Mindfulness-based stress reduction to improve depression, pain and high patient global assessment in controlled rheumatoid arthritis

Abstract

Objective To improve distressing patient-reported outcomes (PROs) that persisted in rheumatoid arthritis patients with clinically controlled inflammation (controlled RA). Methods In a pragmatic pilot study, we offered Mindfulness-Based Stress Reduction (MBSR), a group intervention to controlled RA patients who had high (≥16) Centre for Evaluation Studies—Depression (CES-D) scores and/or Patient General Assessment of disease activity (PGA) at least 2/10 larger than Evaluator General Assessment (EGA) (PGA-EGA: Delta). Evaluations before, 6, and 12 months after MBSR included CES-D, PGA, Modified-HAQ, SDAI, anxiety (General Anxiety Disorder 7; GAD-7), coping strategies (Coping with Health Injuries and Problems; CHIP), sleep disturbance, and pain. Facilitators and obstacles of recruitment and participation were identified. A subset of patients was interviewed for qualitative analysis of their experience. Results Out of 306 screened patients, 65 were referred, 39 (60%) agreed, and 28 (43%) completed MBSR. Anticipated burden, timing, and frequency of group meetings, commuting issues, age extremes, and comorbidities were barriers to participation. Up to 12 months after MBSR, anxiety, depression, emotion-oriented coping, sleep, and function significantly improved. Yet, no significant impact was observed on pain, PGA, Delta, or SDAI. The interviews revealed that benefits including integration of effective coping strategies were maintained. Conclusion We addressed MBSR feasibility issues and selection of outcomes in controlled RA patients with distressing PROs. For patients who chose to participate in MBSR lasting benefits were evident for anxiety, depression, sleep, and function. Larger studies are required to evaluate weaker impact of MBSR on RA-related pain and PGA. Lay summary What does this mean for patients? Current treatments of rheumatoid arthritis (RA) aim to reduce inflammation. Physicians assume that control of inflammation will improve patient well-being. While this is often the case, up to 1 in 5 patients with controlled inflammation still report high levels of pain, depressive and anxious symptoms, functional limitations, sleep problems, and disease severity. We offered at no cost to these patients a standardized 8-session group Mindfulness-Based Stress Reduction (MBSR) program when they presented for regular follow up. Out of 65 eligible patients, 39 consented, and 28 participated. Anticipated burden, especially frequency and timing of group meetings, commuting issues, age, and comorbidities were the most frequent barriers to participation. Up to 12 months after MBSR completion, anxiety, depression, sleep, and function significantly improved. Patient interviews revealed that the previously mentioned benefits were maintained by the integration of effective coping strategies. However, pain levels and patient perception of disease activity were not changed. Patients with controlled RA need be informed that MBSR can induce lasting improvements in persistent distressing symptoms associated with disease. Knowing about the durable positive effects of MBSR might influence patients to overcome barriers to participation. Additional interventions may be needed to lower pain levels and perceived disease activity.

Clinical Prediction Models of Severe Cancer-Related Fatigue in Cervical Cancer Patients and Effectiveness of Mindfulness-Based Stress Reduction: A Randomized Controlled Trial

“…Salvador proved that MBSR could improve the psychological distress, general well-being, and fatigue-related quality of life 32 . Gaboury showed that up to 12 months after MBSR, anxiety, depression, emotion-oriented coping, sleep and function significantly improved 33 . Elimimian showed cancer survivors who participated in an 8-week MBSR reported persistent benefits with reduced anxiety, depression, and improved mental health over 24 months of follow-up 34 .…”

Pain in the joints and beyond; the challenge of rheumatoid arthritis

“…85 The effects of mindfulness-based stress reduction (MSBR) in RA has been investigated in a pilot study of subjects reporting depressive symptoms and/or high PGA despite controlled disease activity measures. 86 The intervention had a marked and enduring impact on depression, anxiety, sleep quality, emotion-oriented coping and a strong positive impact on function. However, these improvements translated into minor or no changes in other RArelated symptoms such as pain and PGA.…”