Revisiting the Role of Mindfulness-based Stress Reduction in the Management of Rheumatoid Arthritis

Year : 2024 | Volume :01 | Issue : 01 | Page : 19-28

Praveen Deepak


Rheumatoid arthritis (RA) is a type of arthritis characterized by a chronic inflammatory disorder that primarily affects the lining of the synovial joints resulting in progressive disability in the movement of diarthrodial joints and arthralgia. It is a debilitating disease associated with premature death and socioeconomic burdens. Its pathogenesis is multifactorial with an individual course of progression where psychological stress is considered to be one of the risk factors associated with RA progression. Most of the therapeutic interventions rely upon the use of NSAIDs, DMARDs, tumor necrosis factor Inhibitors, and more recent T-cell costimulatory blocking agents, B-cell depleting agents, and Interleukin-1 antagonists but, all these modalities lead to severe side effects and havoc on the quality of life of RA patients. Recently, psychological stress is a prominent risk factor that is associated with the pathogenesis of RA and induces flare response in RA patients which indicates the implication of intervention of psychological treatment to RA patients. Recently, Mindfulness-Based Stress Reduction (MBSR) perceived to be an effective modality for the management of RA that has the potential to improve the quality of life of RA patients under medication. However, the extent of this contribution to MBSR is not clear, therefore this review aims to understand the effects of MBSR in patients with RA by searching related literature on databases like Google Scholar, PubMed, Embase, and Web of Science. This study encompasses different interventions of MBSR, such as mindfulness meditation, mindfulness yoga, mindfulness exercise, etc, as a therapeutic modality for RA.

Keywords: Rheumatoid Arthritis (RA), Psychological Stress, Pathogenesis, Meditation, Yoga, Mindfulness-Based Stress Reduction (MBSR)

[This article belongs to International Journal of Vaccines(ijv)]

How to cite this article: Praveen Deepak. Revisiting the Role of Mindfulness-based Stress Reduction in the Management of Rheumatoid Arthritis. International Journal of Vaccines. 2024; 01(01):19-28.
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  1. Saleh SM, Zangor JR. Proinflammatory cytokines profile in patients with Rheumatoid arthritis. Journal of the Faculty of Medicine Baghdad. 2009 Apr 1;51(1):57-9.
  2. Smolen J.S., Aletala D., McInnes I.B. 2016. Rheumatoid arthritis. Lancet 388(10055): 2023-2038.
  3. Bullock J., Rizvi S.A.A., Saleh A.M., Ahmed S.S., Do D.P., Ansari R.A., Ahmed J. 2018. Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical Principle & Practice 27(6):501-507.
  4. Sparks J.A. 2019. Rheumatoid Arthritis. Annals of Internal Medicine 170(1): ITC1-ITC16.
  5. McInnes I.B., Buckley C.D., Isaacs J.D. 2016. Cytokines in rheumatoid arthritis – shaping the immunological landscape. Nature Review Rheumatology 12(1): 63-68.
  6. Dugowson C.E. 2000. Rheumatoid arthritis. Eds Marlene B. Goldman & Maureen C. Hatch. In Women and Health. Academic Press, MA, USA.
  7. Stanford S.M. & Bottini N. 2014. PTPN22: the archetypal non-HLA autoimmunity gene. Nature Review Rheumatology 10(10): 602–11.
  8. Remmers E.F., Plenge R.M., Lee A.T., Graham R.R., Hom G., Behrens T.W., de Bakker P.I.W., Le J.M., Lee H.-S., Batliwalla F., Li W., Masters S.L., Booty M.G., Carulli J.P., Padyukov L., Alfredsson L., Klareskog L., Chen W.V., Amos C.I., Criswell L.A., Seldin M.F., Kastner D.L., Gregersen P.K. 2007. STAT4 and the risk of rheumatoid arthritis and systemic lupus erythematosus. New England Journal of Medicine 357(10): 977–86.
  9. Messemaker T.C., Frank-Bertoncelj M., Marques R.B., Adriaans A., Bakker A.M., Daha N., Gay S., Huizinga T.W., Toes R.E.M., Mikkers H.M.M., Kurreeman F., Nicholson L.B. 2016. A novel long non-coding RNA in the rheumatoid arthritis risk locus TRAF1-C5 influences C5 mRNA levels. Genes & Immunity 17(2): 85–92.
  10. Zhang J., Zahir N., Jiang Q., Miliotis H., Heyraud S., Meng X., Dong G., Frank X., Zhenyue Q., Christopher H., McCulloch A., Keystone E.C., Peterson A.C., Siminovitch K.A. 2011. The autoimmune disease-associated PTPN22 variant promotes calpain-mediated Lyp/Pep degradation associated with lymphocyte and dendritic cell hyperresponsiveness. Nature Genetics 43(9): 902–7.
  11. Chang H.H., Liu G.Y., Dwivedi N., Sun B., Okamoto Y., Kinslow J.D., Deane K.D., Demoruelle M.K., Norris J.M., Thompson P.R., Sparks J.A., Rao D.A., Karlson E.W., Hung H.-C., Holers V.M/, Ho I.-C. 2016. A molecular signature of preclinical rheumatoid arthritis triggered by dysregulated PTPN22. JCI Insight 1(17): e90045.
  12. Klareskog L., Ronnelid J., Saevarsdottir S., Padyukov L., Alfredsson L. 2020. The importance of differences; on environment and its interactions with genes and immunity in the causation of rheumatoid arthritis. Journal of International Medicine 287(5): 514-533.
  13. Deane K.D., Demoruelle M.K., Kelmenson L.B., Kuhn K.A., Norris J.M., Holers V.M. 2018. Genetic and environmental risk factors for rheumatoid arthritis. Best Practice & Research Clinical Rheumatology 31(1): 3-18.
  14. Maeda Y. & Takeda K. 2019. Host-microbiota interactions in rheumatoid arthritis. Experimental & Molecular Medicine 51: 1-6.
  15. Zhao T., Wei Y., Zhu Y., Xie Z., Hai Q., Li Z., Qin D. 2022. Gut microbiota and rheumatoid arthritis: From pathogenesis to novel therapeutic opportunities. Frontiers in immunology 13: 1007165.
  16. Van Delft M.A.M. & Huizinga T.W.H. 2020. An overview of autoantibodies in rheumatoid arthritis. Journal of Autoimmunity. 110: 102392.
  17. Bartok B. & Firestein G.S. 2010. Fibroblast-like synoviocytes: key effector cells in rheumatoid arthritis. Immunology Review 233(1): 233-255.
  18. Müller-Ladner U., Pap T., Gay R.E., Neidhart M., Gay S. 2005. Mechanisms of disease: the molecular and cellular basis of joint destruction in rheumatoid arthritis. Nature Clinical Practice Rheumatology 2: 102-110.
  19. Fang Q., Zhou C., Nandakumar K.S. 1996. Molecular and cellular pathways contributing to joint damage in rheumatoid arthritis. Mediators of Inflammation 2020: 3830212.
  20. Komatsu N. & Takayanagi H. 2022. Mechanisms of joint destruction in rheumatoid arthritis — immune cell–fibroblast–bone interactions. Nature Review Rheumatology 18: 415–429.
  21. Hassett A.L. & Clauw D.J. 2010. The role of stress in rheumatic diseases. Arthritis Research Therapy 12(3): 123.
  22. Yılmaz V., Umay E., Gündoğdu İ., Karaahmet Z.Ö., Öztürk A.E. 2017. Rheumatoid Arthritis: Are psychological factors effective in disease flare? European Journal Rheumatology 4(2): 127-132.
  23. Malysheva O., Pierer M., Wagner U., Baerwald C.G.O. 2010. Stress and rheumatoid arthritis. Z Rheumatology 69(6): 539.
  24. Germain V., Scherlinger M., Barnetche T., Pichon C., Balageas A., Lequen L., Shipley E., Foret J., Dublanc S., Capuron L., Schaeverbeke T. 2021. Role of stress in the development of rheumatoid arthritis: a case-control study. Rheumatology 60(2): 629-637.
  25. Kojima M., Kojima T., Suzuki S., Oguchi T., Oba M., Tsuchiya H., Sugiura F., Kanayama Y., Furukawa T.A. Tokudome S., Ishiguro N. 2009. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Care Research 61:1018–24.
  26. Matcham F., Ali S., Hotopf M, Chalder T. 2015. Psychological correlates of fatigue in rheumatoid arthritis: A systematic review. Clinical Psychology Review. 39:16–29.
  27. DeCock D., Doumen M., Vervloesem C., Breda A.V., Bertrand D., Pazmino S., Westhovens R., Verschueren P. 2022. Psychological stress in rheumatoid arthritis: a systematic scoping review. Seminars in Arthritis and Rheumatism. 55: 152014.
  28. Norton S., Sacker A., Young A., Done J. 2011. Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort. Journal of Psychosomatic Research 71:290–5.
  29. Baumeister H., Balke K., Harter M. 2005. Psychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients. Journal Clinical Epidemiology 58:1090–100.
  30. DiMatteo M., Lepper H.S., Croghan T.W. 2000. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine 160: 2101–7.
  31. Ang D.C., Choi H., Kroenke K., Wolfe F. 2005. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. Journal of Rheumatology 32: 1013–9.
  32. Pratt L.A. & Brody D.J. 2008. Depression and smoking in the US. household population aged 20 and over, 2005–2008. NCHS Data Brief 34: 1–8.
  33. Rizvi T.A., Ennis M., Behbehani M.M., Shipley M.T. 1991. Connections between the central nucleus of the amygdala and the midbrain periaqueductal grey: topography and reciprocity. Journal of Comparative Neurology 303(1): 121–131.
  34. Swanson LW. 2000. What is the brain? Trends in Neuroscience 23(11): 519–527.
  35. LeDoux 2007. The amygdala. Current Biology 17(20): R868–R874.
  36. Reppucci C.J. & Petrovich G.D. 2016. Organization of connections between the amygdala, medial prefrontal cortex, and lateral hypothalamus: a single and double retrograde tracing study in rats. Brain Structure and Function 221(6): 2937–2962.
  37. Castro-Sierra , Chico P.L.F., Portugal R.A. 2005. Neurotransmitters of the limbic system. Amygdala. I. Part one Salud Mental 28(6):27-32.
  38. Herman J.P., McKlveen J.M., Ghosal S., Kopp B., Wulsin A., Makinson R., Scheimann J., Myers. 2016. Regulation of the hypothalamic-pituitary-adrenocortical stress response. Comparative Physiology 6(2): 603-621.
  39. Šimić G., Tkalčić M., Vukić V., Mulc D., Španić E., Šagud M., Olucha-Bordonau F.E., Vukšić M., Hof P.R. 2021. Understanding emotions: Origins and roles of the amygdala. Biomolecules 11(6): 823.
  40. Hinds J.A. & Sanchez E.R. 2022. The Role of the Hypothalamus–Pituitary–Adrenal (HPA) axis in test-induced anxiety: Assessments, physiological responses, and molecular details. Stresses 2(1): 146-155.
  41. Chu B., Marwaha K., Sanvictores T., Ayers D. 2024. Physiology, Stress Reaction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  42. Diego A. & Antonella B. 2017. The key role of the amygdala in stress. In F. Barbara (Ed.). The Amygdala – Where emotions shape perception, learning, and memories (Chapter: 9). IntechOpen, Rijeka.
  43. Tong R.L., Kahn U.N., Grafe L.A., Hitti F.L., Fried N.T., Corbett B.F. 2023. Stress circuitry: Mechanisms behind nervous and immune system communication that influence behavior. Frontier of Psychiatry 14: 1240783.
  44. Sarapultsev, Gusev E., Komelkova M., Utepova I., Luo S., Hu D. 2023. JAK-STAT signaling in inflammation and stress-related diseases: implications for therapeutic interventions. Molecular Biomedicine 4: 40.
  45. Hansen-Grant S.M., Pariante C.M., Kalin N.H., Miller A.H. 1998. Neuroendocrine and immune system pathology in psychiatric disease. In: Schatzberg AF, Nemeroff CB, editors. Textbook of Psychopharmacology. 2nd ed. Washington DC: American Psychiatric Press. pp. 171–94.
  46. Cay M., Ucar C., Senol D., Cervirgen F., Ozbag D., Altay Z., Yildiz S. 2018. Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores. Northern Clinics of Istanbul 5(4): 295-301.
  47. Fagundes C.P. & Way B. 2014. Early-life stress and adult inflammation. Curr Dir Psychol. 23: 277–283.
  48. Morey J.N., Boggero I.A., Scott A.B., Segerstrom S.C. 2015. Current directions in stress and human immune functions. Current Opinion in Psychology 5: 13-17.
  49. Macfarlane E., Seibel M.J., Zhou H. 2020. Arthritis and the role of endogenous glucocorticoids. Bone Research 8: 33.
  50. Williams M.G. & Kabat-Zinn J. 2013. Mindfulness: Diverse perspectives on its meaning: Origins, and multiple applications at the intersection of Science and Dharma. In: M. Williams & J. Kabat-Zinn (Eds.). Mindfulness: Diverse perspectives on its meaning, origins, and applications. (pp. 17). Routledge.
  51. Baer R., Crane C., Miller E., Kuyken W. 2019. Doing no harm in mindfulness-based programs: conceptual issues and empirical findings. Clinical Psychology Review 71: 101–14.
  52. Brown K., & Ryan R. 2003. The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 84: 822-848.
  53. Kabat-Zinn J. 2003. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice 10(2): 144–156.
  54. Zhang D., Lee E.K.P., Mak E.C.W., Wong S.Y.S. 2021. Mindfulness-based interventions: an overall review. British Medical Bulletin 21: Ida005.
  55. Merkes M. 2010. Mindfulness-based stress reduction for people with chronic diseases. Australian Journal of Primary Health 16(3): 2002-210.
  56. Niazi A.K. & Niazi S.K. 2011. Mindfulness=based stress reduction: A non-pharmacological approach for chronic illness. New American Journal of Medical Sciences 3(1): 20-23.
  57. Raj A. & Kumar P. 2018. Efficacy of Mindfulness-Based Stress Reduction (MBSR): A brief overview. Journal of Disability Management and Rehabilitation 4(1): 73-81.
  58. Lee E.K.P., Young N.C.Y., Xu Z., Zhang D., Yu C.-P., Wong S.Y.S. 2020; Effect and acceptability of Mindfulness-Based Stress Reduction Program on patients with elevated blood pressure or hypertension: A meta-analysis of randomized controlled trials. 76:1992–2001.
  59. Harris K., Jackson J., Webster H., Farrow J., Zhao Y., Hohmann L. 2023. Mindfulness-based Stress Reduction (MBSR) for chronic pain management in the community pharmacy setting: A cross-sectional survey of the general public’s knowledge and perceptions. Pharmacy 11(5): 150.
  60. Fogarty F.A., Booth R.J., Gamble G.D., Dalbeth N. & Consedine N.S. 2015. The effect of mindfulness-based stress reduction on disease activity in people with rheumatoid arthritis: a randomized controlled trial. Annals of the Rheumatic Diseases 74: 472–474.
  61. Paglia M.D.G., Silva M.T., Lopes L.C., Barberato-Filho S., Mazzei L.G., Abe F.C., de Cássia Bergamaschi C. 2021. Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis. PLoS One 16(4): e0248866.
  62. Ramamoorthy S. & Cidlowski. 2016. Corticosteroids-Mechanisms of action in health and disease. Rheumatic Disease Clinics of North America 42(1): 15-31.
  63. Harth M. 1992. Mechanisms of action of disease-modifying antirheumatic drugs, Journal of Rheumatoid Supplements 32: 100-103.
  64. Barnes P. 2006. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. British Journal of Pharmacology 148(3): 245-254.
  65. Billmeier U., Dieterich W., Neurath M.F., Atrya R. 2016. Molecular mechanism of action of anti-tumor necrosis factor antibodies in inflammatory bowel disease. World Journal of Gastroenterology 22(42): 9300-9313.
  66. Bonelli M. & Scheinecker C. 2018. How does abatacept really work in rheumatoid arthritis? Current Opinion in Rheumatology 30(3): 295-300.
  67. Baskar S., Klein A.L., Zeft A. 2016. The use of IL-1 receptor antagonist (Anakinra) in idiopathic recurrent pericarditis: A narrative review. Cardiology Research Practice 2016: 7840724.
  68. Cohen M.D. & Keystone E. 2015. Rituximab for rheumatoid arthritis. Rheumatology and Therapy 2(2): 99-111.
  69. Köhler B.M., Günther J., Kaudewitz D., Lorenz H-M. 2019. Current therapeutic options in the treatment of rheumatoid arthritis. Journal of Clinical Medicine 8(7): 938.
  70. Mrid R.B., Bouchmaa N., Ainani H., Fatimy R.E., Malka G., Mazini L. 2022. Anti-rheumatoid drugs advancement: New insights into the molecular treatment of rheumatoid arthritis. Biomedicine and Pharmacotherapy 151: 113126.
  71. Pradhan E.K., Baumgarten M., Langenberg P., Handwerger B., Gilpin K., Magyari T., Hochberg M.C., Berman B.M. 2007. Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. Randomized Controlled Trial 57(7): 1134-1142.
  72. Goldin P.R. & Gross J.J. 2010. Effects of Mindfulness-Based Stress Reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion 10(1): 83-91.
  73. Creswell J.D., Irwin M.R., Burklund L.J., Lieberman M.D., Arevalo J.M.G., Ma J., Crabb Breen E., Cole S.W. 2012. Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behavior and Immunity 26(7): 1095-1101.
  74. Foster A., Rinaman L., Cryan J.F. 2017. Stress & the gut-brain axis: Regulation by the microbiome. Neurobiology in Stress 7: 124-136.
  75. Madison A. & Kiecolt-Glaser J.K. 2019. Stress, depression, diet, and the gut microbiota: human–bacteria interactions at the core of psychoneuroimmunology and nutrition. Current Opinion in Behavioral Science 28: 105-110.
  76. Shaohui G., Liping Y., Feng C., Zhumou Z., Jiangbo L., Wenbo L., Yujie L., Yukun C., Yu B., Lin C., Zihao F., Xinmin L., Junlin H., Yuan L., Zhilin L., Shuai Z., Hengtao W., Qing Z., Honggang W., Xiaodan W., Jingtao Z. 2020. Gut Microbiota Are Associated With Psychological Stress-Induced Defections in Intestinal and Blood-brain Barriers. Frontiers in Microbiology 10: 2019.
  77. Naliboff B.D., Smith S.R., Serpa J.G., Laird K.T., Stains J., Connolly L.S., Labus J.S., Tillisch K. 2020. Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterology and Motility i 32(9): e13828.
  78. Lin L., Zhang K., Xiong Q., Zhang J., Cai B., Huang Z., Yang B., Wei B., Chen J., Niu Q. 2-23. Gut microbiota in pre-clinical rheumatoid arthritis: From pathogenesis to preventing progression, Journal of Autoimmunity 141: 103001,
  79. Short E.B., Kose S., Mu Q., Borckardt J., Newberg A., George M.S., Kozel F.A. 2007. Regional brain activation during meditation shows time and practice effects: An exploratory FMRI study. Evid Based Complement Alternative Medicine 7(1): 121-127.
  80. Pagnoni G., Cekic M., Guo Y. 2008. Thinking about non-thinking neural correlates of conceptual processing during Zen meditation. PLOS ONE 3(9): e3083.
  81. Lutz A., Brefczynski-Lewis J., Johnstone T., Davidson R.J. 2008. Regulation of the neural circuitry of emotion by compassion meditation: Effects of meditative expertise. PLOS ONE 3(3): e1897.

Regular Issue Subscription Review Article
Volume 01
Issue 01
Received February 20, 2024
Accepted February 27, 2024
Published March 28, 2024