Effect of an 8-Week Yoga-Based Lifestyle Intervention on Psycho-Neuro-Immune Axis, Disease Activity, and Perceived Quality of Life in Rheumatoid Arthritis Patients: A Randomized Controlled Trial

Abstract

Various external stressors and environmental challenges lead to the provocation of the immune system in autoimmune diseases like Rheumatoid arthritis (RA). The inappropriate immune response further triggers the cascade of inflammatory changes resulting in precipitation of symptoms and hampers quality of life (QOL). The underlying psycho-somatic component of the disease requires a holistic approach to its treatment dimension rather than the use of pharmacotherapy. The applicability of mind-body interventions has become essential in today’s fast-paced life. Yoga, a mind-body technique, alters the mind’s capacity to facilitate systemic functioning at multiple organ system levels. Hence, we conducted this study to evaluate the impact of 8 weeks of a yoga-based lifestyle intervention (YBLI) on psycho-neuro-immune markers, gene expression patterns, and QOL in RA patients on routine medical therapy. A total of 66 patients were randomized into two groups: yoga group or non-yoga group and were assessed for a panel of inflammatory cytokines (IL-6, IL-17A, TNF-α, and TGF-β), mind-body communicative markers (BDNF, DHEAS, β-endorphin, and sirtuin) and transcript levels of various genes ( IL-6, TNF-α, NFKB1, TGF -β, and CTLA4 ). We assessed disease activity and QOL using the DAS28-ESR and WHOQOL-BREF questionnaire, respectively. Yoga group observed significant improvements in the levels of markers, which influenced the psycho-neuro-immune axis ( p < 0.001) with an estimated effect size from small to medium range. In the yoga group, there was a significant reduction in DAS28-ESR ( p < 0.001) and improvement seen in the physical health, psychological, social relationships domains ( p < 0.001) of QOL, except environmental ( p > 0.05). The yoga group showed downregulation of IL-6, TNF -α, and CTLA4 and upregulation of TGF -β. These results suggest that a decrease in disease activity after yoga practice is associated with a significant reduction in inflammatory cytokines, the elevation of mind-body communicative markers, and normalization of various transcript levels, which improved QOL. Thus the adoption of YBLI improves clinical outcome in RA, and decreases systemic inflammation by its beneficial effects on psycho-neuro-immune axis and normalization of dysregulated transcripts. Thus YBLI may be used for RA patients as an adjunctive therapy.

Yoga therapy as an adjunct to conventional management of systemic sclerosis: A case series

“…Yoga has been found useful in autoimmune conditions such as rheumatoid arthritis. Studies indicate the usefulness of Yoga in reducing the serological markers of inflammation along with symptoms, both physical and psychological, when Yoga is administered along with medications [ [14] , [15] , [16] ]. A Cochrane review indicated positive outcomes of Yoga in patients with chronic pain [ 17 ].…”

Can Yogic Breathing Techniques Like Simha Kriya and Isha Kriya Regulate COVID-19-Related Stress?

“…Enhanced levels of MCP-1 have chemotactic activity on monocytes, enhance the T cells activity (Carr et al, 1994), and stimulate transforming growth factor-β and collagen synthesis (Gharaee-Kermani et al, 1996;Hogaboam et al, 1999). In rheumatoid arthritis, Yoga affects the psycho-neuro-immune axis by reduction in inflammatory cytokines and improvement in mind-body communicative markers and quality of life; disease activity was also reduced in yoga group (Gautam et al, 2020).…”

Yoga—Impact on Mitochondrial Health: Clinical Consequences

“…It works through many mechanisms and has been associated with many positive and objectively measurable changes in an individual, which include reducing stress and anxiety, warding off depression, improving sleep, reducing sympathetic distress, reducing hypertension symptoms, decreasing inflammation, and improving the quality of life. 8,13,14,[16][17][18] The relaxation response elicited due to yoga leads to an elevation of β-endorphins, improvement in cardiovagal tone, reducing sympathetic overactivity, lowering of IOP, and reduces further damage to RGCs. 12,19,20 Yoga is also known to enhance cognitive abilities, boosting memory, increasing thickness of cerebral cortex, neural connectivity, positive changes in electroencephalogram (EEG), and improving neuroplasticity.…”

“…21,22,23 Our recent randomized controlled trial (RCT) on the impact of yoga on RA patients published in Frontiers in Psychology, 2020 supports yoga as an adjunctive therapy to treat this chronic progressive debilitating disease as it aids in decreasing systemic inflammation by its beneficial effects on the psychoneuro-immune axis and normalization of dysregulated transcripts (IL-6, TNF-α, NFKB1, TGF-β, and CTLA4). 8 Yoga improves the mitochondrial integrity by altering the expression levels of transcripts that maintain mitochondrial integrity, which aids in the maintenance of optimal free radical levels, holds the key to increase the mitochondrial copy number, improves COX-II activity, increases NAD+ levels, optimizes OS markers, and increases the expression levels of transcripts that maintain mitochondrial integrity, reduces disease activity and its associated consequences on physical and mental health,and hence can be beneficial as an adjunct therapy. 4,22,23 The regulation of cellular OS within physiological limits after YBLI suggests the potential of this intervention in protecting cells from OS-induced nuclear and mt DNA damage and telomere attrition and in reversing epigenetic changes, which accumulate due to unhealthy lifestyle and adverse environmental conditions.…”