patients from both sex, aged more than or equal 18 years old, attending Physical Medicine, Rheumatology and Rehabilitation department, Assiut University Hospital, on current diagnosis of RA from at least 6 months and current treatment with one or more of DMARDS, with cognitive level enabling them to interact in the study, and free from psychiatric diagnosis other than effective disorder, associated disability due to neurological disorder or trauma and also free from major internal organ failure.