Figure 3. Social factors interact with psychological reactions to rheumatoid arthritis.

Cognitive, affective, and behavioural factors are closely related and show a high degree of mutual influence. These factors can have both positive and negative effects on an individual’s adaptation to having rheumatoid arthritis (RA). Individuals who maintain optimistic perspectives or high levels of self-efficacy are more likely (than individuals with pessimistic perspectives or low self-efficacy) to sustain healthy repertoires for coping with RA and are less likely to show pronounced adverse psychological reactions to the physical symptoms caused by RA. Additionally, the broader social environment can impact a patient’s psychological reactions to RA; patients in supportive environments seem to be more resilient against RA-related declines in physical and psychological function, whereas those in stressful environments show elevated physical symptoms, reduced function, and poor psychological adjustment to RA. Individuals with RA can also adversely influence their immediate social environments via behavioural coping responses such as self-imposed isolation or initiating conflict with others when pain or frustration levels are high, which could then have consequences for future emotional states.