Psychoimmunology and rheumatoid arthritis: concepts and methodologies.

The recent growth of knowledge about the immune-neuroendocrine network has important implications for future research into psychosomatic hypotheses about the aetiology of rheumatoid arthritis. The available evidence suggests that three phases of the aetiological process in rheumatoid arthritis need to be considered separately because of the different role that psychological and social variables may play at different points of the disease. These are the loss of immunological tolerance, the onset of joint inflammation and the long-term disease course. It is suggested that future studies will need to be prospective, include multiple sampling techniques and comparisons within patient groups if they are to elucidate the precise role of psychoneuroimmunological factors in rheumatoid arthritis.