Nonpharmacological Interventions for the Treatment of Rheumatoid Arthritis: A Focus on Mind-Body Medicine
Abstract
Rheumatoid arthritis (RA) is a chronic, autoimmune disease that affects approximately 1.3 million Americans. It is characterized by inflammation of the joints, most often affecting the hands, hips, and knees. Presently, there is no cure, and the commonly used pharmacological therapies are not always effective and have significant side effects, especially when used long term. Consequently, there is a need for alternative treatments for RA. Mind-body medicine (MBM), which uses the mind to affect disease processes, is a promising area for many pathological conditions, especially autoimmune disorders like RA. In this review, we highlight the basis for psychological-based interventions for the treatment of RA. The notion that the mind has an impact on immune function and several processes that underpin the pathophysiology of RA is well established. Correspondingly, there are several lines of evidence to indicate that psychological-based interventions can favorably affect these processes. Clinical trials of MBM in RA have most commonly assessed outcomes such as pain, functional disability, psychological status, coping abilities, self-efficacy, and joint involvement. Across studies, statistically significant improvements were found for all outcomes, though the clinical significance of these changes is open to interpretation. Given that the RA patients included in these studies had generally maximized the use of pharmacological options, any additional therapeutic benefit may be considered significant. Patients with a history of depression appear to exhibit heightened responsiveness to MBM, and this is a group that should be preferentially targeted. Based on the current evidence, MBM can be recommended as an adjunct to conventional therapy to enhance treatment response and possibly reduce the use of more risky pharmacological therapies.
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Statistically significant improvements with mind-body approaches were observed in pain, functional disability, psychological status, coping abilities, and self-efficacy in patients with both rheumatoid arthritis and a history of depression.
“statistically significant improvements with mind-body approaches were observed in pain, functional disability, psychological status, coping abilities, and self-efficacy in patients with both rheumatoid arthritis and a history of depression.28”
From <p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p> (2020) · cites this paper as [28]
Cites
Selye, H. (1956) · Medical Entomology and Zoology · Cited by 5,224 · see citing works
Maternal Immune Activation Alters Fetal Brain Development through Interleukin-6
Smith, S. E. P., Li, J., Garbett, K., Mirnics, K., & Patterson, P. H. (2007) · The Journal of Neuroscience · doi:10.1523/jneurosci.2178-07.2007 · Cited by 1,605 · see citing works
Cardiovascular death in rheumatoid arthritis: A population‐based study
Kremers, H. M., Nicola, P., Crowson, C. S., Ballman, K. V., & Gabriel, S. E. (2005) · Arthritis & Rheumatism · doi:10.1002/art.20878 · Cited by 934 · see citing works
Kremers, H. M., Crowson, C. S., Nicola, P., Ballman, K. V., Roger, V. L., Jacobsen, S. J., & Gabriel, S. E. (2005) · Arthritis & Rheumatism · doi:10.1002/art.20853 · Cited by 923 · see citing works
Whooley, M. A. (2008) · JAMA · doi:10.1001/jama.2008.711 · Cited by 887 · see citing works
Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies
BOSCARINO, J. A. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1314.011 · Cited by 691 · see citing works
New Drugs for Rheumatoid Arthritis
Olsen, N. J., & Stein, C. (2004) · New England Journal of Medicine · doi:10.1056/nejmra032906 · Cited by 632 · see citing works
Prenatal Infection as a Risk Factor for Schizophrenia
Brown, A. S. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj052 · Cited by 540 · see citing works
Stress, emotion, and human immune function.
O’Leary, A. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.108.3.363 · Cited by 519 · see citing works
Mind-Body Medicine: State of the Science, Implications for Practice
Astin, J. A., Shapiro, S. L., Eisenberg, D. M., & Forys, K. L. (2003) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.16.2.131 · Cited by 512 · see citing works
Lorig, K. R., Ritter, P. L., Laurent, D. D., & Plant, K. (2008) · Arthritis Care & Research · doi:10.1002/art.23817 · Cited by 440 · see citing works
Zautra, A. J., Davis, M. C., Reich, J. W., Nicassario, P., Tennen, H., Finan, P., Kratz, A., Parrish, B., & Irwin, M. R. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.3.408 · Cited by 430 · cited 4× · see citing works
“Several inflammatory markers have been implicated in the pathophysiology of vascular disease and are triggered in response to stress.(10,22) The stress response also decreases the ability of the immune system to fight infection.”
BackgroundInfluentialStress as a trigger of autoimmune disease
Stojanovich, L., & Marisavljević, D. (2007) · Autoimmunity Reviews · doi:10.1016/j.autrev.2007.11.007 · Cited by 423 · see citing works
Patterns of cardiovascular risk in rheumatoid arthritis
Solomon, D. H., Goodson, N. J., Katz, J. N., Weinblatt, M. E., Avorn, J., Setoguchi, S., Canning, C., & Schneeweiß, S. (2006) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2005.050377 · Cited by 414 · see citing works
THE STORY OF THE ADAPTATION SYNDROME
Selye, H. (1952) · The American Journal of the Medical Sciences · doi:10.1097/00000441-195212000-00039 · Cited by 329 · see citing works
Effect of Mindfulness‐Based stress reduction in rheumatoid arthritis patients
Pradhan, E. K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A. K., Magyari, T., Hochberg, M. C., & Berman, B. M. (2007) · Arthritis Care & Research · doi:10.1002/art.23010 · Cited by 309 · see citing works
Bradley, L. A., Young, L. D., Anderson, K. O., Turner, R. A., Agudelo, C. A., McDaniel, L. K., Pisko, E. J., Semble, E. L., & Morgan, T. M. (1987) · Arthritis & Rheumatism · doi:10.1002/art.1780301004 · Cited by 225 · see citing works
Health effects of emotional disclosure in rheumatoid arthritis patients.
Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997) · Health Psychology · doi:10.1037/0278-6133.16.4.331 · Cited by 217 · see citing works
Health effects of emotional disclosure in rheumatoid arthritis patients.
Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997) · Health Psychology · doi:10.1037//0278-6133.16.4.331 · Cited by 216 · see citing works
Sharpe, L., Sensky, T., Timberlake, N., Ryan, B., Brewin, C. R., & Allard, S. (2001) · Pain · doi:10.1016/s0304-3959(00)00379-1 · Cited by 182 · see citing works
Effects of stress management on clinical outcomes in rheumatoid arthritis
Parker, J. C., Smarr, K. L., Buckelew, S. P., Stucky‐Ropp, R. C., Hewett, J. E., Johnson, J. C., Wright, G. E., Irvin, W. S., & Walker, S. E. (1995) · Arthritis & Rheumatism · doi:10.1002/art.1780381214 · Cited by 181 · see citing works
Maternal Effects on Schizophrenia Risk
Patterson, P. H. (2007) · Science · doi:10.1126/science.1150196 · Cited by 175 · see citing works
Pain management in rheumatoid arthritis patients
Parker, J. C., Frank, R. G., Beck, N. C., Smarr, K. L., Buescher, K. L., Phillips, L. R., Smith, E. I., Anderson, S. K., & Walker, S. E. (1988) · Arthritis & Rheumatism · doi:10.1002/art.1780310503 · Cited by 169 · see citing works
Group education for patients with rheumatoid arthritis
Taal, E., Riemsma, R. P., Brus, H. L., Seydel, E. R., Rasker, J. J., & Wiegman, O. (1993) · Patient Education and Counseling · doi:10.1016/0738-3991(93)90131-f · Cited by 161 · see citing works
Behavioral intervention with and without family support for rheumatoid arthritis
Radojevic, V., Nicassio, P. M., & Weisman, M. H. (1992) · Behavior Therapy · doi:10.1016/s0005-7894(05)80305-3 · Cited by 150 · see citing works
NPY and Receptors in Immune and Inflammatory Diseases
Wheway, J., Herzog, H., & Mackay, F. (2007) · Current Topics in Medicinal Chemistry · doi:10.2174/156802607782341046 · Cited by 119 · see citing works
Lindroth, Y., Brattström, M., Bellman, I., Ekestaf, G., Olofsson, Y., Strömbeck, B., Stenshed, B., Wikström, I., Nilsson, J. Å., & Wollheim, F. A. (1997) · Arthritis & Rheumatism · doi:10.1002/art.1790100507 · Cited by 95 · see citing works
The effect of cognitive behavior therapy in patients with rheumatoid arthritis
Kraaimaat, F., Brons, M. R., Geenen, R., & Bijlsma, J. W. J. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00094-z · Cited by 95 · see citing works
Immune activation and depression in women with rheumatoid arthritis.
Zautra, A., Yocum, D., Villanueva, I., Smith, B. W., Davis, M. C., Attrep, J. F., & Irwin, M. R. (2004) · PubMed · Cited by 94 · see citing works
Graf, J. D., Scherzer, R., Grünfeld, C., & Imboden, J. B. (2009) · PLoS ONE · doi:10.1371/journal.pone.0006242 · Cited by 83 · see citing works
Prediction of mortality in rheumatoid arthritis based on disease activity markers.
Book, C., Saxne, T., & Jacobsson, L. (2005) · PubMed · Cited by 80 · see citing works
Maisiak, R., Austin, J. S., & Heck, L. W. (1996) · Arthritis & Rheumatism · doi:10.1002/art.1780390818 · Cited by 76 · see citing works
Scherrer, J. F., Virgo, K. S., Zeringue, A., Bucholz, K. K., Jacob, T., Johnson, R. G., True, W. R., Carney, R. M., Freedland, K. E., Xian, H., et al. (2009) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.04.001 · Cited by 65 · see citing works
Maisiak, R., Austin, J. S., West, S., & Heck, L. W. (1996) · Arthritis & Rheumatism · doi:10.1002/art.1790090111 · Cited by 61 · see citing works
Evaluation of a problem-solving intervention for patients with arthritis
DeVellis, B. M., Blalock, S. J., Hahn, P. M., DeVellis, R. F., & Hochbaum, G. M. (1988) · Patient Education and Counseling · doi:10.1016/0738-3991(88)90074-2 · Cited by 55 · see citing works
Field Research on the Relationship between Stress and Disease Activity in Rheumatoid Arthritisa
Zautra, A., Hamilton, N. A., Potter, P. T., & Smith, B. W. (1999) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1999.tb07664.x · Cited by 52 · see citing works
Social isolation stress exacerbates autoimmune disease in MRL/lpr mice
Chida, Y., Sudo, N., & Kubo, C. (2005) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2004.09.002 · Cited by 48 · see citing works
Group therapies for rheumatoid arthritis: A controlled study of two approaches
Strauss, G. D., Spiegel, J. S., Daniels, M. L., Spiegel, T. M., Landsverk, J. L., Roy‐Byrne, P., Edelstein, C. K., Ehlhardt, J., Falke, R. L., Hindin, L., et al. (1986) · Arthritis & Rheumatism · doi:10.1002/art.1780291004 · Cited by 40 · see citing works
Mind as healer, mind as slayer: MindBody medicine comes of age.
Pelletier, K. R. (2002) · PubMed · Cited by 25 · see citing works
Komuro (2001) · doi:10.1002/1529-0131(200112)44:12
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Cited by
Sorted by citations
Taylor, S. J., Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H. L., Schwappach, A., Purushotham, N., Jacob, S., Griffiths, C. J., Greenhalgh, T., et al. (2014) · Health Services and Delivery Research · doi:10.3310/hsdr02530 · Cited by 431 · see citing works
Prothero, L., Barley, E., Galloway, J., Georgopoulou, S., & Sturt, J. (2018) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2018.03.008 · Cited by 115 · see citing works
Mindfulness interventions for rheumatoid arthritis: A systematic review and meta-analysis
Zhou, B., Wang, G., Hong, Y., Xu, S., Wang, J., Yu, H., Liu, Y., & Liang, Y. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2020.101088 · Cited by 63 · see citing works
Psychosocial factors in people with chronic kidney disease prior to renal replacement therapy
McKercher, C., Sanderson, K. A., & Jose, M. (2013) · Nephrology · doi:10.1111/nep.12138 · Cited by 44 · see citing works
Ardakani, A., Seghatoleslam, T., Habil, H., Jameei, F., Rashid, R. B. A., Zahiroddin, A., Motlaq, F. E., & Arani, A. M. (2016) · Europe PMC (PubMed Central) · Cited by 44 · see citing works
Chronic physical illness: a psychophysiological approach for chronic physical illness.
Purdy, J. (2013) · PubMed Central · Cited by 31 · see citing works
Akyüz, G., & Keniş-Coşkun, Ö. (2017) · Rheumatology International · doi:10.1007/s00296-017-3867-2 · Cited by 29 · see citing works
Östlund, G., Björk, M., Thyberg, I. S. M., Thyberg, M., Valtersson, E., Stenström, B., & Sverker, A. (2014) · Clinical Rheumatology · doi:10.1007/s10067-014-2667-2 · Cited by 28 · see citing works
The effectiveness of yoga as a form of exercise in the management of rheumatic diseases
Kocyigit, B. F., Sagtaganov, Z., & Yessirkepov, M. (2023) · Rheumatology International · doi:10.1007/s00296-023-05291-9 · Cited by 24 · see citing works
Senra, H., Rogers, H. L., Leibach, G. G., Altamar, M. L. P., Olivera, S. L., Perrin, P. B., & Durán, M. A. S. (2014) · International Journal of Rheumatic Diseases · doi:10.1111/1756-185x.12412 · Cited by 20 · see citing works
Olsen, A. L., & Skjærven, L. H. (2016) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2015.1115568 · Cited by 16 · see citing works
Nguyen, T. T. T., Jensen, C. G., Khoury, L. R., Deleuran, B. W., Blom, E. S., Breinholt, T., Christensen, R., & Skov, L. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10143107 · Cited by 9 · see citing works
Graham‐Engeland, J. E., Song, S., Mathur, A., Wagstaff, D. A., Klein, L. C., Whetzel, C. A., & Ayoub, W. T. (2018) · Psychological Reports · doi:10.1177/0033294118796655 · Cited by 8 · see citing works
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D'Ippolito, M., Purgato, A., & Buzzi, M. G. (2020) · Journal of Pain Research · doi:10.2147/jpr.s236507 · Cited by 7 · see citing works
Östlund, G., Björk, M., Thyberg, I. S. M., Thyberg, M., Waltersson, E., Stenström, B., & Sverker, A. (2013) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2013-eular.1111 · Cited by 1 · see citing works
Living well with multiple autoimmune diseases: An interpretive description
Cey, E. (2013) · University Library - University of Saskatchewan (University of Saskatchewan)
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Sorbero, M. E. S., Ahluwalia, S. C., Reynolds, K. A., Lovejoy, S. L., Farris, C. A., Sloan, J., Miles, J. N. V., Vaughan, C., Kandrack, R., Apaydin, E. A., et al. (2015) · RAND Corporation eBooks · doi:10.7249/rr1138
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- Authors
- Leverone, D., & Epstein, B. J.
- Affiliations
- University of Florida (US)
- Corresponding author
- Epstein, Benjamin J.
- Venue
- Journal of Pharmacy Practice
- Publisher
- SAGE Publications
- Published
- 2010-02-10
- Volume
- 23
- Issue
- 2
- Pages
- 101-109
- ISSN
- 0897-1900 (ISSN-L)
- 1531-1937
- OpenAlex
- W2124728139
- Cited by
- 18
- References
- 40
- Citations by year
- 2024: 1 · 2023: 1 · 2021: 1 · 2020: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 4
- FWCI
- 0.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pharmacy Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Keywords
- rheumatoid arthritis, mind-body medicine, psychological intervention, non-pharmacological treatment, autoimmune disease, pain, functional disability, coping, self-efficacy, depression, adjunctive therapy, immune function
- MeSH terms
- Arthritis, Rheumatoid, Autoimmune Diseases, Humans, Pain, Treatment Outcome, Antirheumatic Agents, Mind-Body Therapies, Pain Management
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