RHEUMATOID arthritis stigma may be reduced through stronger social support, higher self-esteem, and more positive coping.
Rheumatoid Arthritis Stigma Linked to Support
Patients with rheumatoid arthritis frequently experience moderate stigma, with new multicenter data suggesting that social support may play a clinically meaningful role in reducing that burden. The cross-sectional study identified self-esteem and coping modes as mediators in the relationship between social support and rheumatoid arthritis stigma, pointing to potential nursing intervention targets beyond disease activity alone.
The analysis included patients with rheumatoid arthritis recruited by convenience sampling from rheumatology departments at four hospitals in China between June and September 2023. Researchers assessed stigma, social support, self-esteem, and coping styles using the Internalized Stigma of Mental Illness Scale-Rheumatoid Arthritis, Social Support Rating Scale, Rosenberg Self-Esteem Scale, and Medical Coping Modes Questionnaire.
Self-Esteem and Coping Shape Stigma Burden
Participants had a mean age of 53.62 years, with a standard deviation of 12.40 years. Stigma scores differed significantly by family history, income, education, morning stiffness duration, DAS28 score, and pain level, with all comparisons reaching p<0.001.
Rheumatoid arthritis stigma was negatively correlated with self-esteem, confrontation coping, and social support. The strongest negative association was observed with social support, followed by confrontation coping and self-esteem. By contrast, stigma was positively correlated with avoidance and acceptance coping, suggesting that less active coping responses may align with greater internalized stigma.
Social support had a direct negative association with stigma, with a β value of -0.502. It was also indirectly associated with stigma through self-esteem and coping modes. These indirect pathways accounted for 31.51% of the total association between social support and stigma.
Clinical Implications for Nursing Care
The findings suggest that stigma in rheumatoid arthritis is not only shaped by clinical disease features, but also by psychosocial resources and patient response patterns. For healthcare professionals, this reinforces the value of identifying patients with lower social support, reduced self-esteem, or less constructive coping styles during routine care.
Nurses may be especially well positioned to help patients build positive support networks, strengthen self-esteem, and adopt more active coping modes. While the cross-sectional design prevents causal interpretation, the results highlight actionable areas for psychosocial support that may improve wellbeing for patients living with rheumatoid arthritis.
Reference
Zhang Y et al. Self-Esteem and Coping Modes as Mediators of the Social Support-Stigma Relationship in Rheumatoid Arthritis Patients: A Multicentre Cross-Sectional Study. Nurs Open. 2026;13(6).
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