Press Release
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Embargoed For Release at 5:30 pm PT, Sunday Nov. 13, 2005
Arthritis News
STILL THE MIND, CALM THE RHEUMATOID ARTHRITIS
SAN DIEGO, CALIFORNIA – Utilizing meditation to reduce stress has shown
promise in alleviating some symptoms of rheumatoid arthritis patients,
according to research presented this week at the American College of Rheumatology
Annual Scientific Meeting in San Diego, California.
Meditation has been a practice of contemplative traditions for centuries.
However, the study of its therapeutic properties has occurred more recently,
with published scientific investigations indicating its association with
reduced cardiovascular risk factors, decreased psychological distress
and improved sleep patterns. Support for this approach has grown, thanks
to research suggesting that programs like the Mindfulness-Based Stress
Reduction (MBSR) program, which incorporates meditation, yoga and relaxation
exercises, may lead to these beneficial results.
To more definitively assess the effect of MBSR in reducing psychological
distress and rheumatoid arthritis disease activity, researchers conducted
a study among 63 predominately female rheumatoid arthritis patients. Participants
were randomly assigned to either an MBSR class once a week for eight weeks
or a waitlist control group. The MBSR group was asked to practice meditation,
yoga and relaxation exercises at home six days a week. The waitlist control
group was offered the MBSR class at the end of the study.
All participants were asked to attend assessment sessions at the time
they joined the study, two months later and again six months later. The
assessments included an examination by a rheumatologist for tender and
swollen joints, completion of a self-report questionnaire to monitor psychological
distress and a blood test to measure erythrocyte sedimentation rate, a
non-specific test of inflammation. All participants remained under the
regular care of their rheumatologists during the study and continued with
their normally prescribed medications.
When the study began, both groups showed moderate levels of disease activity
and above normal levels of psychological distress. Two months later, there
was no change in disease activity, but the MBSR group showed a 20 percent
reduction in psychological distress compared to the control group. At
the end of the six month observation period, there was a 33 percent reduction
in psychological distress, an 11 percent decrease in rheumatoid arthritis
disease activity and a 46 percent decrease in erythrocyte sedimentation
rate (indicating less inflammation) in the MBSR group compared to the
control group, all of which were statistically significant.
“While physicians have treated rheumatoid arthritis competently with
a range of effective medications, this study shows that mindfulness-based
stress reduction may complement that therapy and provide additional benefit
to people with this disease,” said Elizabeth Kimbrough Pradhan, MPH, co-investigator
of the study led by Brian Berman, MD, at the Center for Integrative Medicine
at the University of Maryland School of Medicine, Baltimore. “Our results
indicate that MBSR may reduce psychological distress and disease activity
among rheumatoid arthritis patients. Doctors may wish to recommend a meditation-based
program to patients in addition to the medication regimen already prescribed.”
The American College of Rheumatology is the professional organization
for rheumatologists and health professionals who share
a dedication to healing, preventing disability and curing arthritis
and related rheumatic and musculoskeletal diseases. For more information
on the ACR's annual meeting, see www.rheumatology.org/annual.
###
Editor's Notes: Ms. Pradhan will present this research during a scientific
session at the ACR Annual Scientific Meeting from 10:15-11:45 am PT
on Thursday, November 17, 2005 in the Marriott-South Tower, Level 3,
Ballroom, Salon E. She will be available for media questions and briefing
at 8:30 am PT on Tuesday, November 15, in Room 23 A of the San Diego
Convention Center.
Presentation Number: 1968
Effect of Mindfulness-Based Stress Reduction in Patients with Rheumatoid
Arthritis
Elizabeth K. Pradhan, Barry Handwerger, Brian Berman, Adele Gilpin, Marc
Hochberg. University of Maryland School of Medicine, Baltimore, MD
Purpose:
The Mindfulness-Based Stress Reduction (MBSR) program incorporates
mindfulness meditation, yoga and relaxation exercises. Research has shown MBSR
beneficial in several patient populations. A pilot study was designed to assess
the effect of MBSR in reducing psychological distress and disease activity
among rheumatoid arthritis (RA) patients.
Methods:
A randomized, waitlist-controlled pilot study was conducted. Participants were
randomized to either MBSR class once a week for 8 weeks or a waitlist control
group. The MBSR group were asked to practice at home 6 days a week the exercises
learned in class. Participants were evaluated at baseline and 10 and 24 weeks
past baseline. Assessment included a rheumatologist's examination of tender
and swollen joints, an erythrocyte sedimentation rate (ESR), and self-report
questionnaires. Psychological distress was measured by the Symptoms Checklist-90
Revised. RA disease status was measured by the Disease Assessment Score-28
(DAS28), an algorithm including tender and swollen count of 28 joints, ESR,
and patient disease assessment. Repeated measures analyses were performed
on an intent-to-treat basis to determine treatment effects at 10 and 24 weeks.
Changes in outcome measures pre- to post-intervention were analyzed by paired
t-tests within treatment group.
Results:
2 participants withdrew. Of 61 remaining, complete data ranged 83-100%. The
sample was predominantly female, well educated and of mid to high socioeconomic
status. 74.6% took DMARDs, 15.9% biologic response modifiers, 50.8% NSAIDS
and 31.8% corticosteroids. Psychological distress measured above normal at
baseline, falling in the 73 rd centile of the referent normal population.
Mean (SD) DAS28 at baseline was 3.1 (1.2) in treatment and 3.3 (1.2) in control,
indicating moderate disease activity. Mean ESR, swollen and tender joints
at baseline were 22.1 (16.7), 3.3 (2.9), 2.9 (4.3) in MBSR and 22.1 (16.7),
3.8 (SD) 2.1 (2.3) in control. Preliminary analyses were conducted (database
as of 30/03/05). Final analyses will be presented at the ARHP conference.
Repeated measures analyses indicated treatment associated with 14% and 28%
reductions in psychological distress at 10 and 24 weeks (p=0.29, p=0.11,
respectively), reflecting a drop to 54 th centile by 24 weeks. The reduction
of psychological distress pre- to post-intervention was statistically significant
in MBSR group only (paired t-test, p=0.01 at 10 weeks, p=0.002 at 24 weeks).
There was no change in RA disease status at 10 weeks. At 24 weeks, repeated
measures analyses indicated treatment was associated with mean reductions
of 0.36 in DAS28 (p=0.17), 3.5 in ESR (p=0.36), and 1.7 in swollen joint
count (p=0.09). Decreases in DAS28, ESR and swollen joints pre- to post-intervention
were statistically significant in the MBSR group alone (paired t-tests, p=0.03,
0.04 and 0.04, respectively).
Conclusion: Preliminary data indicate a benefit of MBSR
in reducing some symptoms of RA patients.
Disclosure: E.K. Pradhan, None; B. Handwerger,
None; B. Berman, None; A. Gilpin,
None; M. Hochberg, None.
