessimistic, helpless attitude
• Recognize that you may feel anger or resentment as a result of your disease and coping with it effectively. Do not direct your anger at yourself or others. Recognize the true source of your feelings and seek ways that you do control to make life easier.

Many healthcare professionals believe that whatever allows a person with a rheumatic condition to feel more effective in managing their symptoms or the challenges of living with their condition will eventually lead to improved health. Many studies have shown that the more active you are in managing your condition, being responsible for your health and learning coping skills the better your emotional and physical health will be in the long run. Taking advantage of the knowledge and experience of psychologists, physical therapists and nurse educators will benefit you as well.

Your culture also has an impact. If you grew up in a culture where your identity is based on your role within a group (such as your family), and your condition affects your ability to perform that role well, you may become depressed. People who grow up in cultures that more individualistic may experience less of an impact on their identity and self-esteem, but have more difficulties seeking help when they need it. Becoming involved in a support group that reflects your culture may be extremely helpful.

Studies of the interconnections between the mind and body are continuing. This is an area of medicine that is evolving and continuing to produce new information.