Good Marriages May Help Rheumatoid Arthritis Patients
But troubled unions don't provide same benefits, study finds
FRIDAY, Oct. 29 -- A good marriage helps people with rheumatoid arthritis enjoy better quality of life and experience less pain, a new study suggests.
"There's something about being in a high-quality marriage that seems to buffer a patient's emotional health," said research leader Jennifer Barsky Reese, a postdoctoral fellow at the Johns Hopkins University School of Medicine in Baltimore.
But RA patients in distressed marriages were no better off in terms of quality of life and pain than the unmarried patients she studied.
The report is published in the October issue of The Journal of Pain.
Reese said her study went further than other research that has linked being married to aspects of better health. "What we did was look at both marital status and how the quality of the marriage is related to different health status measures in the patient," such as their perception of pain and physical and psychological disability, she said.
The researchers evaluated 255 adults with RA, a painful and potentially debilitating form of arthritis, for marital adjustment, disease activity and pain. Forty-four were in distressed marriages, 114 not distressed and 97 were unmarried. Their average age was 55.
The participants answered questions about how happy they were in their marriage, and also noted how much they agreed or disagreed in key areas, including finances, demonstrations of affection, sex, philosophy of life and interaction with in-laws.
"Before we controlled for anything [such as disease severity], being in a high-quality marriage is associated with better outcome," she said.
"These findings suggest the links between being married and health depend on the quality of the marriage, not simply whether or not one is married," she said.
When the researchers took into account such factors as age and disease severity, they found that "better marital quality is still related to lower affective pain and lower psychological disability," Reese said.
Affective pain is an emotional evaluation of pain, how unpleasant a patient finds it. Another measure, sensory pain, reflects how the pain is perceived, how it feels physically to the patient, Reese said.
The greater effect was for psychological disability more than affective pain, Reese said.
Reese can't say for sure that being in a high-quality marriage leads to better functioning. "It could be people with better emotional health may be more likely to get into a high-quality marriage," she said.
Because the study included more women than men women, it didn't explore whether being male or female affects the results.
The findings are no surprise to Dr. Nancy Klimas, an immunologist and internist who works with patients who have painful conditions such as chronic fatigue syndrome.
In the field of psychoneuroimmunology -- what some call "positive psychology" -- there is evidence that "you can modify inflammation with coping styles," said Klimas, a professor of medicine at the University of Miami Miller School of Medicine.
Noting that Reese found that being in a distressed marriage was just like being alone for those with RA, Klimas said "that would suggest what's helping these people is being in a supportive relationship."
"Coping is an interesting, complex mechanism," Klimas said. "You have self-coping, things you teach yourself to deal with pain and chronic disease and to learn sort of an internal message" that helps keep you going, she said. "Then there is the kind of coping you draw from the environment."
If that is in the form of a supportive partner, "it adds a whole other layer of support that someone alone or in a non-supportive relationship won't have," she said.
For RA patients in troubled marriages, the findings suggest that efforts to improve the couple's communication and coping skills might boost health and functioning for the RA patient, the authors said.
Because only traditional marriages were evaluated, further research should look at the effect of a high-quality relationship between committed but unmarried partners, both same-sex and heterosexual, the authors said.
To learn more about rheumatoid arthritis, visit the Arthritis Foundation.
Source: SOURCE: Jennifer Barsky Reese, Ph.D., postdoctoral fellow, department of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine, Baltimore; Nancy Klimas, M.D., professor, medicine, University of Miami Miller School of Medicine; October 2010 The Journal of Pain
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