RAMP

Rheumatoid arthritis (RA) is one of the most common autoimmune disorders and is characterized by chronic joint inflammation and extra-articular involvement. The risk of developing RA increases with age and peaks between the ages of 65 and 80. With a lifetime risk of 3.6%, women are more than twice as likely to develop RA than men. Genetics, environmental factors, and modifiable behaviors all influence the development of RA, but the complete disease mechanism is unclear. The most common physical symptoms of RA are joint pain, stiffness, and swelling; these typically begin gradually but can become intense.

Researchers and clinicians are keenly interested in the effect of RA on mental health and vice versa. Many patients with RA also experience depression and/or anxiety. Certainly, RA symptoms including pain, fatigue, and physical disability can be major stressors that contribute to psychological strain. This trend is bidirectional: increased depression and anxiety  in RA patients are associated with worsening disability, fatigue, pain, and overall quality of life. This relationship between RA symptoms and mental health conditions can become a vicious cycle, making treatment for both conditions much more difficult.

Through the RAMP study, investigators will

• Assess the effect of mood disorders (e.g., depression, anxiety) on RA disease activity and pain
• Test whether treatment of mood disorders changes RA activity and associated pain

The RAMP study will include approximately 50 adults whose RA has been in remission for ≥6 months but who report ongoing pain. Study participants will be seen in Carilion’s Rheumatology clinic once every 3 months over the course of 1 year (4 visits total). At each visit, RA and levels of pain will be evaluated, and disease activity will be measured. Participants’ RA treatment will be changed as needed. In addition, re-evaluation of participants’ mood disorder will occur monthly initially, with changes to therapy as indicated; depending on response to therapy, the timing of psychiatry visits will be modified as appropriate.