Rheumatoid arthritis (RA) is a chronic autoimmune disease that can affect your whole body — and as a result, how you feel about your body. While some RA-related changes are visible, such as joint damage or using a cane, others, like fatigue or pain, aren’t so apparent. But both kinds of changes can affect you psychologically and affect
body image, or how you feel about and perceive your body.
“The three most common emotions I see in people with rheumatoid arthritis are embarrassment, anger, and a deep sense of feeling out of control,” says Susan Albers, PsyD, a psychologist at the women’s health center at Cleveland Clinic in Wooster, Ohio.
“Embarrassment often comes from the visible changes in the body,” she says. “There is also a lot of anger. It can feel unfair that your body is changing in ways you did not choose or cannot control. And underneath that, there is often a feeling of losing control or even betrayal. That can be just as distressing as the physical symptoms.”
While RA’s impact on your body image may affect you greatly, there are ways to lessen the distress that stems from it and come to a place of greater acceptance, neutrality, and compassion.
RA causes many changes in how your body looks and functions. Whether it’s due to joint swelling, fatigue, or another
symptom of the condition, your experience of living in your body is different from how used to be, in ways that can be distressing.
Experiencing pain, developing a limp, and moving more slowly than you used to are also common RA-related physical changes, says Theodore R. Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York City.
Sometimes, people are reluctant to accommodate physical changes because of body image concerns.
Medication-related changes in appearance can also be hard to accept. Moderate to high-dose steroids can cause weight gain, fluid retention, a puffy face, or hair loss, Dr. Fields says, while
methotrexate’s side effects can include hair loss, swelling and sores in the mouth or throat, or skin reactions after sun exposure. And drugs that inhibit tumor necrosis factor (TNF), including adalimumab (Humira) and etanercept (Enbrel), can cause injection-site skin reactions, while janus kinase (JAK) inhibitors including upadacitinib (Rinvoq) and baricitinib (Olumiant) can lead to acne.
“The general psychological effect that patients talk about … is that it is making them ‘a different person,’” Fields says.
Dr. Albers agrees. There is “a shift in identity,” she says. “People often say they no longer feel like the version of themselves they are used to.”
A sense of betrayal can also hit those with RA hard. “Many people feel like their body is no longer on their side. When your body feels unpredictable, it can shake your sense of trust in it,” says Albers.
And the psychological impact of developing a negative body image can lead people to change their behavior. It might be hard to imagine yourself enjoying a party an old friend is throwing if you have a limp or swelling in your hands when you reach for the hors d’oeuvres, for example, so you opt not to go. Research indicates that body dissatisfaction can lead to social withdrawal and is connected to disruptions in social connections, which lessens your perception of how much social support you receive, as well as your feelings of belonging.
“Even simple things like going out in public or seeing friends can start to feel more emotionally loaded,” Albers says.
If the physical effects of RA have led you to develop a negative body image, there are a number of ways to improve how you feel.
Mindfulness
A shift toward
mindfulness — paying attention to the present moment, nonjudgmentally — may help increase body satisfaction when it’s practiced with kindness and self-compassion.
“Mindfulness is really about acceptance. That does not mean you have to love your body,” Albers says. “It means learning to accept it as it is, especially in this moment. It is a shift away from constantly evaluating how your body looks and toward noticing what your body does for you.”
“That might be noticing your breath, the ability to move in a way that feels okay, or even small moments of comfort,” she says. “This approach can take some of the pressure off. You are not trying to force positive feelings. You are simply creating space to relate to your body in a more neutral and compassionate way.”
Albers also suggests focusing on sensory experiences. “The feeling of soft clothing, a warm shower, or even stepping outside and noticing a breeze,” she says. “These moments may seem simple, but they help rebuild a positive connection with the body.”
Movement
Making the effort to move your body in ways that feel good can evoke a positive body image; that is, appreciating your body for what it
can do. According to research, exercise can decrease body dissatisfaction, and frequent movement is linked to a more positive body image.
But exercise can be hard with RA-related physical changes. “Movement that once boosted mood or helped someone feel energized can start to feel painful or draining,” says Albers. “Instead of being a source of relief, it can feel like something to avoid.”
“Over time, some people cope by emotionally checking out from their body altogether. They may try to numb or ignore what they are feeling because it is overwhelming,” she says. “But when you disconnect in that way, it does not just dull the discomfort. It can also dull positive sensations.”
Albers says that
finding ways to move that work with your body as it is right now is key. If cardio is too much, you might try yoga, tai chi, or stretching. Research has shown that
yoga and mindfulness-based exercise programs can also improve mood in people with RA.
And participating in shared tai chi sessions was found to provide an increased awareness of the links between mind and body, a reduction in anxiety and depression, and improvements in self-esteem and motivation in people with RA.
Optimizing Your Treatment Plan
It may also help to be proactive about fine-tuning your treatment regimen, to reduce the impact of side effects and improve your ability to function as much as possible. “At the same time, it is important to acknowledge that this is not always a perfect tradeoff,” says Albers.
“Sometimes the most effective treatments do come with side effects, and people may still have mixed feelings. You can feel grateful for relief and frustrated by the changes at the same time.”
It is important for people with RA patients to optimize their
disease-modifying medications so they have good control of disease activity and less unpredictable disease flares. This will improve swelling, pain, and possibly any visible abnormalities. Adjunctive (complementary) treatments can also help such as "physical therapy, local injections, topical pain relievers, nonsteroidal anti-inflammatory agents," Fields says. They can temporarily relieve pain and swelling while disease modifying medications are optimized. Complementary practices, like adequate nutrition and gentle exercise techniques, may also help mitigate side effects of medications.
Psychotherapy
Research has shown that several types of psychotherapy can support efforts to improve your body image, including acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT).
“Acceptance and commitment therapy, or ACT, is especially powerful here,” Albers says. “Instead of trying to fight or eliminate difficult thoughts or feelings, ACT helps people make space for them while still engaging in what matters most to them.”
She also says that DBT can be beneficial. “[It] can help with emotional regulation. It gives people tools to manage intense feelings like frustration, anger, or shame, without turning to unhelpful coping strategies.”
CBT works by helping people become aware of — and learn how to change — unhelpful thought patterns. “For example, if someone is thinking, ‘My body is broken’ or ‘I look terrible,’ CBT helps reframe those thoughts into something more balanced and less harsh,” Albers says.
She points out that mindfulness is core to all three types of therapy. “Mindfulness helps people reconnect with their body in a gentler, more neutral way.”
