Introduction

Depression is a common and illness affecting the mind that negatively impacts how one feels, how they think and how they act and makes one have feelings of sadness and lose interest in activities that one used to enjoy. The disorder impairs functioning in multiple domains to include workplace, home life, family and self-care, which severely compromises capacity independent living and self-care. A bidirectional relationship has been found between depression various autoimmune disorders whereby it increases the risk of developing them. Depression has also been found to elevate the hazard of the onset of autoimmune diseases. The immune system is also likely to influence the pathological processes that underlie depression (Garrido et al., 2011). These autoimmune disorders include multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease. Understanding the mechanism underlying this overlap can significantly help in preventing this co-occurrence and treating the diseases.

The connection between Depression and Rheumatoid Arthritis

One of the common autoimmune diseases which is also chronic that occurs with depression is rheumatoid arthritis (RA). The condition occurs when the body’s immune system usually attacks tissues and joints and is characterized by systemic inflammation, stiffness and pain that involves joints especially those of the extremities. The mechanisms that underlie the relationship between depression and rheumatoid arthritis have not been clarified well, but research has pointed to the potential role of inflammatory processes. The perturbation of the immune system drives both conditions, and the shared mediating factor is therefore altered immune functionality. Inflammatory immune processes mediate depression, and a significant role of inflammation in the development of RA has also been found.

The proinflammatory cytokines that are implicated in the pathogenesis of depression, to include interleukin (IL)-IB, il-6 and tumour necrosis factor have also been found to be involved in the development of RA. Concerning the neurobiology of depression, immune-mediated inflammation has effects on neurogenesis, neurotransmission and neuroendocrine activity. As an instance inflammation has been associated with a reduction in brain-derived neurogenesis and neurotrophic factor (Euesden et al., 2017). The low mood that comes with depression predicts the subsequent worsening in signs and symptoms of rheumatoid arthritis. People who have depression before they develop rheumatoid arthritis are usually less responsive to treatment of rheumatoid arthritis. These individuals also have more significant pain, are less productive at work, and are at a higher risk of developing heart and cardiovascular diseases, are at an increased risk of economic hardship, sexual dysfunction and deterioration of relationships with family and friends.

Role of Stress Hormones and Inflammation in Rheumatoid Arthritis

Patients with RA usually have an occurrence of a stressful life event before the onset of their illness. Through disturbing immune system balance, stress activates inflammation both centrally and peripherally which leads to various stress-related diseases, RA is one of them. Stress activates the Hypothalamic-pituitary axis (HPA) via secretion of a corticotropin-releasing hormone (CRH) which suppresses immune response via secretion of glucocorticoids (GCs) from the adrenal glands. GCs are part of the major stress hormones that are secreted in response to stress and have anti-inflammatory and immunosuppressive properties. However, these GCs have a pro-inflammatory effect on the immune system. For acute stress, the GCs act to prevent inflammation and enhance the immune function. However, with chronic stress, there is an over-activation of the immune system leading to an imbalance between anti-inflammation and inflammation (Hassett and Clauw, 2010).

This over-activation leads to secretion of cytokines such as C-reactive protein, IL-6, TNF, IL-1B and the transcription factor of nuclear factor kappa B. All these cytokines are mediators of inflammation that activate inflammation centrally and peripherally and involved in enhancing the development of RA. For patients with RA already, stress worsens that comes along with RA. There is also reduced responsiveness of GCs which should improve anti-inflammatory response (Hassett and Clauw, 2010).

. In summary, stress activates the sympathetic nervous system (SNS) system to release norepinephrine (NE) and neuropeptide Y (NPY) which are hormones involved in stress that facilitate phosphorylation of MAPKs or HMGB1 release, causing induction of systematic inflammation via IL-6, CRP which accelerate or promote RA development.

Teaching Strategies to reduce the Effects of Rheumatoid Arthritis

RA can have profound effects on the life of the affected individual as well as to their significant others. It is therefore essential to come up with strategies of how to reduce these effects. The patients can be taught various strategies to mitigate these effects. One of the ways is to teach them regarding the diet to take which is called an anti-inflammatory diet. Systemic inflammation causes an elevation in cortisol levels, which can be naturally decreased through diet modification, which will, in turn, result in a decrease in the risk of RA and improved wellness. The patient can be taught to devise a low-inflammatory diet and follow it strictly to control inflammation (Fried and Nesse, 2014).

Dietary strategies to control inflammation can coincidentally assist with adrenal support as diet can affect adrenal burden directly since cortisol is released in response to demands in metabolism. To minimize inflammation, patients can be advised to take a portion of food with low glycemic load, eliminate trans fats and decrease intake of saturated fats, eliminate or reduce caffeine, eliminate alcohol or take in moderation, consume whole plant foods, take recommended amounts of omega-3 fatty acids, exercise regularly and take probiotics if needed.

A second strategy is to teach patients on effective stress management. As discussed stress is a major activator of inflammation, which worsens the symptoms of RA. Patients can be taught such strategies as undergoing counselling when they are facing stressful issues. They can also be advised to share with people that they trust and read books that recommend on stress management. Getting a more and better quality of sleep also helps the brain to rest enough and therefore reduce stress. Relaxation exercises involving breath-work and cardio exercises. It is also significant to advise the patients to consider taking a team approach to managing their stress.

The third strategy is to teach the patients to comply with the medications that they are taking. Although the condition is not curable, they should be informed that ensuring compliance with the anti-inflammatory medications that they are given will help in reducing the effects of the disease. The reason is that pain and stiffness will be reduced and therefore they will be productive in their work and therefore affect no one nor interfere with the life of significant others.

Methods to use to encourage adoption of the strategies

Convincing patients to adopt a given lifestyle to improve their health can be quite challenging especially when they have a given routine. To promote the adoption of the suggested strategies, I can give the patients real-life experiences of people who have adopted these strategies and have been able to live a better life with fewer effects of the disease. I would also review with them the adverse impact that the condition has when it is not well managed to reduce its effects. These may include failure to meet targets at work which can lead to loss of a job. I would also remind them of other benefits of these strategies outside the disease, such as reducing the risk factors for the development of other conditions such as obesity and cardiovascular disorders.

Conclusion

Depression is a devastating state which puts individuals at risk of developing various diseases, more importantly, chronic and autoimmune diseases such as RA. These diseases can have a significant impact on an individual’s life to the extent of affecting the experience of others. Understanding the mechanism between the development of RA in patients with depression can go an extra mile in offloading patients of this burden by coming up with better ways of managing the condition. Inflammation that is linked with depression plays a significant role in the development of RA. It is therefore vital that patients come up with ways of minimizing this inflammation as well as have their depression treated early enough and also follow the strategies advised in effective stress management.

References

Euesden J., Danese A., Lewis C. M.& Maughan B., (2017). A bidirectional relationship between depression and the autoimmune disorders – New perspectives from the National Child            Development Study. PLoS One. 2017; 12(3): e0173015.

Published online 2017 Mar 6. doi: 10.1371/journal.pone.0173015

Fried E. I. & Nesse R. M. (2014).  The Impact of Individual Depressive Symptoms on        Impairment of             Psychosocial Functioning. PLoS ONE 9(2): e90311.             https://doi.org/10.1371/journal.pone.0090311

Garrido, M. M., Hash-Converse, J. M., Leventhal, H., & Leventhal, E. A. (2011). Stress and chronic disease management. In R. J. Contrada & A. Baum (Eds.). The handbook of           stress science: Biology, psychology, and health (pp. 487–500). New York, NY: Springer     Publishing Company.

Hassett A.L. & Clauw D. J., (2010). The role of stress in rheumatic diseases. Arthritis Res Ther. 2010; 12(3): 123. Published online 2010 Jun 7. doi: 10.1186/ar3024