Pain and Stress Management for People With Rheumatoid Arthritis

• Joint count
• pain
• physical disability
• psychological impairment
• C-reactive protein

• Psychological impairment [ Time Frame: one year ] [ Designated as safety issue: No ]
• Pain [ Time Frame: one year ] [ Designated as safety issue: No ]
• Physical disability [ Time Frame: one year ] [ Designated as safety issue: No ]
• C-reactive protein [ Time Frame: one year ] [ Designated as safety issue: No ]
• Fatigue [ Time Frame: one year ] [ Designated as safety issue: No ]

• RA flares
• medication use
• fatigue
• morning stiffness

Self-management of rheumatoid arthritis (RA) symptoms using written emotional disclosure (ED), coping skills training (CST), or a combination of both may benefit people with RA. The purpose of this study is to determine the benefits of ED, CST, or CST and ED together in adults with RA. This study will be conducted at Wayne State University in Detroit, Michigan and Duke University Medical Center in Durham, North Carolina.

Two self-management strategies hold promise for improving the health of people with RA: ED (writing about stress, RA, and coping options) and CST (learning six pain and stress coping skills). A strategy integrating ED with CST may be more effective than either intervention alone. This study will compare the effectiveness of ED, CST, ED in combination with CST, and control groups in alleviating the symptoms of RA.

This study will last until May 2009. Participants with RA will be randomly assigned to 1 of 4 treatment groups. Each participant will receive 3 writing sessions and 8 training sessions. Group 1 will receive ED writing followed by CST; Group 2 will receive ED writing followed by arthritis education; Group 3 will receive health behavior writing followed by CST; and Group 4 will receive health behavior writing followed by arthritis education.

Participants will be evaluated at baseline and at Months 1, 4, and 12 for pain, physical disability, psychological impairment, and disease activity. In addition, participants will record daily diaries for 30 days regarding their pain, symptoms, coping, stress, and mood prior to each of the evaluations. Changes in health status over time will be compared among groups.

• Behavioral: Coping skills training
  8 sessions of pain and stress coping skills training
• Behavioral: Written emotional disclosure
  4 sessions of writing about stress
• Behavioral: Arthritis education
  8 sessions of learning about rheumatoid arthritis
• Behavioral: Health behavior writing
  4 sessions of writing about various health behaviors

• Experimental: 1
  Education: Either coping skills training or arthritis education interventions
  Interventions:

  • Behavioral: Coping skills training
  • Behavioral: Arthritis education
• Experimental: 2
  Writing: Either emotional disclosure writing or health behavior writing
  Interventions:

  • Behavioral: Written emotional disclosure
  • Behavioral: Health behavior writing

• Kelley JE, Lumley MA, Leisen JC. Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychol. 1997 Jul;16(4):331-40.
• Somers TJ, Shelby RA, Keefe FJ, Godiwala N, Lumley MA, Mosley-Williams A, Rice JR, Caldwell D. Disease severity and domain-specific arthritis self-efficacy: relationships to pain and functioning in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2010 Jun;62(6):848-56.

Inclusion Criteria:

• Meet American College of Rheumatology (ACR) 1987 criteria for RA

Exclusion Criteria:

• Other disorders that would significantly affect function (e.g., lupus, chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF], cancer)
• Judged by the physician to have cognitive impairment (dementia, retardation, psychosis) or illiteracy
• Has experienced recent (last 6 months) significant stressor resulting in substantial emotional instability
• Currently in psychotherapy or a formal behavioral pain management program
• Unable to walk. Participants who use walking aids are not excluded.
• Physically unable to write