Zusammenfassung
Rheumatische Krankheiten definieren eine heterogene Krankheitsgruppe mit prominenten Schmerzen des Bewegungsapparats und resultierender Bewegungseinschränkung. Es liegen häufig systemische Autoimmunprozesse zugrunde. Die Prävalenzraten von koexistenten Depressionen und Ängsten sind bei allen rheumatischen Krankheiten signifikant erhöht und je mit negativeren Krankheitsverläufen verbunden. Zumindest für eine rheumatoide Arthritis und einen systemischen Lupus ist empirisch nachgewiesen, dass präexistente affektive und Stress-bezogene Störungen mit einem erhöhten Inzidenzrisiko assoziiert sind. Psychologisch ist der Einfluss von chronischen Schmerzen mit Einschränkungen der allgemeinen Bewegungsfähigkeit prominent. Diese Zusammenhänge müssen auch neurobiologisch reflektiert werden. In den Schmerzzirkel sind Effekte von Angst, Depression und PTBS integral miteinzubeziehen. Lokale pathophysiologische (autoimmune, degenerative, inflammatorische) Prozesse in den Gelenken und angrenzenden Bindegewebsstrukturen gehen über einen Feedbackmechanismus mit einer neuroinflammatorischen Aktivität des ZNS einher. Hierüber werden eine erhöhte affektive und kognitive Vulnerabilität, chronische Müdigkeit, verstärkte Schmerzsensitivität sowie Schlafstörungen induziert. Studien zur Psychotherapie und Pharmakotherapie koexistenter affektiver und Stress-bezogener Symptome bei den diversen rheumatischen Krankheiten werden referiert.
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Kapfhammer, HP. (2022). Rheumatische Erkrankungen. In: Depression, Angst, traumatischer Stress und internistische Erkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-65873-4_10
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