Rheumatoid Arthritis Linked to Neuropsychiatric Symptoms

Suspected neuropsychiatric symptoms should be evaluated using a thorough clinical history and physical examination, as well as secondary radiological, electrophysiological, and laboratory studies when necessary, Dr. Joaquim advised, noting that neuroimaging studies may someday also prove a useful tool in this setting.

The authors note that the high prevalence of neuropsychiatric conditions in RA highlights the need for a more integrated health care model.

“The model of medical care in rheumatology needs to be more integrated with mental health professionals. The biopsychosocial model of care, rather than the reductionist biomedical model, is more appropriate for chronic illness, Dr. Joaquim concluded.

Table. Neuropsychiatric Manifestations of Rheumatoid Arthritis¹

Brain-Related	Spinal	Peripheral Nervous System
·    Brain (incidence unknown) ·    Psychiatric symptoms –   Depression –   Anxiety ·    Autoimmune autonomic ganglionopathy ·    Cognitive dysfunction ·    Headaches ·    Meningoencephalitis ·    Focal neurological deficits/stroke-like episodes ·    Seizures ·    Normal pressure hydrocephalus ·    Cranial nerve involvement	·    Atlantoaxial subluxation ·    Subaxial subluxation ·    Cranial settling/basilar impression/superior migration of the ondontoid ·    Spinal infection ·    Degenerative changes and fractures ·    Myelitis	·    Peripheral nervous system involvement ·    Compressive neuropathies –   Carpal, cubital, or tarsal tunnel syndrome –   Posterior interosseous nerve palsy –   Morton neuroma ·    Noncompressive neuropathies –   Mononeuritis multiplex –   Distal symmetric sensory neuropathy/sensorimotor neuropathy –   Demyelinating peripheral neuropathy ·    Autoimmune autonomic ganglionopathy

Summary and Clinical Applicability

Among patients with rheumatoid arthritis, depressive symptoms are associated with increased pain, fatigue, and disability. Psychiatric depressive symptoms should be addressed together with physical joint pain symptoms, as it has also been shown depression is an independent risk factor for mortality.³

References

1. Joaquim AF, Appenzeller S. Neuropsychiatric manifestations in rheumatoid arthritis. Autoimmun Rev. 2015;14(12):1116-1122. Epub 2015 Jul 31. Review.

2. Irwin MR, Olmstead R, Carrillo C, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. 2012;35(4):537-543.

3. Ang DC, Choi H, Kroenke K, Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol 2005; 32:1013.

This article originally appeared on Psychiatry Advisor