**4. Conclusion**

208 Rheumatoid Arthritis – Etiology, Consequences and Co-Morbidities

They found significant gender-specific pattern in the use of coping strategies and their perceived effectiveness. The authors reported that females were significantly more likely than males to seek appropriate help and try to solve the problem, but also to use eating, cleaning, shopping, crying and praying. Interestingly enough, males were more likely to report using sex and masturbation in their attempt to cope than females. Both sexes

Cultural aspects of coping emerge as a new dimension in the ethnically diverse world today. Native Americans, for example, tend to turn to spiritual leaders and extended family (informal helping system) rather than to formal helping systems such as therapists (LaFramboisie, 2000). Similar findings have been reported for African Americans and Hispanic cultures (Sue & Sue, 1997); in England the Government's race equality strategy (Department of Health UK, 2003) have illustrated how local African community avoid statutory care systems and try to contain problems in their homes long beyond the expected point of seeking outside help. This could be a result of natural difficulty with disclosing problems or sharing emotions in this group or inadequacy of existing services to address their psychological needs. In his timely review Brendan Kelly (Kelly, 2003) highlighted that globalisation and large-scale social changes could induce a wave of 'anomie'in migrants, that is in essance a breakdown of social values (Durkheim, 1947). For Durkheim, in 1897 anomie arised more generally from a mismatch between personal or group standards and wider social standards, or from the lack of a social ethic, which produced moral deregulation and an absence of legitimate aspirations. For migrants living in a state where societal standing is compromised and social ties are broken, anomie becomes a nurtured

Patients do not respond to treatment in a predictable manner and show a wide variation in perception of causation. Individual preconceptions determine help seeking, compliance and treatment outcome, yet clinicians rarely explore these issues. Early exploration of illness

Lay illness representations often diverge from the clinician's understanding of the presenting problem and strongly influence treatment behaviour. Perception of the significance of decline in social functioning, including some losses in valued activities, which an individual regards as being important, e.g. visiting the family, going away on holiday is an important factor that only recently has been emphasised by Katz & Yelin (1995). In their 4-yr longitudinal study they found that patients' perception of a decline in valued activities by 10% was followed by a seven-fold increase in depression over the subsequent year. The self-regulation model (Leventhal et al, 1980) suggests that the cognitive and emotional aspects of illness perception guide the response to illness and determine the effectiveness of coping. Furthermore, five components of illness perception have been recognised: the identity of the illness (i.e., the symptoms and their labels); the perceived consequences of the illness; the illness's causation; its likely time line and the

Studies investigating the relationship between illness perceptions and coping show that the way affected people deal with their illness has great influence on their physical and

perceptions may enhance health behaviour and maximise the impact of intervention.

described avoiding others, doing nothing, and ignoring the problem as least helpful.

condition that has detrimental effects on their coping capacity.

potential for control and cure (Lau et al, 1989).

**3.2.7 Cultural aspects of coping** 

**3.3 Illness perception** 

While today we celebrate the advances in clinical science and in therapeutics, the enigmatic nature of RA still gives way to conceptualisation disparity. Indeed, despite some significant gains in the areas of immunopathology and genetics, Landré Beauvais' first clinical description of rheumatoid arthritis in 1800 encompasses most of what we know about this disease today. Where no single factor can provide a satisfactory explanation of a disorder in question, the biopsychosocial approach helps to position the multiple layers of existing knowledge in relation to it. Laboratory studies of inflammation and genetics provide the scientific basis of mainstream treatments, although the speciality still lacks good clinical and laboratory markers for making prognosis in each individual case.

In conclusion, our predecessors are to be congratulated for providing a platform for future developments. There are compelling data to suggest that the combination of earlier use of disease modifying treatments, attention to coexisting conditions and patient's coping and illness perception, that are considered to be important contributing factors in the relationship between physical and psychological factors in RA. The evolution and refinement of the newer therapies will allow more patients to realistically strive for disease remission and return of function in the near future. Rheumatologists of tomorrow are to be encouraged to carefully sift through the complex information generated during assessment process and to focus clinical and therapeutic developments where they can best be translated into better care for those with this taxing disease.

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**12** 

*Sweden* 

**Sexual Health and Intimate Relationships** 

The aim of this chapter is to describe how rheumatoid arthritis (RA) can affect sexual health and intimate relationships negatively and to explore some possible ways to improve sexual health for persons with RA. To introduce the subject the chapter will begin with a short introduction to the term sexual health and how chronic illness can affect sexual health. Thereafter follows a description of how RA affects sexual health and intimate relationships, current research in this field by the authors, suggestions on how to improve sexual health and intimate relationships for persons with RA, and finally new research in the area and

According to World Health Organization (WHO) (World Health Organization 2006) sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. Sexual health incorporates a positive and respectful approach to sexuality and sexual relationships, and includes the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. To have a good sexual health is not only absence of sexual diseases, but is connected to self-esteem, intimate relationships and general quality of life. Sexuality has a multidimensional nature consisting of biologic, affective, cognitive and motivational parts. During the lifespan, sexuality is an integrated part of life. A good sexual health is to many people an important factor in order to achieve a desired quality of life, but the essence of what is good sexual health differs between individuals. A description of what a good sexual health is can also differ during the lifespan for the same person due to life circumstances. According to a recent study one of the two main predictors of global life satisfaction is satisfaction with sexual life (Tasiemski, Angiaszwili-Biedna, and Wilski 2009). A person´s sexual health affects their intimate relationship. A poor sexual health can also affect the person's view of the possibilities of

Chronic illness affects the patient physically, psychologically, socially and in their relationship with their partner.. The impact of a chronic disease on sexual health can be due to indirect factors influencing sexual function such as altering self-image, fatigue, pain and dependency (Basson and Schultz 2007). Sexual health is one of the domains that can be

finding a partner to share an intimate relationship with.

**1. Introduction** 

conclusions.

**2. Background** 

 **in Rheumatoid Arthritis**

*1Lund University, Samrehab, Värnamo Hospital,* 

*2Futurum – Academy for Healthcare* 

Kristina Areskoug Josefsson1 and Ulrika Öberg2

