Psychological risk variables in patients with ankylosing spondylitis

Keys and guidelines to contribute as health professionals to the improvement of the quality of life in EA patients

Generally, the assessment of rheumatic diseases has had its main basis in the study of physical variables. However, research in recent years reveal that comorbidity with psychological disorders are increasing; This reduces the patient's quality of life; Therefore, it is necessary to orient the general population in this regard and implement inclusion strategies, as well as timely multidisciplinary intervention.

Content

• What is ankylosing spondylitis (EA)?
• Health consequences of a late diagnosis and treatment
• Psychological variables that influence
  • 1.      Depression
  • 2.      Generalized anxiety
  • 3.      Sleep disorders
  • 4.      Fear-Evitation Model of pain
  • 5.      Affective dispositions of the sense of humor
  • 6.      Stress
  • 7.      Sexual problems
  • 8.      Gender differences
  • 9.      Personality change due to medical disease, in this case: EA
• 8 Guidelines to improve the quality of life in patients with EA
  • 1. Get to the disease, but not to health
  • 2. Be positive while still being realistic
  • 3. Develops greater tolerance to frustration
  • 4. Don't make your body shout you, better listen to it before
  • 5. Change the ways in which you perceive pain
  • 5. Learn from what the disease teaches us
  • 6. Cheer up to take responsibility for your own health and your body!
  • 7. Laughs, sip you and try to maintain a good mood
  • 8. Support groups for people with ankylosing spondylitis
• Conclusion
  • Links

What is ankylosing spondylitis (EA)?

Is a way chronicle and reactive of arthritis that mainly affects, But also to joints, nerves and bones, producing stiffness and chronic pain, is of autoimmune character; mostly affects the base of the column producing low back pain that can become Incapacitating due to the high grade of pain they produce; In turn, the joints are inflamed and swollen. Over time, the intervertebral space may disappear, mainly that of the affected vertebrae.

The secondary EA can be associated with inflammatory intestinal disease, psoriatic arthritis and reactive arteritis (reiter syndrome) or, accompanied by primary ankylosing spondylitis, so they are classified within the serotonigenous spondyl arthropathies.

The disease usually starts between the 17 and the 40 years, But you can start at earlier stages, although being more aggressive, The severity of the symptoms and the limitation of movement vary from one individual to another. It has been determined that genes and inheritance play a very important role. There is evidence that it can be triggered by some types of infection, the study of different kinds of bacteria indicates that they could influence the development of the EA.

Health consequences of a late diagnosis and treatment

The delay in the diagnosis has represented a big problem, since this is a chronic degenerative disease, 75% of people take years to be diagnosed by various causes. In men, the diagnoses are generally given between 5 and 7 years, among the population with more access to health and education. In the case of the most disadvantaged, it can be postponed up to 15 years.

In women, the diagnosis can be delayed another 4 to 5 years on average, compared to the diagnostic time of a man, or even get overlooked. Because? Keep reading, you will find a answer later.

Psychological variables that influence

most of Chronic diseases negatively impact the different areas of the person.  There are a number of psychopathologies associated with the EA that can overshadow the prognosis and quality of life of the patient.

He chronic pain and its consequences, such as movement limitation, They generate high negative emotionality for long periods of time When it is not properly treated.

A greater inflammatory activity, pain, rigidity and functional limitation due to axial deficiencies ... greater risk of psychological disorders ”, psychological variables can affect the expression of pain and the rest of physical variables, worsening the symptoms associated with these pathologies, which will result in a detriment in the global health of the patient.

According to the report made by Novartis (2017), where they indicate that the Limitations in daily activities of patients negatively affect mental health by up to 45% of people with spondyl artis, as a result of the impact of symptoms and their chronicity.

Next, I will quote a series of Psychological variables, I call them that, for its high impact on the response to treatment From patients with EA, these are factors that can relieve or worsen the symptoms of the disease although they are not merely biomedical.

1.      Depression

In the first stage many They experience loneliness Due to the misunderstanding and lack of containment, due to lack of understanding towards symptoms and disease itself, being depression, anxiety and sleep disorders, the most common psychological risk factors in patients with EA.

2.      Generalized anxiety

When entering the most advanced stages of the disease, where the consequences of the Van movement limitation affected other important spheres of the individual such as the work, professional, family and couple area For example; In addition to the impossibility of healing and the partial effectiveness of the treatments used, they keep the person in a constant evil that generates a lot of anxiety, fear and sadness, putting at risk the emotional and mental state of the patient.

The constant uncertainty and Excessive concern about the future, The fear of thinking that perhaps later there will be a greater limitation of movement, with a slight tendency to present a greater frequency of catastrophic thoughts, terribly raised anxiety levels in the person. "It is better to take care of something we can do, to worry about everything we cannot do, especially because it takes a little more than before to carry out seemingly simple daily activities".

3.      Sleep disorders

Insomnia, Because the pain intensifies and many patients cannot remain in bed many hours in a row, which produces a Excessive sleepiness by day and tiredness, which after years results in Chronic fatigue, which affects all areas of the person negatively.

Likewise, we can observe circadian rhythm disorders, due to the persistent presence of an unstructured sleep pattern and non -specified dysomnias.

4.      Fear-Evitation Model of pain

They are the origin of the avoidance of movement, certain provisional variables such as generalized anxiety, coupled with cognitive variables such as catastrophism and over-adaptive or normalized beliefs about pain. Lack of movement intensifies pain chronification, And this in turn, increases the limitation of movement per se.

5.      Affective dispositions of the sense of humor

Dimensions such as the feeling of joy, gratitude, the ability to surprise and to laugh contributes to the improvement of the state of health. As well as the cognitive disposition that is partly, our way of conceiving the world. If we adopt a positive attitude towards daily challenges, this influences physical and psychological health directly.

6.      Stress

There are many social stressors around the EA, mostly generated by the perception of the image, That due to the deformities of the progress of the condition, the labor and relational problems derived from the disease can result in cognitive distortions, generate fear of suffering rejection and abandonment, among others.

Therefore, many patients prefer to hurt themselves or allow situations of abuse, to give pleasure to others, whether consciously or not, that way, they believe they will be less vulnerable to being rejected or abandoned although their disease progresses.

7.      Sexual problems

Sometimes the sexual desire is diminished by the periods of reactivity of the disease, the pain, the stiffness and fatigue of the body. Men can present episodes of helplessness, erectile and testicular dysfunction, this is multifactorial, because it even has the difficulty that the patient faces to be in certain positions. Likewise, there is an increase in relationship problems associated with the disease.

Alterations in the body image that are presented, if they are not treated psychologically it can generate loss of self -esteem, decreased sexual satisfaction And in the end, triggers a disinterest in sexual relations, There is also one decrease in frequency of sexual relations Among patients with this diagnosis, thus losing the benefits that sex brings to health.

It is important to educate ourselves in sexuality, the most powerful sexual organ of the body is called: brain!, We have to reinvent ourselves, first in the way of relating to ourselves, and then with others. We can find new ways to generate pleasure, without hurting us. During sex important neurotransmitters are released, such as dopamine, oxytocin, endorphins, etc. Same that can help us relieve pain a little, to calm anxiety and remove negative thoughts; because during intercourse and then, they are released generating in us a feeling of good-being, so: love and let yourself be loved!, That does your body, your mind and your heart.

8.      Gender differences

EA is more easily recognized in men. In women, due to sociocultural factors, even the diagnosis takes 4 to 5 years more years, with respect to men, or overlooks. Hormones are a bit guilty of these differences, because they add for example, a little estrogen, who plays an important role in pain perception. Also, it has been observed that the Level of disease reactivity is changing, according to the phases of the menstrual cycle in women suffering chronic pain, having an increase in symptoms before and during the menstrual period.

Men tend more to concentrate on the physical sensations they perceive, and women in the emotional aspects of pain, which produces more emotional and even physical pain, due to emotions generally associated with pain are negative.

Young people and women have a greater risk of psychological problems, According to the Axial Spondyle Atlas in Spain 2017, the study reveals the risk of suffering a psychiatric disorder is higher in people with EA, 70.4% in women and 60.6% in men.

Other social factors also intervene, such as gender, because some doctors tend to rule out some physical symptoms in women, associating them exclusively to psychological problems, thus delaying their diagnosis and quality of life. This occurs, because the symptoms that the patient refers to: insomnia, awakening at night or in the mornings very early because The inability to remain in the same position for a long time, the fear and the crisis of anguish, the tendency to isolation that produce occasional and growing disability to participate in activities with family and friends, the apparent personality changes and emotional lability, They are some symptoms that could easily associate with mood disorders, stress, generalized anxiety and this, is exacerbated with the hormonal changes that happen marking important differences in the stages of the development of women.

9.      Personality change due to medical disease, in this case: EA

It can be of different types, with its possible combinations, we find mainly Affective lability (ease to change the affective state). You can see certain personality changes For one more type disinhibited to which he presented before, a poor impulse control regarding what was usual, sexual indiscretions, etc. Other types of changes are usually towards more aggressive behaviors, with paranoid features and apathy attitudes mostly. The presence of one of these features can be accentuated, or they can occur in a combined way in different degrees.

There are significant relationships between personality, moods, ways to face and the effect on perceived daily pain. The pain is likely to be modified from the type of coping strategies that are put into play, and that this choice will be favored by the personality type: The most maladaptive styles of normal personality will be more related to the level of pain.

8 Guidelines to improve the quality of life in patients with EA

1. Get to the disease, but not to health

The Acceptance of this new condition, and embrace it with all its changes and challenges will be high impact on health and in quality of life, This is the first step towards our health, so one of the most important, while later to accept and aware of our own abilities and limitations, we are giving more freedom to the disease to continue advancing.

2. Be positive while still being realistic

EA is an autoimmune, chronic-degenerative condition, All efforts you make for being well, will contribute directly to your quality of life and with a good multidisciplinary treatment you can make the negative effects of the disease delay; But you must be aware that this does not guarantee you days free of pain and suffer from the consequences of the disease.

A lot of courage and realistic optimism!, The mood should not come from the belief that everything will be better tomorrow ... but of the internal conviction that the circumstances are, we will fight because our attitude and responses are the most efficient and adaptable to the context we live, that is: that is: the best!, This is a variable that Yes we can control and all this contributes to a feeling of subjective good.

3. Develops greater tolerance to frustration

Many days your mind and heart will tell you that you want and you can be in that desired job interview, or in that special family event, that you will surely be fine on Saturday night to go out to dance a little and move the skeleton , that tomorrow you will take your little one to your little one to the park and that they will play football and who knows how many more things ... but your body just a few hours before you shout that you will not go, simply because the pain is so intense that it is disabling ..

Breathe long and deeply, invokes and develops patience in all its forms, It is important that you begin to develop tolerance to frustration, you cannot change the fact that you will not be able to go, nor the fact that you have to notify as much before possible in case you have made commitments, be sincere as soon as the reasons, Your condition merits it!, There will be more awareness among the general population, while we are making known this condition and you will find the empathy of many people. However,  Avoid giving long explanations, Most people do not finish understanding this disease and you could end up more frustrated and sad to see that people do not seem to understand and far from supporting us, exert unnecessary pressure on us. Who really is interested in knowing about your condition can you pass some links to know a little more about the EA and if you have comments after reading, they can discuss them.

By the time your plans are frustrated, I recommend that you always have a plan B, C, D ... the Concentrating our energy and attention on another activity that interests us, can reduce the feeling of discomfort and contribute to being better even if the reactivity of the disease is greater, It can be something as simple, how to always have a good book at hand.

4. Don't make your body shout you, better listen to it before

Many would like the disease to be more predictable, so that it allows us to make plans, activities and commitments. Sometimes, Although we really want to continue doing things, our body asks us to stop, to stop for a moment... maybe it's time to listen to it and meet your needs, which we have surely ignored for a long time, that's why we reach this point of chronicity.

5. Change the ways in which you perceive pain

Practice Breathing techniques, full attention, meditation and relaxation,  They are very powerful tools, to deal with these psychological risk factors. Breathing can help us change states of anguish, anxiety, emotional lability and fear, for states of relaxation and greater clarity. Same that benefit us regarding the perception of pain.

It is always better to think about what we can still do with everything and the limitation of movement and pain, than to think about all those that we can no longer do, it is preferable to use our energy to enjoy with gratitude, prudence and wisdom of each day with movement.

5. Learn from what the disease teaches us

EA teaches us that stiffness increases pain and even the limitation of physical movement, so we must try to preserve our body flexibility as far as possible through movement and following the advice of health professionals, and above all try Develop the mental flexibility, tolerance to frustration and patience, because they are virtues that we will need more to adapt to the challenges of life and that the same chronic-degenerative condition imposes us.

Be indulgent with yourself: EA and pain affect the different areas of your life, and despite this, great teachers can be, if we know how to listen to them, to be able to go to their own rhythm.

6. Cheer up to take responsibility for your own health and your body!

First listening and respecting their abilities, their limitations, following medical suggestions; Take care of yourself, eat well and try to stay in motion, remember that even if the movement is painful, it will be greater if we allow the disease to make us more and more rigid, if we allow the unfounded fear to limit us more and more the movement , then we will also limit our freedom to do many things. Performing delicate movements always accompanied by correct breathing, help us deal a bit with pain.

Spondylitis = in
Anillosant = Action

7. Laughs, sip you and try to maintain a good mood

Affective features, whether positive or negative can influence the physical state of patients. Let's use this in favor of health, opting to take things with a sense of humor, which is a feature of positive and intelligence adaptability.

8. Support groups for people with ankylosing spondylitis

Personality affects In the course of medical disorder, once this has been diagnosed. Sometimes, academic and professional aspirations can be truncated because of the disease, this due to the inability to spend a long time in the same position, occasional absence due to the reactivity of the condition, chronicity of pain, all these challenges and others, face day To day the patients with this condition.

It is very helpful, to have the support of people suffering from EA, Living with people who pass or went through the same problems as you will make you feel great relief, Shared knowledge about the most recent research and advances in terms of treatments they can share, the therapeutic support of a person who lives a series of conditions similar to yours, will help you not feel alone, to know more about your disease And of all the things you can do to have a better quality of life that are many.

As his name says it, these groups are of great support, especially when the most common psychological problems associated with EA are depression and the anxiety. In social networks you can find a large number of them, look for one or more that adapt to your needs and tastes.

Conclusion

The increase in autoimmune diseases are going up, so it is necessary to establish multidisciplinary and timely intervention strategies as health professionals. Psychological factors exert great influence on functional capacity between spondylitic patients; Scientific literature points out that symptoms of depression, anxiety and other psychological problems are present in almost half of patients with EA and are proportionally influenced by functional limitation, painful entities and education level.

A timely diagnosis can help reduce the degree of disability and avoid associated psychological and socio -labor problems.

It is important to establish an interdisciplinary treatment plan, talk to your doctor and remember that psychologists are of great help, as they can design an adequate intervention program according to the detection of specific needs and thus contribute to a better quality of life of the patient.

Practice deep meditation techniques, full attention, relaxation, breathing, automation and mental control, They can help us deal with pain and accept many processes. By becoming external observers, we can acquire another more complete vision and stop drowning in pain, which effectively seems that due to characteristics of the disease, over time becomes chronic.

Given EA's comorbidity with other psychological disorders, it is necessary to include within the multidisciplinary group of health professionals to psychologists, as they are an effective complement to biomedical treatment to face the different stages of the disease and with the application of their strategies, They contribute to the best adaptation of the patient to their condition, while helping to increase their welfare levels, and to physical and emotional preparation to adapt with wisdom, grace and love to the changes that their body and condition impose them.

Links

https: // scholar.Google.com.MX/Scholar?q = spondylitis+approach+psychological & hl = es & as_sdt = 0 & as_vis = 1 & oi = scholarot & sa = x & ved = 0ahkewjjjj9dfv8uhxahxahufvyykhewvbdaqgqmijdaa
http: // www.Tucuentasmucho.com/take care/atlas-space/
http: // www.Elsevier.Es/Es-Revista-Revista-Colombiana-Reumatology-374-Articulo-Ansiety-Depression-Spondylitis-Ankylums-A-A-S0121812315000912
http: // aexpebadajoz.Blogspot.mx/
http: // Helvia.UCO.is: 8080/handle/10396/13727
http: // www.APA.org/News/Press/Releases/2010/08/Gender-Pain-Differences.ASPX