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Arthritis Today

Relationships Help People With Rheumatoid Arthritis

Arthritis Foundation researcher, Shelley Kasle, finds positive results in heartfelt relationships.

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Can close relationships really improve the health of women and men with rheumatoid arthritis (RA)? They can, according to recent research by Shelley Kasle, PhD, research assistant professor, Arizona Arthritis Center, at the University of Arizona in Tucson.

Recent studies, funded in part by the Arthritis Foundation, are part of Kasle’s larger research project, Close Relationships and Arthritis Studies (formerly called the Couples and Arthritis Studies), which seeks to understand how relationship quality may be linked with health outcomes for people with rheumatoid arthritis and their spouses/partners.

In the initial study, which focused on women with RA and their relationships with spouses/partners, Kasle examined medical records and administered questionnaires to more than 100 coupled patients. She wanted to understand the level of mutuality in close relationships, “the degree to which people are interested in knowing what the other person is thinking and feeling,” and its impact on health, she says.

“Mutuality is not the same thing as love,” explains Kasle. “People may love each other, but their communication patterns may not fit the definition of mutuality.”

In a parallel study, funded by the American College of Rheumatology Research and Education Foundation, Kasle focused on men with RA.

For both women and men, the studies examined physical and psychological health outcomes of married/partnered patients with RA in relation to their perceptions of their own responsiveness (self-mutuality), their partner's responsiveness (partner-mutuality), and combined responsiveness (overall mutuality), and sought to understand the potential male and female differences in the links between mutuality and depressive symptoms.

Meaningful results

In general, results for men and women with RA were similar.

Women who reported high levels of overall, self- and partner-mutuality reported less anxiety and depression, and less arthritis impact (a measure of symptoms and impact on  daily activities). In addition women reporting more mutuality reported less physical disability. Physical disability didn’t attain statistical significance for men.

Findings from these studies have been published in the peer-reviewed journal, Arthritis Care & Research, July 2008.

“When you have a chronic illness, there are health and quality-of-life considerations,” says Kasle. “Just as your doctor might prescribe physical exercise to enhance health, my findings suggest that a prescription to engage in fulfilling relationships might similarly be good for your health and quality of life.”

Further Arthritis Foundation-funded research by Kasle revealed that women with rheumatoid arthritis who reported more mutuality had less inflammation. Reported in the Jan. 15, 2010 Arthritis Care & Research, Kasle and her team measured mutuality and levels of the inflammatory marker erythrocyte sedimentation rate, or ESR, at baseline, six and 12 months.

Women who had higher levels of mutuality at baseline and at six months had lower levels of ESR at six and 12 months, even after controlling for the effects of earlier inflammation, disease-modifying antirheumatic drugs, anti-inflammatory drugs and flares. Mutuality exerted lagged effects on ESR, accounting for 9 percent additional variance in ESR levels at six months and 12.5 percent at 12 months.

ESR levels, however, had no effect on subsequent reports of mutuality, suggesting that mutuality has a beneficial effect on inflammation.

Next steps

Kasle wants to understand what happens in the body that makes social support, such as mutuality, health-enhancing. “A lot of people in psycho-social research right now think the neurohormone oxytocin is helping to format and drive a lot of our connective social behaviors,” she says.

She hopes to conduct additional research into non-spouse/partner relationships and other rheumatology populations, such as those with systemic lupus erythematosus and psoriatic arthritis to further understand how autoimmune activity and neuroendocrine factors impact these conditions. She is currently studying fibromyalgia patients and their spouse/partners and close non-household relationships.

Kasle's long-term goal is to develop social supportive interventions for rheumatology patients.

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