Mindfulness program may improve some rheumatoid arthritis symptoms

By Shereen Lehman

By Shereen Lehman (Reuters) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study. “I think these findings are pretty consistent with other studies of mindfulness and chronic conditions,” said Mary Jo Kreitzer, who was not involved in the research. Although it was small, and relatively brief, the study’s findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing. “I would say more research is needed to really understand how the mechanisms work,” Kreitzer told Reuters Health, “so this trial is incredibly encouraging, but it’s not definitive.” Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds. “Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease,” write the study authors in Annals of the Rheumatic Diseases. Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia – a widespread pain syndrome of unknown cause – MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja). But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients. They wanted to see if mindfulness techniques had any impact on the disease process itself. Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels. For their study, Fogarty’s team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study. The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants’ disease symptoms. These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients’ own assessments of their stiffness and pain based on a scale of 1 to 100. On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group. There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups. The authors conclude that MBSR likely helped participants by changing their “experience” of the disease. “This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis,” the authors write. “I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out,” Kreitzer said. “Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation,” she said. Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There’s so much that people can do on their own,” she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms. MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said. “People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities,” she said. SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104. (This story has been refiled to correct spelling of Dr. Kreitzer's name in paragraphs 20 and 21)