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There is still proportionally little agreement about nearly all topics according to arthritis; the character and progress of pain and fatigue in arthritis itself as well as their relations with problematic moods and several resources/burdens, as personal and network characteristics. The literature review found that there is no direct attribution between pain and affective problems. On the other hand symptoms were of great impact for psychiatric illnesses but mediated also between inflammation and stress. It is well documented in this report that the degree of fatigue as well as pain and other factors can predict depression.  Few studies could detect that a past episode of depression could have the effect of trigging more pain at the beginning of arthritis was higher than in people without a depression history. Furthermore social distress had a strengthening effect on this relation. Other studies introduce that psychosocial factors had impact on the relation between RA symptomatic and mood problems which are found to correlate  and some researchers  detected that helplessness affect depression but also increases pain perception and mediate the relation between depression and pain and other even found that that internal attributions as helplessness enforce pain perception and depression. These findings are well documented in Covic  2006; Zautra (2007; Frantom, 2006; Chaney, 2004)

 

Our interviews indicates that arthritis could develop sence of fatigue an depression  or ,anxiety which could lead to social distress. However,  social support is important to comfort patent and mediate the impact of loneliness  or social isolation. Thus, good social support is particularly important for coping with symptoms as fatigue, pain and emotions in rheumatoid arthritis whereby accretive social isolation and problematic social support worsen the experience of disease symptoms. Evdence on this was recorded in   Krol, et.al, 1993, Morrison & Bennet, 2006; Riemsma, et.al, 2000, and Szotek, 2010.

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