Arthritis Patients Practice Zen and the Art of Joint Maintenance

BALTIMORE, Sept. 28 -- Patients with rheumatoid arthritis who meditated were measurably less stressed after six months than those given standard care, but the disease was no better, said investigators here.

An analysis of the effects of a mindfulness-based stress reduction program in RA patients showed that those who used the technique had both significantly lower psychological distress and a higher sense of well-being than controls, found Elizabeth K. Pradhan. M.P.H., Ph.D., of the University of Maryland, and colleagues.

There were also trends towards lower depressive symptoms scores and enhanced mindfulness among the patients who meditated, but the practice had no effect of the severity of RA, the authors reported in the October issue of Arthritis & Rheumatism -- Arthritis Care & Research.

"For doctors wishing to offer patients a complement to medical management, mindfulness meditation may offer hope for improving psychological distress and strengthening well-being in patients with RA," they wrote.

The mindfulness-based stress reduction program was developed is a meditation training program developed by Jon. Kabat-Zinn, Ph.D., of the University of Massachusetts Medical School in Worcester, and colleagues.

The program defines "mindfulness" as "moment-to-moment nonjudgmental attention and awareness actively cultivated and developed through meditation."

Similar in philosophy to cognitive behavioral therapy, mindfulness-based stress reduction "teaches participants to notice and relate differently to thoughts and emotions, with a sense of compassion for self and others underlying the endeavor," the authors wrote. "By continually brining the mind back to the present moment, mindfulness meditation is thought to increase clarity, calmness, and well-being."

In both descriptive and controlled studies, the technique has been linked to improvement of psychological symptoms in patients with anxiety disorders, fibromyalgia, chronic pain, cancer, and multiple sclerosis, and has been shown to reduce relapse among patients in remission from major depressive disorder, they noted.

In this pilot study 31 patients with RA were randomly assigned to mindfulness training for eight weeks followed by a four-month maintenance period, and 32 were put on a waitlist for training and received standard care, and were offered the mindfulness training free of charge at the study's end.

All patients received standard care from their rheumatologists during the study. The outcomes measures included responses to self-reported items on the Symptom Checklist-90-R, looking at depressive symptoms, psychological distress, well-being and mindfulness.

Arthritis severity was measured by the Disease Activity Score in 28 joints (DAS28) by a physician masked to treatment status. The authors estimated adjusted means and mean changes in outcomes in mixed-model repeated measures analyses.

They found that there were no statistically different outcomes between those who meditated and controls at two months, but at six months the patients who underwent the mindfulness training and practiced medication had significantly less psychological stress than controls (P=0.04) and had significantly greater well being (P=0.03).

Patients in the meditation group had a 35% greater reduction in psychological distress from baseline than did controls. The meditating patients also had nonsignificant trends towards lower depressive symptom scores (P=0.08) and more mindfulness (P=0.09).

There was no effect of the intervention on DAS28 scores, however, the authors noted.

The authors acknowledged that the study had limitations including the small sample size and a patient sample with a relatively high socioeconomic status, suggesting more social support and coping mechanisms than other patients with rheumatoid arthritis might have.