Gautam Surabhi, Tolahunase Madhuri, Kumar Uma, Dada Rima
Department of Anatomy, Laboratory for Molecular Reproduction and Genetics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Rheumatology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Restor Neurol Neurosci. 2019;37(1):41-59. doi: 10.3233/RNN-180875.
BACKGROUND: Recovery of patients with rheumatoid arthritis (RA) depends on several physical and psychological factors, besides pharmacological treatment. Co-morbid depression adversely affects the outcome in RA. Usual medical therapies have a limited scope and fail to cure the psychological component of the disease. With advanced therapeutic options, achieving a state of remission has become the treatment goal, yoga based mind body intervention (MBI) may provide a holistic approach in its treatment dimension. Hence, MBIs are the need of hour as majority of diseases have a psychosomatic component. OBJECTIVE: To explore the effect of Yoga based MBI on disease specific inflammatory markers and depression severity in active RA patients on routine disease modifying anti-rheumatic drugs (DMARDs) therapy. METHODS: A total of 72 RA patients were randomized into 2 groups: yoga group (yoga with DMARDs) and control group (DMARDs only). Blood samples were collected pre and post intervention for primary outcome measurements of systemic biomarkers. Disease activity score 28, erythrocyte sedimentation rate (DAS28ESR) and health assessment questionnaire disability index (HAQ-DI) were used to assess disease activity and functional status respectively at pre and post intervention time-points. Secondary outcome, depression severity, was assessed by Beck Depression Inventory II scale (BDI-II) at 2 weekly intervals during 8 weeks of the study interventional plan. RESULTS: After 8 weeks of yoga based MBI, there was significant decrease in the severity of RA as seen by reduction in levels of various systemic inflammatory markers as well as in DAS28ESR (p-value <0.0001; effect size = 0.210) and HAQ-DI (p-value 0.001; effect size = 0.159). Also, yoga group experienced a statistically significant time dependent step-wise decline in depression symptoms over the period of 8 weeks as compared to control group (p-value <0.0001; effect size = 0.5). Regression analysis showed greater reduction in the scores of BDI-II with DAS28ESR (R2 = 0.426; p < 0.0001) and HAQ-DI (R2 = 0.236; p = 0.003) in yoga group. CONCLUSIONS: Yoga, a mind body intervention re-established immunological tolerance by aiding remission at molecular and cellular level along with significant reduction in depression. Thus in this severe autoimmune inflammatory arthritis with a major psychosomatic component, yoga can be used as a complementary/adjunct therapy.
背景：类风湿关节炎（RA）患者的康复除药物治疗外，还取决于多种生理和心理因素。共病抑郁症会对RA的治疗结果产生不利影响。常规医学疗法作用有限，无法治愈该疾病的心理方面。随着治疗选择的不断进步，实现缓解状态已成为治疗目标，基于瑜伽的身心干预（MBI）可能在其治疗层面提供一种整体方法。因此，由于大多数疾病都有身心成分，MBIs是当下的需求。 目的：探讨基于瑜伽的MBI对接受常规改善病情抗风湿药物（DMARDs）治疗的活动性RA患者的疾病特异性炎症标志物和抑郁严重程度的影响。 方法：总共72例RA患者被随机分为2组：瑜伽组（瑜伽联合DMARDs）和对照组（仅使用DMARDs）。在干预前后采集血样，用于主要结局指标系统性生物标志物的测量。疾病活动评分28、红细胞沉降率（DAS28ESR）和健康评估问卷残疾指数（HAQ-DI）分别用于在干预前后的时间点评估疾病活动度和功能状态。次要结局指标抑郁严重程度，在研究干预计划的8周期间每2周通过贝克抑郁量表II（BDI-II）进行评估。 结果：基于瑜伽的MBI干预8周后，多种系统性炎症标志物水平以及DAS28ESR（p值<0.0001；效应量=0.210）和HAQ-DI（p值0.001；效应量=0.159）降低，RA严重程度显著降低。此外，与对照组相比，瑜伽组在8周期间抑郁症状出现了具有统计学意义的随时间逐步下降（p值<0.0001；效应量=。回归分析显示，瑜伽组BDI-II评分随DAS28ESR（R2=0.426；p<0.0001）和HAQ-DI（R2=0值0.236；p=0.003）的降低幅度更大。 结论：瑜伽这种身心干预通过在分子和细胞水平辅助缓解以及显著减轻抑郁，重新建立了免疫耐受。因此，在这种具有主要身心成分的严重自身免疫性炎症性关节炎中，可以将瑜伽用作辅助/补充疗法。
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