Having a chronic illness like rheumatoid arthritis can put a lot of stress on a relationship — it could even lead to divorce.

Living with a chronic illness like rheumatoid arthritis can take a toll on your emotions and on your relationships, and can lead to intimacy difficulties and even divorce.

"Divorce is certainly a potential consequence of having a chronic disease like rheumatoid arthritis," says Kristin Flynn Peters, PhD, a clinical health psychologist and clinical assistant professor at the School of Health Professions at the University of Missouri in Columbia. In fact, the divorce rate among people with rheumatoid arthritis (RA) has been reported to be as much as 70 percent higher than that in the general population.

One reason for the high rate of divorce among people with rheumatoid arthritis and severe rheumatoid arthritis symptoms is that when one spouse has a chronic illness that causes severe pain and is debilitating, it can put strain on the marriage, no matter how strong that relationship is. "As the disease progresses and damage gets to the point of visible physical changes, many people may feel unattractive, and that changes how they relate to their spouse," says Flynn Peters. Also, spouses may become resentful when one partner is too fatigued to do what she had been doing for the household, whether it's taking the children to school, shopping for groceries, or making dinner. Surveys also show that many people with rheumatoid arthritis who are divorced do not remarry, Flynn Peters says.

Related: 10 Tips for Juggling RA and Family

When people with RA, especially women, are divorced and single parents, they may be under more stress, which can exacerbate their health condition. Stress can develop over such issues as shared child care and money. "They also may be grieving over the lost marriage, the changes in body image associated with RA, and the greater challenges of managing a household with ongoing rheumatoid arthritis symptoms of pain and fatigue," Flynn Peters says.

Rheumatoid arthritis also can interfere with intimacy between couples. "The physical changes of joints can cause women and men to feel unattractive," Flynn Peters says. "This can change their motivation for intimacy. The joint pain and overall fatigue that rheumatoid arthritis causes can interfere with the logistics of sexual intercourse."

Some data also suggests that men with RA are likely to experience higher rates of erectile dysfunction (ED). "Originally, researchers thought that ED was because some folks with RA also have cardiovascular disease," Flynn Peters says. "But [they] recently found that men with RA alone, perhaps because of the medications, have higher rates of ED than the general population. More studies are needed to examine the effects of RA medications and the disease itself on ED and on women's abilities to have orgasms."

Coping With RA, Relationships, and Divorce

If you have RA, these tips may help you develop a more successful partner relationship:

Adjust your expectations. "When you get rheumatoid arthritis, you have to adjust your expectations and so does your spouse," Flynn Peters says. The spouse with rheumatoid arthritis may be in bed part of the day and can't contribute to running the household like she did before becoming ill. Everyone must realize the change and adapt, or resentment and more stress will build. If you set realistic expectations — perhaps the spouse with RA agrees to do more on days when feeling better — neither of you will be set up for disappointment.

Vivienne Lloyd-Williams, who has had RA for 19 years and is divorced, has found that being realistic is very important. "Know that the things that might take other people 10 minutes might take you an hour, and be prepared to organize your life around this. Don't put pressure on yourself," says Lloyd-Williams, who now lives in Wales, United Kingdom.

Seek support. If you have RA and are divorced, joining a support group can be very helpful. You can find support groups that meet locally or online. Research has shown that arthritis support groups can help participants improve their mood, provide better coping skills, decrease pain, and bring relief from negative emotions, such as the fear, resentment, and hopelessness that are often associated with divorce. The key to a successful support group is not making it a gripe session, but a place where members can share experiences and talk about what works for them.

Speak up. "You need to work on your communication skills," Flynn Peters says. "Let people know, ‘I am having a flare. I need your help.'" You will get the help you need if you're specific. Don't just say, "Can you help?" Say, "Can you get my kids at school at 2 p.m.?" or "Can you bring me dinner tonight?" The more specific you are, the better people will be able to help you and the more likely you are to get the help you really need.

Very often patients with RA look "normal," which makes it harder for their spouses to understand why they're behaving differently, Flynn Peters says. "The visible changes in their hands and joints don't happen right away, so a person with rheumatoid arthritis symptoms can be experiencing the stiffness and joint pain, but otherwise look okay. That can make it hard for the healthy spouse to understand. The couple needs to be on the same page about what's going on with the illness, and often the person with RA has to talk about what's going on and what they're feeling so everyone knows."

Related: Sex and Intimacy With Rheumatoid Arthritis

Find new ways of being intimate. If you have a partner or are seeing someone new, plan ahead for sex. The partner with arthritis can prepare by taking pain medication and saving her energy for the date. Offering a massage with a loving touch also may help the partner with RA relax and get in the mood.

When you have a chronic illness such as RA, sometimes you have to work even harder at relationships, even ones that are strong and long lasting. For women with RA, coping with divorce can be another stressor, and stress can exacerbate rheumatoid arthritis symptoms.

Knowing how to communicate your needs and having a positive outlook are essential. Lloyd-Williams says it is really all about attitude. "I fully realize that although my disability can be held in check with drugs, it is my state of mind that has the biggest effect on my health and emotional well-being," she says.