Mindfulness Meditation Eases Stress, Lowers ESR

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.