Pain, isolation and depression are a vicious cycle of arthritis. Many people ignore the cycle because they think the symptoms are not real, but "only in the mind."

Psychological symptoms, such as depression, are closely connected to physical symptoms, such as pain. Once symptom intensifies the other, creating a cycle. Here's how the cycle works:

Because of pain, people tend to limit their activities and often their interaction with other people. They say things like, "I won't go this time. I'd rather lie down for a while" or "I won't exercise today. I'm tired." This leads to isolation.

Isolation can start slowly and become a way of life. Friends who are turned down repeatedly might stop calling. Hobbies and other interests become less important. Pain becomes a more important part of life. This leads to depression.

Medical studies show that depression decreases the body's immune system and thus its ability to fight disease. Depressed people feel their physical pain more intensely. Feeling "blue" robs a person of energy, which leads to less activity, more pain, more isolation, more depression, to begin the cycle again.

The following are some ways to break this cycle:

• First, decide on the kind of exercises and activities you are most likely to enjoy and do regularly. Get your doctor's approval.
• Make your activities and exercises as important in your schedule as taking your medicine.
• Understand the value of pleasurable activity and repetitive exercise. They release endorphins, the body's natural painkilling substance. Extensive research has shown that listening to music, laughing, handicraft, prayer, meditation and exercise decrease pain. Even simple exercises such as doing stretches while sitting in a chair give you some control over arthritis pain. It does not have to control you.

Exercise increases your range of motion. Think of your joints as becoming "rusty" when they are not used. Exercise strengthens and tones your muscles. Strong muscles are better able to move your joints and keep them healthier.