The Mental Health Toll Of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints. It can be exceptionally painful and cause significant disability in many individuals. The chronic pain coupled with the loss of quality of life can lead to depression in RA patients. In fact, as many as 48% of individuals with rheumatoid arthritis are also diagnosed with depression. This suggests inadequacy in current methods of pain control and a need for alternate therapies to address the physical and mental health needs of RA patients. Ketamine has already demonstrated great efficacy in treating refractory depression, but it may also provide relief for chronic pain associated with RA. Read our blog to learn more.  

Rheumatoid Arthritis vs Osteoarthritis

The word “arthritis” comes from the Greek root, arthron (joint) and itis (Inflammation). Generally speaking, all forms of arthritis involve inflammation of one or more joints. The affected areas, disease progression, and cause of the underlying inflammation are different in each type, however. 

Osteoarthritis Definition

Osteoarthritis (OA) is very common and is also known as “wear-and-tear” arthritis. It involves the gradual wearing down of the cartilage between the joints, which acts as a cushion that prevents the bones from touching. When this cushion wears away, the joints can grind against each other, causing pain, stiffness, and inflammation. 

OA is prevalent in older individuals and occurs most in weight-bearing joints, such as the knees and hips. It can also affect younger individuals as a result of trauma to a joint, certain infections, repetitive use of a joint, or being overweight. Treatment consists largely of over-the-counter pain medications, physical therapy, ice/heat therapy, and rest. In extreme cases, surgery may be warranted to replace a severely eroded joint.  

Rheumatoid Arthritis Definition

Rheumatoid arthritis also causes swelling and pain in the joints. Unlike OA, however, it is not caused by injury or natural erosion of the joint over time. RA is an autoimmune disorder that mistakenly signals the body to attack its own cartilage and bone. It affects nearly all the joints in the body, save for the thoracic and lumbar spine. The top joints of the fingers, called the distal interphalangeal joints, are also typically unaffected in RA. This is not true of OA patients, who can experience pain and swelling in these areas. 

While OA is limited to the joints, RA can also affect other body systems, including the skin, eyes, lungs, heart, and blood vessels. For example, people with RA are at greater risk of hardening of the arteries, lung disease, and lymphoma. 

Conventional Treatments for Rheumatoid Arthritis

Treatment for RA focuses on controlling symptoms and slowing joint damage. The most common treatments include:

Over-The-Counter Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help relieve pain and reduce inflammation in milder cases. They are primarily for pain control and do not have any effect on disease progression.

Corticosteroids

These medications reduce inflammation and suppress the immune system, which is overactive in rheumatoid arthritis. Since they are fast-acting, corticosteroids are often prescribed in tandem with other drugs, such as DMARDS (see below), that are better at slowing joint damage but take longer to be effective. 

Disease-modifying Antirheumatic Drugs (DMARDs)

These drugs can slow the progression of RA and save the joints and other tissues from permanent damage. DMARDs work broadly to stop your immune system from attacking healthy tissues, and more specifically on immune system proteins.  The most commonly prescribed “traditional” DMARD is methotrexate, although there are several others. 

A second, non-traditional class of DMARD is known as “biologics.” Biologics are made of proteins sourced from plants or animals that target the body’s own inflammatory pathways. Where traditional DMARDs are taken by mouth, biologics are injected. Biologics are often prescribed when traditional methods have failed or cause too many side effects. 

Physical Therapy

A physical therapist can teach exercises to help keep joints flexible. They may also suggest new ways to do daily tasks to ease the strain on your joints. 

Surgery 

If medications fail to prevent or slow joint damage, surgery may be necessary to repair or replace the affected joints. The type of surgery needed will depend on the patient’s age and goals, with the primary aim of restoring function, independence, and comfort. 

Why Do RA Patients Get Depressed?

As a chronic, progressive disease, rheumatoid arthritis can take a significant toll on an affected individual's mental health. Aside from near-constant pain, the disease can have other aspects that contribute to mental health struggles:

Chronic Stress: managing a long-term illness requires constant vigilance, which can be mentally exhausting and carry a significant financial burden. It can also tax caregivers, adding to the stress of the disease. 

Social Isolation: physical limitations due to pain and loss of joint mobility can reduce the ability to participate in activities once enjoyed, which can lead to feelings of loneliness and resentment. 

Loss of Independence: the inability to do certain daily tasks, such as housework, bathing, cooking, or dressing, may lead individuals with rheumatoid arthritis to feel the disease has taken over their physical autonomy. 

Treatment Trial and Error: the process of finding the right medication, dose, and add-on therapies can be arduous and fraught with false hope. Add in the similar trial-and-error process needed to find an effective treatment for depression, and RA patients may find themselves doubly overwhelmed. 

What If Depression In RA Goes Untreated?

Unfortunately, depression may go undiagnosed and, therefore, untreated in RA patients. This is primarily because many of the symptoms of RA, including fatigue and poor sleep, overlap with depression symptoms. 

However, it is very important that those with RA and associated depressive symptoms seek treatment. Unmanaged depression in rheumatoid arthritis has been linked with poorer outcomes since depressed patients are less likely to comply with prescribed therapies. 

Exploring Alternative Therapies: Ketamine for Chronic Pain and Depression

The problem with many first-line therapies for rheumatoid arthritis is that they come with a long list of side effects, some of them just as disruptive to quality of life as the disease itself. Methotrexate, for example, leaves patients at risk for serious infection and potential liver damage. Long-term use of NSAIDs is not recommended due to the risk of stomach ulcers; likewise, prolonged use of corticosteroids can have adverse effects, including loss of bone density, high blood pressure, and adrenal atrophy, a condition that reduces the body’s ability to deal with stress. 

Suffice it to say that alternate therapies for the treatment of both physical and emotional symptoms of rheumatoid arthritis are badly needed.   

Ketamine For Chronic Pain

Ketamine is being explored for a wide variety of illnesses, both physiological and psychological. It has demonstrated efficacy in chronic pain conditions, such as CRPS. Ketamine works by blocking NMDA receptors in the brain, which are involved in pain transmission. This can be particularly beneficial for RA patients whose pain is not adequately managed by conventional treatments. Ketamine's pain-relieving properties can provide much-needed relief, allowing for improved physical function and quality of life.

Ketamine For Depression

In addition to its pain-relief benefits, ketamine is FDA-approved for treatment-resistant depression. Years of clinical research also support its use for PTSD, anxiety, OCD, Bipolar Disorder, and certain types of addiction. 

Unlike traditional antidepressants, which can take weeks to show effects, ketamine can provide rapid relief of depressive symptoms. This fast action is particularly important for individuals experiencing severe depression and/or suicidal thoughts; and for RA patients who have already been through the trial and error of finding an anti-inflammatory regimen, the idea of fast relief of their mental health symptoms with few side effects may be especially appealing. 

Ketamine-Assisted Psychotherapy in Destin and Panama Beach

Rheumatoid arthritis is a debilitating condition that affects both the body and mind. Conventional treatments can be effective for managing physical symptoms and slowing disease progression, but they often fall short in addressing the associated mental health struggles. Alternative therapies like ketamine offer hope for comprehensive relief. By addressing both chronic pain and depression, ketamine can significantly improve the quality of life for individuals with RA, offering a more holistic approach to treatment.

The Crane Center is a top ketamine clinic in Destin, FL, providing compassionate and creative solutions to help our patients feel better. We offer conventional and alternative therapies so you can find the best relief possible from your symptoms. Text or email us today to schedule your appointment at our ketamine clinic in Destin or our new location in Panama Beach.