Written by Joyce Smith, BS. Eight weeks of intensive yoga practice significantly decreased the severity of physical and psychological symptoms in patients with active rheumatoid arthritis (RA) .
RA is a heterogeneous autoimmune disease that is the unintended consequence of genetic and environmental factors. It causes extensive systemic inflammation, cartilage damage, and synovial hyperplasia that leads to physical disability and psychiatric comorbidity 1,2. Depression, which often accompanies individuals with RA, poses a significant healthcare burden on the patients, their caregivers, healthcare systems, and society as a whole 3. Existing medical therapies for RA are limited in their ability to treat the psychological component of the disease and have numerous side effects. RA patients with depression often display less tolerance and compliance to medical treatment, which impair health outcomes and exacerbates disease severity 4. The pathogenesis of RA involves an accelerated inflammatory response that generates free radicals such as reactive oxygen species (ROS) resulting in oxidative stress (OS) and cell membrane and DNA damage. An important treatment objective is to achieve a state of disease remission. Several studies have shown value in mind body interventions (MBIs) for improving wellbeing and quality of life 5. Yoga practice, with its mind body-based physical activities, facilitates self-regulation and behavior modification 6; however, more research is needed to expand the knowledge of its effect on multiple pathways at both cellular and molecular levels to better understand the processes involved in disease remission.
In a study by Gautum et al 7, 72 RA patients were randomized into a yoga mind-body intervention (MBI) group and a control group without MBI. The yoga MBI group practiced 120 minutes of modified yoga per day, five days a week for a duration of eight weeks. Test and control groups simultaneously underwent routine drug therapies (DMARDs). The study objectives were to determine changes in RA severity as evidenced by changes in levels of systemic biomarkers of inflammation, cellular aging, and oxidative stress, functional status, and disease activity from baseline to week 8. In addition, changes in severity of patient depression were measured by Beck Depression Inventory-11 scale (BDI-11) scores from baseline and at weeks 2, 4, 6, and 8.
Compared to the control group, eight weeks of yoga BMI significantly improved biomarkers of neuroplasticity, increasing BDNF, serotonin, and ß endorphins; significantly decreasing systemic inflammation biomarkers including ESR, CRP, IL-6, IL-17A and TNF-α; and significantly increasing anti-inflammatory cytokine and immunomodulatory marker TGF-ß and soluble HLA-G. Also significantly increased were cellular health and integrity biomarkers such as ROS and TAC. Only the yoga MBI group demonstrated an increase in telomerase activity while telomere length remained unchanged in both groups. Depression decreased significantly in the BMI group as well. Overall, the improvements seen in the psychological health and the reductions in disease severity of the yoga MBI group contributed greatly to the increased compliance apparent within the group as well as the group’s ability to perform more daily chores with less difficulty.
These results provide evidence that yoga MBI positively modifies the pathobiology of autoimmunity at both cellular and molecular levels by targeting mind-body communications, thus making RA remission a more achievable treatment goal. In addition, the yoga MBI regimen combined with routine drug therapy reduced the severity of depression by promoting neuroplasticity.
Limitations include the absence of an active control group that, in addition to drugs taken, had some form of exercise intervention to compare with the asanas, dhyana and pranayama practiced by the yoga MBI group. Large scale studies designed to further explore yoga’s contribution to RA treatment are warranted.
Source: Gautam, Surabhi, Madhuri Tolahunase, Uma Kumar, and Rima Dada. “Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial.” Restorative neurology and neuroscience 37, no. 1 (2019): 41-59.
© 2019 – IOS Press and the authors.
Posted April 22, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. New England Journal of Medicine. 2011;365(23):2205-2219.
- Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular Manifestations in Rheumatoid Arthritis. Maedica. 2010;5(4):286-291.
- Sambamoorthi U, Shah D, Zhao X. Healthcare burden of depression in adults with arthritis. Expert review of pharmacoeconomics & outcomes research. 2017;17(1):53-65.
- Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nature reviews Rheumatology. 2016;12(9):532-542.
- Fernros L, Furhoff AK, Wändell PE. Improving quality of life using compound mind-body therapies: evaluation of a course intervention with body movement and breath therapy, guided imagery, chakra experiencing and mindfulness meditation. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2008;17(3):367-376.
- Gard T, Noggle JJ, Park CL, Vago DR, Wilson A. Potential self-regulatory mechanisms of yoga for psychological health. Front Hum Neurosci. 2014;8:770.
- Gautam S, Tolahunase M, Kumar U, Dada R. Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial. Restorative neurology and neuroscience. 2019;37(1):41-59.
