An autoimmune disorder can take a toll on the brain as well as the body. Life with a chronic disease impacts your quality of life, which generally affects your mental health. But research has specifically shown that people who have rheumatoid arthritis (RA) are more likely to experience mental health disorders than those who have not been diagnosed with the autoimmune disease. One study, published in July 2018 in Arthritis Care & Research, found that the incidence of depression was 45 percent higher in people with RA, anxiety was 25 percent higher, and bipolar disorder was 20 percent more common than in people without RA. Episodes of depression and anxiety were also more frequent and longer-lasting in those with RA.

The relationship between rheumatoid arthritis and mental health is complex and likely involves a number of factors, but it seems to go both ways — inflammatory arthritis can contribute to mental health problems, and mental health disorders can worsen RA symptoms and outcomes.

3 Ways Rheumatoid Arthritis Contributes to Mental Health Conditions, and How to Deal With the Risks

Here’s what experts understand about the connection between rheumatoid arthritis and certain mental health disorders, and what you can do to sidestep or minimize symptoms.

1. A Chronic Disease Like RA Causes Chronic Stress

The pain and expense of a long-term health problem can be a significant burden. Indeed, the rate of depression among people living with rheumatoid arthritis is estimated to be anywhere from 13 to 42 percent, according to some research. “Certainly, pain with RA is one factor, but we know from studies — including ours — that there is more depression and anxiety in people with RA even before the RA is diagnosed,” says Carol Hitchon, MD, a rheumatologist in the Rady Faculty of Health Sciences at the University of Manitoba in Winnipeg and the author of the 2018 study in Arthritis Care & Research. “This suggests that other factors may link these conditions, including genetics, environmental exposures, and health habits.”

2. Inflammation Is a Common Thread in RA and in Depression

Scientific researchers speculate that chronic inflammation, which is when your body’s immune system goes into overdrive and stays there, contributes to many diseases beyond rheumatoid arthritis, including heart disease, cancer, diabetes, stroke, and depression.

“There is evidence that depression is an inflammatory disease, and there is also evidence that people with high levels of certain inflammatory biomarkers in their system are more likely to develop depression. Some of those markers are the same ones that are elevated in rheumatoid arthritis,” says Patti Katz, PhD, a professor of medicine at the University of California in San Francisco, where she studies adults with chronic health conditions.

3. RA Pain Leads to Depression, and Depression Worsens Pain Perception

According to a review of research published in November 2022 in Medicina, “depression in RA is associated with increased pain, fatigue, and physical disability” and depression “lowers thresholds of pain, leading to higher disease activity scores and complicating the management of the disease.” Even when patients use DMARDs to control disease activity, those with underlying mood disorders may have persistent pain. Researchers suspect a “bidirectional relationship” between depression and rheumatoid arthritis, akin to the proverbial chicken and the egg: Chronic pain can lead to depression, and feeling down in the dumps can worsen the perception of pain.

A research review published in October 2021 in Joint Bone Spine noted that conclusive evidence shows depression negatively impacts “just about all outcomes of RA, including disease activity, arthritis-related complications, level of pain, chance of remission, quality of life, and mortality.” What’s more, depression is still underdiagnosed in people with RA.

Recognize Early Signs and Symptoms of Mental Health Disorders When You Have RA

If you have RA and you’re worried about the state of your mental health, “it’s best to see your doctor about your concerns,” says Dr. Hitchon. Experts have developed questionnaires that can assess the risk of having depression, anxiety, or bipolar disorder, she notes. "Signs of depression can include a change in your level of interest in things you normally like to do, feeling down, difficulty sleeping, or changes in appetite or concentration,” she adds. Anxiety may be present if the level of worry you have about your life interferes with your regular activities. “Hyperactivity, racing thoughts, needing less sleep, or doing things that are not usual for you, especially if they interfere or cause problems with your work or family life, may be a sign of bipolar disorder,” Hitchon says.

Practice Self-Care to Protect Your Mental Health When You Have RA

First, see a doctor to discuss mood changes and possible treatments. But it's also important to take steps to live more healthfully in order to manage mood symptoms. “Eating healthy food, keeping physically active as best as you can, and getting enough sleep can help,” says Hitchon. She says some people find activities like meditation and mindfulness practices helpful. And if medication is needed, “make sure your doctors are aware of all medications, both prescribed and nonprescribed, that you are taking so they can determine if there are any concerns with the interactions between the medications,” she says.

Additional reporting by Deborah Shapiro.

Rheumatoid Arthritis and Mental Health: The Link Between RA, Depression, and Anxiety