Can yoga help live better with rheumatoid arthritis?

Photo by Earl Wilcox on Unsplash. Because, why not?

There’s a new-found interest in immunology out there since the pandemic; everybody now talks about antibody levels and long-term immunity and vaccine responses. I’m not going to lie, it does make me chuckle when I hear these conversations (sorry, that sounded patronising, I know), but at least this means that people are interested – I have very vivid memories of trying to explain my PhD to people only to watch that slight glaze in their eyes.

In the blog, I’ve been delving a little more into the evidence that yoga may support a healthy immune system and the pivotal role of stress here. One key area that fits into this is what does yoga actually do for people who live with autoimmune disease, which includes Crohn’s disease, ulcerative colitis, rheumatoid arthritis, type 1 diabetes to name a few.

What are autoimmune diseases?

Here’s a really quick immunology lesson (that you can just skip through if you wish). The cells of our immune system have to go through a sort of training as they develop to learn to recognise what is self and what is non-self; in my case, that would be learning what is Rachel and what is not Rachel, so perhaps a bacterium, a virus or a dodgy Rachel-like cell like a cancer cell. The stakes are high, and so if the developing immune cells fail, they die. Think of it as a sort of totalitarian regime that keeps you healthy.

But, sadly the education system is not perfect, and sometimes mistakes happy. Rogue cells graduate, go off into the world that is your body, and start attacking your gut, your joints, your pancreas etc. These now ‘adult’ cells multiply, and their ‘offspring’ keep on attacking the same self-organ, and so we get full-blown autoimmunity.

Is there evidence that yoga can help?

What we know from the research is that practicing yoga is linked with reducing the levels of molecules that drive inflammation, aka an ‘excessive’ immune reaction. But does that translate to an actual improvement in disease activity?

Let’s look at rheumatoid arthritis

This is an autoimmune disease that affects the joints, leading to swelling and stiffness and a consequent difficulty in mobility. It’s the one that I have come across the most when looking at the literature, and I had written about it before so I was hopeful.

Overall, we have the usual issues with yoga research

The studies are small, define yoga interventions in different ways and some had no control (ie something to compare to). And although the individual studies (eg see 1, 2, 3, 4, 5) are on the whole quite positive about the effects of yoga, when the studies are consolidated and re-analysed (in this systematic review), the outcome is a bit less impressive:

  1. Yoga improved physical function compared to doing nothing at all (control) but not when it was compared to ‘usual care’ (ie whatever the treatment the patient was on). But, yoga plus medication was better than medication alone.
  2. Yoga improved disease activity (defined as swelling and stiffness of joints) compared to control but not when compared with ‘usual care’. But, again, yoga plus medication was better than medication alone.
  3. Although individual studies found a reduction in levels of molecules that promote inflammation (which might be an indication of an altered immune response), the meta-analysis concluded that this was not statistically significant.
  4. Yoga was found to reduce pain levels compared to doing nothing, but there was no difference it was compared with ‘usual care’ or when yoga plus medication was compared to medication alone.

The individual studies also found improvements in things like mental health and quality of life, which the review doesn’t cover for some reason but are really important.

What does this mean?

It looks like yoga is a good add-on to your treatment regimen if you have rheumatoid arthritis. At the very least, it’s likely to help improve your quality of life, and for me that’s enough of a reason to do it.

Yoga together with medication was better than medication alone in some of these metrics, which is important because no one would really advocate to give up treatment in favour of yoga. So when they say that there was no difference to ‘usual care’ – well no, I wouldn’t expect yoga to be better than medication.

From this meta-analysis, it would seem that yoga offers improvements on a musculoskeletal level, by promoting mobility and stretch – so not by reducing inflammation. Which is disappointing, to me anyway.

But one thing to remember is that a meta-analysis is only as good as the research it analyses. There is a decent amount of non-rheumatoid arthritis research showing that yoga influences the expression of genes that code for molecules that promote inflammation. So I wouldn’t rule out that yoga works on this level to.

All we need is better research!

Are you living with an autoimmune disease? Has yoga helped?

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