Physio findings: yoga for arthritis and less time in casts

Yoga may ease rheumatoid arthritis symptoms

An eight-week programme of intensive yoga may ease the severity of physical and depressive symptoms in patients with active rheumatoid arthritis, a small clinical trial suggests.

Underlying depression can worsen the physical symptoms of rheumatoid arthritis and interfere with adherence and responsiveness to drugs but the available treatments don’t seem to be able to tackle this effectively, say the researchers.

They wanted to see if yoga practice might influence systemic markers of inflammation, cellular aging, and oxidative stress as well as easing depressive symptoms in patients with active disease and receiving treatment with disease modifying antirheumatic drugs (DMARDs).

They randomly assigned 72 patients to either an eight-week programme of intensive yoga (120 minutes, five days a week) on top of DMARD treatment or to drug treatment alone. Blood samples were collected before and after the eight weeks, and disease activity and disability were similarly assessed using validated measures: DAS28ESR and HAQ-DI, respectively.

The severity of depression was assessed using the Beck Depression Inventory II scale every fortnight.

After eight weeks, the levels of systemic inflammatory markers studied had fallen significantly in the yoga therapy group compared with those in the drug treatment group, suggesting that yoga has an impact on the immune system, say the researchers.

The test group also experienced a reduction in symptom severity and disability as well as a significant incremental easing of their depressive symptoms over the period. These improvements had the knock-on effect of enabling them to stick more readily to their drug treatment and made it easier to carry out routine chores and activities.

It’s not clear exactly how yoga might affect the body at the cellular level, say the researchers. Further research is needed to explore this. But the findings back up those of other studies which have looked at how yoga can ease clinical symptoms and boost quality of life, psychological wellbeing, and functional ability in people with rheumatoid arthritis.

The researchers conclude that yoga might be a useful addition to drug treatment to relieve both physical and psychosomatic symptoms.

“Our results provide evidence that yoga positively modifies the pathobiology of autoimmunity at cellular and molecular levels by targeting mind-body communication,” comments lead study author Professor Rima Dada, of the Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

As many diseases have a psychosomatic element, this approach may be more widely applicable, the researchers suggest. And a more holistic dimension to treatment may make reaching a state of remission a more achievable treatment goal.

Gautam S, et al.Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active rheumatoid arthritis patients: A randomized controlled trial. Restorative Neurology and Neuroscience 2018 doi 10.3233/RNN-180875

Three weeks in a cast may be as good as six for healing ankle fractures

Wearing a cast or brace for three weeks may be as good as the usual six weeks for healing the most common type of ankle fracture (Weber-B), finds a comparative study of 247 people with an average age of 45.

A shorter period of immobilisation may be better for patients, by reducing stiffness, skin damage, and blocked blood vessels as well as reducing healthcare costs, say the researchers.

Fractures were assessed by an external-rotation (ER) stress test and participants were randomly allocated to either the conventional six-week cast (84 people); three weeks in a cast (83); or to a simple ankle brace for three weeks (80).

They were subsequently monitored at six, 12 and 52 weeks to measure ankle fracture symptoms using the Olerud-Molander Ankle Score (OMAS), where higher scores indicate better healing.

The researchers also assessed ankle function, pain, quality of life, ankle motion and x-ray results, and they asked the patients to describe any side effects of the treatment.

After 12 months, the average OMAS scores showed that three weeks were no worse than six weeks, with the three-week cast and brace groups scoring 91.7 and 89.8, respectively, compared with 87.6 in the six-week cast group.

There was also a slight improvement in ankle mobility among those wearing the ankle brace compared with those in the six week cast group.

If it is subsequently proved that the shorter option is more effective, “it is intuitive that patients would choose the shorter or the more convenient treatment strategy,” conclude the researchers.

Kortekangas T, et al. Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial.
The BMJ 2019

Comments and conclusions

Exercise may not help to ease the symptoms of postnatal depression, suggest the results of a randomised controlled trial of 639 pregnant women. But failure to comply with the exercise programmes was substantial, note the researchers, and so may have underestimated the possible benefits of the approach.

JAMA Network Open 2019 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720074

There’s no good evidence to suggest that middle-aged or older people can preserve brain power or stave off dementia by taking vitamin or mineral supplements, finds a review of 28 published studies involving more than 83,000 people over the age of 40. But long-term use of antioxidant vitamins may be moderately helpful.

Cochrane Database of Systematic Reviews 2018 www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011906.pub2/full

Gait may help to signal depression, suggest the results of a study of more than 3500 people aged 50+. Those newly diagnosed with depression walked more slowly and took shorter steps than those without.

Journal of the American Geriatrics Society 2019 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15783%20