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Sagtaganov Z, Yessirkepov M, Bekaryssova D. Yoga as a complementary therapy for rheumatoid arthritis: a case-based review. Rheumatol Int 2024; 44:1575-1579. [PMID: 38850325 DOI: 10.1007/s00296-024-05641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
Rheumatoid arthritis (RA) presents patients with chronic pain and functional limitations due to its autoimmune nature. Despite symptomatic and pharmaceutical interventions, many patients experience inadequate relief, prompting exploration into non-pharmacological approaches such as yoga. This study aims to evaluate the effectiveness of yoga as an adjunctive therapy for RA by examining clinical data from patients experiencing chronic pain and limitations. This study analyzed several clinical cases at the Shymkent City Regional Clinical Hospital. Ten RA patients, irrespective of various demographic factors, were enrolled. Parameters including pain intensity, inflammation activity, systolic blood pressure, joint function, and morning stiffness were assessed to gauge the impact of yoga. The findings demonstrated notable positive changes following a three-month yoga program. These changes encompassed enhanced joint health, reduced pain severity, and decreased disease activity. Particularly noteworthy was the reduction in morning stiffness by an average of 31 min, alongside a decrease in the average pain index from 80 mm to 41.5 mm. The mean RA activity level decreased from 5.8 to 4.7. Furthermore, mean systolic blood pressure decreased by 15.5 mmHg, and mean cholesterol levels decreased from 5.3 mmol/L to 4.8 mmol/L. These results underscore the potential significance of yoga as a supplementary intervention for RA. Yoga practice may enhance patients' quality of life and alleviate disease symptoms. Nevertheless, the study's limited sample size necessitates caution, and further research is warranted to validate these findings.
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Affiliation(s)
- Zhaxybek Sagtaganov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
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2
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Sibilia J, Berna F, Bloch JG, Scherlinger M. Mind-body practices in chronic inflammatory arthritis. Joint Bone Spine 2024; 91:105645. [PMID: 37769800 DOI: 10.1016/j.jbspin.2023.105645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 10/03/2023]
Abstract
Mind-body practices are complementary approaches recognized by the World Health Organization (WHO). While these practices are very diverse, they all focus on the interaction between mind and body. These include mindful meditation, yoga, Tai Chi, sophrology, hypnosis and various relaxation techniques. There is growing interest in incorporating these strategies in the management of chronic rheumatic diseases including rheumatoid arthritis. The aim of this review is to describe the main mind-body practices and analyze the existing evidence in chronic rheumatic diseases. In rheumatoid arthritis, the Mindfulness-Based Stress Reduction program, yoga, Tai Chi and relaxation may improve patient-reported outcomes, but the benefit on inflammation and structural progression is unclear. In spondyloarthritis, very few studies are available but similar evidence exist. Further evaluations of these practices in chronic rheumatic diseases are needed since their risk/benefit ratio appears excellent.
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Affiliation(s)
- Jean Sibilia
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Fabrice Berna
- Service de Psychiatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Gérard Bloch
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marc Scherlinger
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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3
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Mooventhan A, Pavithra, Meha N, Monisha S, Deepika R, Poorani R, Nivethitha L. A comprehensive scientific evidence-based impact of yoga in patients with rheumatoid arthritis. Int J Rheum Dis 2023; 26:2359-2365. [PMID: 38041649 DOI: 10.1111/1756-185x.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/16/2023] [Accepted: 08/02/2023] [Indexed: 12/03/2023]
Affiliation(s)
- A Mooventhan
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - Pavithra
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - N Meha
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - S Monisha
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - R Deepika
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - R Poorani
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
| | - L Nivethitha
- Department of Naturopathy, Government Yoga and Naturopathy Medical College, Chennai, Tamilnadu, India
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4
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Slagter L, Demyttenaere K, Verschueren P, De Cock D. The Effect of Meditation, Mindfulness, and Yoga in Patients with Rheumatoid Arthritis. J Pers Med 2022; 12:1905. [PMID: 36422081 PMCID: PMC9696072 DOI: 10.3390/jpm12111905] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Mind-body therapies (MBTs), including meditation, yoga, and mindfulness, create an interaction between the mind and body to enhance health. MBTs are perceived by both patients and healthcare professionals as valuable in the management of rheumatoid arthritis (RA), but the extent of this contribution is unclear, as are the patient subgroups who benefit most from MBTs. Therefore, this systematic literature review investigates the effects of meditation, mindfulness, and yoga in patients with RA. METHODS We searched four databases (PubMed, Embase, Web of Science (core collection, Chinese and Korean collection), and CINAHL). All studies were screened by two independent reviewers via the title/abstract/full text. The studies included any form of meditation/mindfulness/yoga as an intervention for RA. Animal studies, case reports, non-English articles, qualitative studies, conference abstracts, and articles without full-text access were excluded. Each study was assessed for its quality. RESULTS Out of 1527 potentially eligible records, 23 studies were included. All three MBTs showed various effects on patient-reported outcomes, such as vitality, functioning, and mental health, as well as on disease activity markers. Mindfulness-based interventions mainly reduced the subjective disease activity parameters (e.g., joint tenderness, morning stiffness, and pain), rather than the objective disease activity parameters (e.g., swollen joints and C-reactive protein (CRP)). RA patients with recurrent depression may benefit more from these non-pharmacological therapies than patients without recurrent depression. DISCUSSION This systematic literature review found that MBTs show added value in RA management, especially for patients with depressive symptoms. These non-pharmacological approaches, when used in addition to medication, might diminish polypharmacy in specific RA patient populations. Lay Summary: In recent decades, more attention has been given to the management of rheumatoid arthritis (RA) with options other than solely using medication. Such alternative options for patients to increase their quality of life are, for instance, meditation, yoga, and mindfulness. These examples of mind-body therapies (MBTs) are techniques that create an interaction between the mind and the bodily functions in order to obtain relaxation and enhance overall health. Although it is believed that these mind-body techniques are valuable in the management of RA, the extent of their contribution is still unclear, as is the question of if certain subgroups of patients benefit more from these complementary therapies. This systematic literature review investigated the effects of meditation, mindfulness, and yoga in patients with rheumatoid arthritis. A literature search was systematically performed within four different scientific databases by two independent reviewers. Out of 1527 potentially eligible articles, 23 studies were included. All three MBTs showed beneficial effects, which were mostly on the vitality, functioning, and mental health of patients with RA, but also on symptoms related to disease activity. RA patients with recurrent depression seemed to benefit more from these non-pharmacological therapies than patients without recurrent depression. Hence, we can conclude that MBTs show added value in the management of RA.
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Affiliation(s)
- Laura Slagter
- Skeletal Biology and Engineering Research Centre, KU Leuven, 3001 Leuven, Belgium
| | - Koen Demyttenaere
- Department of Neurosciences, Psychiatry Research Group and University Psychiatric Center KU Leuven, Belgium University Psychiatric Center, KU Leuven, 3001 Leuven, Belgium
| | - Patrick Verschueren
- Skeletal Biology and Engineering Research Centre, KU Leuven, 3001 Leuven, Belgium
- Department of Rheumatology, University Hospitals of Leuven, 3001 Leuven, Belgium
| | - Diederik De Cock
- Skeletal Biology and Engineering Research Centre, KU Leuven, 3001 Leuven, Belgium
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1005 Brussels, Belgium
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Tripathy A, Swain N, Gupta B. Understanding the Role and Uses of Alternative Therapies for Management of Rheumatoid Arthritis. Curr Rheumatol Rev 2021; 18:89-100. [PMID: 34784872 DOI: 10.2174/1573397117666211116102454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/30/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
With growing popularity of complementary and alternative medicine (CAM) among the individuals with chronic pain and muscular problems, a number of patients with rheumatoid arthritis (RA) show their interest in CAM interventions for disease improvement. Various reports published on CAM are based on animal model of RA however there is often lack of high quality clinical investigations for explaining the success stories of CAM therapies in patients with RA. CAMs having potential to be used for therapy in patients with RA have been identified, however lack of awareness and scepticism of their efficacy has made the patients reluctant to choose these drug less therapies. In this review, we have summarized the existing evidences which suggest promising efficacy of different alternative therapies in managing RA and providing both physical and mental well being to RA patients.
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Affiliation(s)
- Archana Tripathy
- Disease Biology Laboratory, School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) deemed to be University, Bhubaneswar-751024, Odisha. India
| | - Nitish Swain
- Disease Biology Laboratory, School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) deemed to be University, Bhubaneswar-751024, Odisha. India
| | - Bhawna Gupta
- Disease Biology Laboratory, School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) deemed to be University, Bhubaneswar-751024, Odisha. India
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Sarbaz Y, Beni KN, Hosseininejad A, Eftekharsadat B, Jahanjoo F. The effect of yoga practice on muscular strength improvement in patients with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/Aims Multiple sclerosis is a common condition in the central nervous system where patients experience many issues, including muscle weakness. This study offers an investigation of continuous hatha yoga exercises on patients with multiple sclerosis. Methods A total of 22 participants with multiple sclerosis were selected, 11 were allocated to the intervention group, and 11 to the control group. In both groups, surface electromyography and dynamometer were performed at the beginning and the end of the study. The intervention group undertook 90-minute sessions of hatha yoga training three times a week for 6 months and the control group did not do any particular exercise during this period. Results Dynamometer results indicated that yoga significantly improved the muscle strength of the participants with multiple sclerosis (before the intervention: 40.00 Nm ± 14.66 Nm vs 56.82 Nm ± 20.28 Nm after the intervention, P=0.037). However, there was no significant difference in muscle strength changes between the intervention and control groups (16.82 Nm ± 23.26 Nm vs -2.86 Nm ± 23.36 Nm, P=0.171). Yoga significantly increased participants muscle strength according to the surface electromyography signals (before the intervention: 39.91 V ± 8.86 V vs 54.09 v ± 8.95 V after the intervention, P=0.007). The muscle strength of the control group participants with multiple sclerosis decreased after 6 months, however it was not statistically significant (41.55 Nm ± 9.3 Nm vs 34.55 Nm ± 8.36 Nm, P=0.073). The comparison of changes showed that the surface electromyography signals in the intervention group were significantly higher than those of the control group (P=0.001). Conclusions: Yoga exercises, in addition to common multiple sclerosis treatment methods, can be considered as a complementary therapy to improve the physical aspects of multiple sclerosis symptoms.
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Affiliation(s)
- Yashar Sarbaz
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Kamran Naderi Beni
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Azar Hosseininejad
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jahanjoo
- Department of Biostatistics and Epidemiology, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Abstract
The practice of rheumatology in a country like India presents its own unique challenges, including the need to manage patients in a cost-constrained setting, where the lack of uniform government funding for healthcare merits the need to optimize the use of cheaper medicines, as well as devise innovative strategies to minimize the use of costlier drugs such as biologic disease-modifying agents. Use of immunosuppressive agents is also associated with increased risks of infectious complications, such as the reactivation of tuberculosis. In this narrative review, we provide a flavor of such challenges unique to Rheumatology practice in India, and review the published literature on the management of common rheumatic diseases from India. In addition, we critically review existing guidelines for the management of rheumatic diseases from this part of the world. We also discuss infectious etiologies of rheumatic complaints, such as leprosy, tuberculosis, and Chikungunya arthritis, which are often encountered here, and pose a diagnostic as well as therapeutic challenge for clinicians. There remains a need to identify and test more cost-effective strategies for Indian patients with rheumatic diseases, as well as the requirement for more government participation to enhance scant facilities for the treatment of such diseases as well as foster the development of healthcare services such as specialist nurses, occupational therapists and physiotherapists to enable better management of these conditions.
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9
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Akyuz G, Kenis-Coskun O. The Efficacy of Tai Chi and Yoga in Rheumatoid Arthritis and Spondyloarthropathies: A narrative biomedical review. Rheumatol Int 2017; 38:321-330. [DOI: 10.1007/s00296-017-3867-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
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10
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Mooventhan A, Shetty GB. Effect of Integrative Naturopathy and Yoga in a Patient with Rheumatoid Arthritis Associated with Type 2 Diabetes and Hypertension. Anc Sci Life 2017; 36:163-166. [PMID: 28867861 PMCID: PMC5566828 DOI: 10.4103/asl.asl_80_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 54-year old married woman was diagnosed with rheumatoid arthritis in 2002, essential hypertension in 2008, type-2 diabetes in 2011 and gangrene over 2nd toe of right foot. She underwent conventional management in private hospitals. Her symptoms, began with moderate to severe pain associated with swelling, stiffness (more in the morning) in multiple joints especially over small joints. In July-2014 she visited our college hospital with the complaints of pain, mild swelling and stiffness over multiple joints associated with poor quality of sleep (QOS) and quality of life (QOL). Subject received integrative Naturopathy and Yoga therapies (INYT) with conventional medicine daily for 10-days. After 10-days, improvements in pain, blood sugar, depression, anxiety, stress, QOS, QOL, blood analysis with normal blood pressure (BP) was observed. This suggests that INYT could be considered as an adjuvant to conventional medicine in RA associated with type-2 diabetes and essential hypertension.
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Affiliation(s)
- A Mooventhan
- Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India
| | - Geetha B Shetty
- Department of Acupuncture, S.D.M. College of Naturopathy and Yogic Sciences, Ujire, Karnataka, India
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McNamara C, Johnson M, Read L, Vander Velden H, Thygeson M, Liu M, Gandrud L, McNamara J. Yoga Therapy in Children with Cystic Fibrosis Decreases Immediate Anxiety and Joint Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9429504. [PMID: 28077950 PMCID: PMC5204083 DOI: 10.1155/2016/9429504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7-20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p < 0.001). Joint pain improved (3.25 to 3.65, p = 0.028). CFQ-R emotion subscale improved from 79.2 to 85 (p = 0.073), and the respiratory subscale improved from 66.7 to 79.2 (p = 0.076). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.
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Affiliation(s)
| | - Mahrya Johnson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Lisa Read
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Megan Thygeson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Meixia Liu
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gandrud
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - John McNamara
- Children's Respiratory and Critical Care Specialists, PA, Minneapolis, MN, USA
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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12
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Kumar LD, Karthik R, Gayathri N, Sivasudha T. Advancement in contemporary diagnostic and therapeutic approaches for rheumatoid arthritis. Biomed Pharmacother 2016; 79:52-61. [PMID: 27044812 DOI: 10.1016/j.biopha.2016.02.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
This review is intended to provide a summary of the pathogenesis, diagnosis and therapies for rheumatoid arthritis. Rheumatoid arthritis (RA) is a common form of inflammatory autoimmune disease with unknown aetiology. Bone degradation, cartilage and synovial destruction are three major pathways of RA pathology. Sentinel cells includes dendritic cells, macrophages and mast cells bound with the auto antigens and initiate the inflammation of the joints. Those cells further activates the immune cells on synovial membrane by releasing inflammatory cytokines Interleukin 1, 6, 17, etc., Diagnosis of this disease is a combinational approach comprises radiological imaging, blood and serology markers assessment. The treatment of RA still remain inadequate due to the lack of knowledge in disease development. Non-steroidal anti-inflammatory drugs, disease modifying anti rheumatic drugs and corticosteroid are the commercial drugs to reduce pain, swelling and suppressing several disease factors. Arthroscopy will be an useful method while severe degradation of joint tissues. Gene therapy is a major advancement in RA. Suppressor gene locus of inflammatory mediators and matrix degrading enzymes were inserted into the affected area to reduce the disease progression. To overcome the issues aroused from those therapies like side effects and expenses, phytocompounds have been investigated and certain compounds are proved for their anti-arthritic potential. Furthermore certain complementary alternative therapies like yoga, acupuncture, massage therapy and tai chi have also been proved for their capability in RA treatment.
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Affiliation(s)
- L Dinesh Kumar
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamil nadu, India
| | - R Karthik
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamil nadu, India
| | - N Gayathri
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamil nadu, India
| | - T Sivasudha
- Department of Environmental Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamil nadu, India.
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13
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Del Rosso A, Maddali-Bongi S. Mind body therapies in rehabilitation of patients with rheumatic diseases. Complement Ther Clin Pract 2015; 22:80-6. [PMID: 26850811 DOI: 10.1016/j.ctcp.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/29/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
Mind body therapies (MBT) share a global approach involving both mental and physical dimensions, and focus on relationship between brain, mind, body and behavior and their effects on health and disease. MBT include concentration based therapies and movement based therapies, comprising traditional Oriental practices and somatic techniques. The greatest part of rheumatic diseases have a chronic course, leading to progressive damages at musculoskeletal system and causing physical problems, psychological and social concerns. Thus, rheumatic patients need to be treated with a multidisciplinary approach integrating pharmacological therapies and rehabilitation techniques, that not should only aim to reduce the progression of damages at musculoskeletal system. Thus, MBT, using an overall approach, could be useful in taking care of the overall health of the patients with chronic rheumatic diseases. This review will deal with different MBT and with their effects in the most common chronic rheumatic diseases (Rheumatoid Arthritis, Ankylosing Spondylitis, Fibromyalgia Syndrome).
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Affiliation(s)
- Angela Del Rosso
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy.
| | - Susanna Maddali-Bongi
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy.
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14
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Hollan I, Dessein PH, Ronda N, Wasko MC, Svenungsson E, Agewall S, Cohen-Tervaert JW, Maki-Petaja K, Grundtvig M, Karpouzas GA, Meroni PL. Prevention of cardiovascular disease in rheumatoid arthritis. Autoimmun Rev 2015; 14:952-69. [PMID: 26117596 DOI: 10.1016/j.autrev.2015.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
Abstract
The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been recognized for many years. However, although the characteristics of CVD and its burden resemble those in diabetes, the focus on cardiovascular (CV) prevention in RA has lagged behind, both in the clinical and research settings. Similar to diabetes, the clinical picture of CVD in RA may be atypical, even asymptomatic. Therefore, a proactive screening for subclinical CVD in RA is warranted. Because of the lack of clinical trials, the ideal CVD prevention (CVP) in RA has not yet been defined. In this article, we focus on challenges and controversies in the CVP in RA (such as thresholds for statin therapy), and propose recommendations based on the current evidence. Due to the significant contribution of non-traditional, RA-related CV risk factors, the CV risk calculators developed for the general population underestimate the true risk in RA. Thus, there is an enormous need to develop adequate CV risk stratification tools and to identify the optimal CVP strategies in RA. While awaiting results from randomized controlled trials in RA, clinicians are largely dependent on the use of common sense, and extrapolation of data from studies on other patient populations. The CVP in RA should be based on an individualized evaluation of a broad spectrum of risk factors, and include: 1) reduction of inflammation, preferably with drugs decreasing CV risk, 2) management of factors associated with increased CV risk (e.g., smoking, hypertension, hyperglycemia, dyslipidemia, kidney disease, depression, periodontitis, hypothyroidism, vitamin D deficiency and sleep apnea), and promotion of healthy life style (smoking cessation, healthy diet, adjusted physical activity, stress management, weight control), 3) aspirin and influenza and pneumococcus vaccines according to current guidelines, and 4) limiting use of drugs that increase CV risk. Rheumatologists should take responsibility for the education of health care providers and RA patients regarding CVP in RA. It is immensely important to incorporate CV outcomes in testing of anti-rheumatic drugs.
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Affiliation(s)
- I Hollan
- Lillehammer Hospital for Rheumatic Diseases, Norway
| | - P H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Ronda
- Department of Pharmacy, University of Parma, Italy
| | - M C Wasko
- Department of Rheumatology, West Penn Hospital Allegheny Health Network, USA
| | - E Svenungsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - S Agewall
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - J W Cohen-Tervaert
- Clinical and Experimental Immunology, Maastricht University, Maastricht, The Netherlands
| | - K Maki-Petaja
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - M Grundtvig
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - G A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, USA; Los Angeles Biomedical Research Institute, Torrance, USA
| | - P L Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Italy; IRCCS Istituto Auxologico Italiano, Italy
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15
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Moonaz SH, Bingham CO, Wissow L, Bartlett SJ. Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial. J Rheumatol 2015; 42:1194-202. [PMID: 25834206 DOI: 10.3899/jrheum.141129] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of Integral-based hatha yoga in sedentary people with arthritis. METHODS There were 75 sedentary adults aged 18+ years with rheumatoid arthritis (RA) or knee osteoarthritis randomly assigned to 8 weeks of yoga (two 60-min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health [Medical Outcomes Study Short Form-36 (SF-36) physical component summary (PCS)] adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF-36 health-related quality of life (HRQOL), and RA disease activity. In everyone completing yoga, we explored longterm effects at 9 months. RESULTS Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 years (12 yrs). Average disease duration was 9 years and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5, 95% CI 2.0-10.7), walking capacity (125 m, 95% CI 15-235), positive affect (5.2, 95% CI 1.4-8.9), and lower Center for Epidemiologic Studies Depression Scale (-3.0, 95% CI -4.8 - -1.3). Significant improvements (p < 0.05) were evident in SF-36 role physical, pain, general health, vitality, and mental health scales. Balance, grip strength, and flexibility were similar between groups. Twenty-two out of 28 in the waitlist group completed yoga. Among all yoga participants, significant (p < 0.05) improvements were observed in mean PCS, flexibility, 6-min walk, and all psychological and most HRQOL domains at 8 weeks with most still evident 9 months later. Of 7 adverse events, none were associated with yoga. CONCLUSION Preliminary evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health and HRQOL. Clinical Trials NCT00349869.
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Affiliation(s)
- Steffany Haaz Moonaz
- From the Maryland University of Integrative Health, Laurel; Department of Medicine, and School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.S.H. Moonaz, PhD, Maryland University of Integrative Health; C.O. Bingham III, MD, Department of Medicine, Division of Rheumatology, Johns Hopkins University; L. Wissow, MD, MPH, School of Public Health, Johns Hopkins University; S.J. Bartlett, PhD, Associate Professor of Medicine, Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University
| | - Clifton O Bingham
- From the Maryland University of Integrative Health, Laurel; Department of Medicine, and School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.S.H. Moonaz, PhD, Maryland University of Integrative Health; C.O. Bingham III, MD, Department of Medicine, Division of Rheumatology, Johns Hopkins University; L. Wissow, MD, MPH, School of Public Health, Johns Hopkins University; S.J. Bartlett, PhD, Associate Professor of Medicine, Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University
| | - Lawrence Wissow
- From the Maryland University of Integrative Health, Laurel; Department of Medicine, and School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.S.H. Moonaz, PhD, Maryland University of Integrative Health; C.O. Bingham III, MD, Department of Medicine, Division of Rheumatology, Johns Hopkins University; L. Wissow, MD, MPH, School of Public Health, Johns Hopkins University; S.J. Bartlett, PhD, Associate Professor of Medicine, Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University
| | - Susan J Bartlett
- From the Maryland University of Integrative Health, Laurel; Department of Medicine, and School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.S.H. Moonaz, PhD, Maryland University of Integrative Health; C.O. Bingham III, MD, Department of Medicine, Division of Rheumatology, Johns Hopkins University; L. Wissow, MD, MPH, School of Public Health, Johns Hopkins University; S.J. Bartlett, PhD, Associate Professor of Medicine, Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University.
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Sharma M. Yoga as an Alternative and Complementary Approach for Arthritis. J Evid Based Complementary Altern Med 2013; 19:51-8. [DOI: 10.1177/2156587213499918] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States, approximately 21% of the adults suffer from arthritis. Yoga offers one possible way of managing arthritis. The purpose of this study was to look at studies from 2010 to June 2013 and examine whether yoga can be an efficacious approach for managing arthritis. A systematic search from Medline, Cumulative Index to Nursing and Allied Health, and Alt HealthWatch databases was conducted for quantitative articles involving all schools of yoga. A total of 9 articles met the inclusion criteria. Five of these were from the United States and 4 from India. Of the 9 studies, 6 demonstrated positive changes in psychological or physiological outcomes related to arthritis. Despite the limitations not all studies using randomized controlled design, having smaller sample sizes, having different outcomes, having nonstandardized yoga intervention, not using behavioral theory, and having varying lengths, yoga appears to be a promising modality for arthritis.
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Middleton KR, Ward MM, Haaz S, Velummylum S, Fike A, Acevedo AT, Tataw-Ayuketah G, Dietz L, Mittleman BB, Wallen GR. A pilot study of yoga as self-care for arthritis in minority communities. Health Qual Life Outcomes 2013; 11:55. [PMID: 23548052 PMCID: PMC3637098 DOI: 10.1186/1477-7525-11-55] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. METHODS/DESIGN In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. DISCUSSION There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. TRIAL REGISTRATION ClinicalTrials.gov: NCT01617421.
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Affiliation(s)
- Kimberly R Middleton
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Michael M Ward
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | | | - Sinthujah Velummylum
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Alice Fike
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 31 Center Dr, Bethesda, MD, USA
| | - Ana T Acevedo
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Gladys Tataw-Ayuketah
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
| | - Laura Dietz
- National Institutes of Health, Clinical Center, Rehabilitation Medicine, 10 Center Drive, Bethesda, MD, USA
| | - Barbara B Mittleman
- National Institutes of Health, Office of Science Policy, Office of the Director, Building 1, Bethesda, MD, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Nursing Department, 10 Center Drive, Bethesda, MD, USA
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Uhlig T. Tai Chi and yoga as complementary therapies in rheumatologic conditions. Best Pract Res Clin Rheumatol 2013; 26:387-98. [PMID: 22867933 DOI: 10.1016/j.berh.2012.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/24/2012] [Indexed: 02/06/2023]
Abstract
Tai Chi and yoga are complementary therapies which have, during the last few decades, emerged as popular treatments for rheumatologic and musculoskeletal diseases. This review covers the evidence of Tai Chi and yoga in the management of rheumatologic diseases, especially osteoarthritis of the knee, hip and hand, and rheumatoid arthritis. There is evidence that Tai Chi and yoga are safe, and some evidence that they have benefit, leading to reduction of pain and improvement of physical function and quality of life in patients. Recommendations for Tai Chi in knee osteoarthritis have recently been issued by the American College of Rheumatology. To allow broader recommendations for the use of Tai Chi and yoga in rheumatic diseases, there is a need to collect more evidence researched with larger randomised controlled trials.
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Affiliation(s)
- Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Arankalle DV. Integrating naturopathy and yoga in management of musculoskeletal disorders. Int J Prev Med 2013; 4:120-1. [PMID: 23413399 PMCID: PMC3570904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/05/2012] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dhananjay V Arankalle
- Department of AYUSH, Ministry of Health and Family Welfare, Govt. of India Division of Intramural Research, National Institute of Naturopathy, Pune, India,Correspondence to: Dr. Dhananjay Arankalle, National Institute of Naturopathy, Bapu Bhavan, Tadiwala Road, Pune - 411 001, Maharashtra, India. E-mail:
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Balaji PA, Varne SR, Ali SS. Physiological effects of yogic practices and transcendental meditation in health and disease. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:442-8. [PMID: 23112963 PMCID: PMC3482773 DOI: 10.4103/1947-2714.101980] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Yoga is an ancient Indian way of life, which includes changes in mental attitude, diet, and the practice of specific techniques such as yoga asanas (postures), breathing practices (pranayamas), and meditation to attain the highest level of consciousness. Since a decade, there has been a surge in the research on yoga, but we do find very few reviews regarding yogic practices and transcendental meditation (TM) in health and disease. Keeping this in view, a Medline search was done to review relevant articles in English literature on evaluation of physiological effects of yogic practices and TM. Data were constructed; issues were reviewed and found that there were considerable health benefits, including improved cognition, respiration, reduced cardiovascular risk, body mass index, blood pressure, and diabetes. Yoga also influenced immunity and ameliorated joint disorders.
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Affiliation(s)
- P A Balaji
- Department of Physiology, Dr. B R Ambedkar Medical College, Bangalore, Karnataka, India
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Telles S, Singh N. Is yoga a suitable treatment for rheumatoid arthritis: current opinion. Open Access J Sports Med 2012; 3:81-7. [PMID: 24198591 PMCID: PMC3781903 DOI: 10.2147/oajsm.s25707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We reviewed published literature regarding the use of yoga for managing rheumatoid arthritis to determine whether adequate evidence exists to suggest its usefulness as a therapy. A search for previous studies involving yoga and rheumatoid arthritis in PubMed yielded eight reports. These studies reported the benefits of yoga in the physical and mental health of patients with rheumatoid arthritis (RA), suggesting that yoga is a useful add-on therapy for RA patients. However, all studies showed limitations with respect to sample size, study design, description and duration of yoga intervention, and assessment tools and statistical methods used. Additionally, the studies did not attempt to understand the mechanisms underlying observed benefits. Hence, evidence suggests a definite role of yoga in RA improvement, reducing pain, improving function, and creating a positive mental state. However, detailed analysis and additional studies are necessary to verify these observations.
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Alomari MA, Keewan EF, Shammaa RA, Alawneh K, Khatib SY, Welsch MA. Vascular function and handgrip strength in rheumatoid arthritis patients. ScientificWorldJournal 2012; 2012:580863. [PMID: 22606051 PMCID: PMC3317755 DOI: 10.1100/2012/580863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/17/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. METHODS Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. RESULTS The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = -0.3; P = 0.009) and RHVR (r = -0.3; P = 0.007). CONCLUSION The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.
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Affiliation(s)
- Mahmoud A Alomari
- Division of Physical Therapy, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
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