Rheumatoid Arthritis (RA) is a severe chronic progressive inflammatory autoimmune disorder of unknown etiology. Genetic and environmental causes are believed to have a role, as in the case of other autoimmune diseases. The disease is characterized by systemic inflammation where the connective tissues (cartilage and joint synovium) are most frequently targeted and affected. It is associated with personal cost and challenge, due to the increasing prevalence, chronic periodicity with acute exacerbations, functional impairment and progressive disability. For almost a century it has been observed that there is an epidemiological link and associations between RA and psychological problems . Patients with RA have a high prevalence of depression comorbidity.

The lifetime prevalence of depression in RA patients was reported to be 41-66% [6-8]. A Canadian study reported that the prevalence of depression was 46% higher in patients with RA compared to a matched control group. The factors that contribute to depression in rheumatic patients are diverse. It is not clear whether the mechanism of psychiatric comorbidity related to the immune-inflammatory state or it is a squeal of the chronic illness and disability. The disease activity with long term pain suffering from somatic symptoms functional limitations and disease progression may contribute to depression development.

Psychiatric disorders have been identified as major causes of disease burden and disability. They can worsen HealthRelated Quality Of Life (HRQoL) compromise medical treatment, management and leading to high costs of health care services. Moreover RA patients with comorbid depression were shown to have increased levels of pain, irrespective the disease activity and expanded mortality rates. Comorbid depression is an independent risk factor for cardiovascular disease as myocardial infarction and increase overall mortality. Several studies suggested that depression may also be important determinants of work impairment. In RA, depression has been found to predict future disability pension and functional disability.