Nonpharmacological interventions for the treatment of rheumatoid arthritis: a focus on mind-body medicine

Abstract

Rheumatoid arthritis (RA) is a chronic, autoimmune disease that affects approximately 1.3 million Americans. It is characterized by inflammation of the joints, most often affecting the hands, hips, and knees. Presently, there is no cure, and the commonly used pharmacological therapies are not always effective and have significant side effects, especially when used long term. Consequently, there is a need for alternative treatments for RA. Mind-body medicine (MBM), which uses the mind to affect disease processes, is a promising area for many pathological conditions, especially autoimmune disorders like RA. In this review, we highlight the basis for psychological-based interventions for the treatment of RA. The notion that the mind has an impact on immune function and several processes that underpin the pathophysiology of RA is well established. Correspondingly, there are several lines of evidence to indicate that psychological-based interventions can favorably affect these processes. Clinical trials of MBM in RA have most commonly assessed outcomes such as pain, functional disability, psychological status, coping abilities, self-efficacy, and joint involvement. Across studies, statistically significant improvements were found for all outcomes, though the clinical significance of these changes is open to interpretation. Given that the RA patients included in these studies had generally maximized the use of pharmacological options, any additional therapeutic benefit may be considered significant. Patients with a history of depression appear to exhibit heightened responsiveness to MBM, and this is a group that should be preferentially targeted. Based on the current evidence, MBM can be recommended as an adjunct to conventional therapy to enhance treatment response and possibly reduce the use of more risky pharmacological therapies.