RHEUMATOID ARTHRITIS: EFFECTS ON THE DISEASE PROCESS UTILIZING A BEHAVIORAL MEDICINE APPROACH TO TREATMENT (STRESS, IMMUNOLOGY, BEHAVIORAL)

Rheumatoid arthritis is an immune system disorder characterized by joint swelling, pain, stiffness and deformity. To date, medical treatment has paid minimal attention to psycho-social factors. Impaired coping skills accompanied by secondary gains in the environment may elicit a chronic emotional stress response which further suppresses immuno-activity.; Utilizing a multiple baseline design (Hersen & Barlow, 1976) this study was developed to assess the effect of self-regulation procedures on immune function and on coping issues related to chronicity. Treatment consisted of relaxation and imagery training for pain and symptom management. Six female and two male patients ranging in age from 44 to 57 years and who had been treated for RA over a period of eight to 14 years were selected from the private practice of a physician.; Medical measures taken pretreatment and posttreatment included the erythrocyte sedimentation rate, indices of joints inflamed and morning stiffness duration. Psycho-social measures included the Stanford Arthritis Center Disease and Disability Survey (Fries, Spitz, Kraines & Holman, 1980) and the Rheumatology Reaction Pattern Survey (Udelman & Udelman, 1978). Continuous measures included self-monitoring of pain and tension levels. A follow-up assessment was taken at six weeks and one year post-treatment. Patients received training during one 50 minute session each week for six weeks.; Medical results indicated that all subjects experienced an immune system effect shown by significantly lowered levels of inflammatory activity (p < .05), improvement in functional mobility, reduction in pain, decreases in numbers of inflamed joints and duration of morning stiffness. Psycho-social results yielded reports of improved self-satisfaction, increased activity level and the experience of some control over the disease process. Results at the six week follow-up revealed a slight loss in five subjects of treatment gains in coping and pain management. Results at the one year follow-up indicated that in every subject but one, there was a return to pretreatment symptomatology.; Conclusions were discussed in terms of coping skills and secondary gains for chronic illness.