Chen XM, Cheng X, Wu W. Dynamic psychological vulnerability and adaptation in rheumatoid arthritis: Trajectories, predictors, and interventions. World J Psychiatry 2026; 16(1): 111812 [DOI: 10.5498/wjp.v16.i1.111812]
Corresponding Author of This Article
Wei Wu, MD, Department of Traditional Chinese Medicine and Rheumatism Immunology, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyanzheng Street, Shapingba District, Chongqing 400038, China. wuwei@tmmu.edu.cn
Research Domain of This Article
Psychiatry
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jan 19, 2026; 16(1): 111812 Published online Jan 19, 2026. doi: 10.5498/wjp.v16.i1.111812
Dynamic psychological vulnerability and adaptation in rheumatoid arthritis: Trajectories, predictors, and interventions
Xue-Meng Chen, Xian Cheng, Wei Wu
Xue-Meng Chen, Xian Cheng, Wei Wu, Department of Traditional Chinese Medicine and Rheumatism Immunology, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
Co-first authors: Xue-Meng Chen and Xian Cheng.
Author contributions: Chen XM and Cheng X contributed equally to study conception, systematic literature search, data extraction, and manuscript drafting as co-first authors; Wu W supervised the study design, provided critical revisions of the manuscript, and approved the final version for submission. All authors approved the final version to publish.
Supported by Chongqing Health Commission and Chongqing Science and Technology Bureau, No. 2023MSXM182.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Wu, MD, Department of Traditional Chinese Medicine and Rheumatism Immunology, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyanzheng Street, Shapingba District, Chongqing 400038, China. wuwei@tmmu.edu.cn
Received: August 6, 2025 Revised: September 14, 2025 Accepted: October 30, 2025 Published online: January 19, 2026 Processing time: 146 Days and 19 Hours
Abstract
Rheumatoid arthritis (RA) patients face significant psychological challenges alongside physical symptoms, necessitating a comprehensive understanding of how psychological vulnerability and adaptation patterns evolve throughout the disease course. This review examined 95 studies (2000-2025) from PubMed, Web of Science, and CNKI databases including longitudinal cohorts, randomized controlled trials, and mixed-methods research, to characterize the complex interplay between biological, psychological, and social factors affecting RA patients’ mental health. Findings revealed three distinct vulnerability trajectories (45% persistently low, 30% fluctuating improvement, 25% persistently high) and four adaptation stages, with critical intervention periods occurring 3-6 months post-diagnosis and during disease flares. Multiple factors significantly influence psychological outcomes, including gender (females showing 1.8-fold increased risk), age (younger patients experiencing 42% higher vulnerability), pain intensity, inflammatory markers, and neuroendocrine dysregulation (48% showing cortisol rhythm disruption). Early psychological intervention (within 3 months of diagnosis) demonstrated robust benefits, reducing depression incidence by 42% with effects persisting 24-36 months, while different modalities showed complementary advantages: Cognitive behavioral therapy for depression (Cohen’s d = 0.68), mindfulness for pain acceptance (38% improvement), and peer support for meaning reconstruction (25.6% increase). These findings underscore the importance of integrating routine psychological assessment into standard RA care, developing stage-appropriate interventions, and advancing research toward personalized biopsychosocial approaches that address the dynamic psychological dimensions of the disease.
Core Tip: This review identifies three distinct psychological vulnerability trajectories in rheumatoid arthritis patients, with early intervention within 3-6 months post-diagnosis reducing depression incidence by 42% and maintaining benefits for 24-36 months. Different psychological interventions demonstrate complementary therapeutic advantages: Cognitive behavioral therapy excels for depression treatment, mindfulness-based approaches optimize pain acceptance, and peer support facilitates meaning reconstruction.
