Spring 2023 (Volume 33, Number 1)
Mindfulness-Based Stress Reduction in
Symptomatic Patients with Controlled
Rheumatoid Arthritis
By Isabelle Gaboury, PhD; Patricia L Dobkin, PhD;
Françoise Gendron, MD;
Pasquale Roberge, PhD;
Marie Claude Beaulieu, MD; Nathalie Carrier, MSc;
Pierre Dagenais, MD, PhD; Sophie Roux, MD, PhD;
and Gilles Boire, MD, MSc, FRCPC
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Current treatments of rheumatoid arthritis (RA)
are very effective at controlling inflammation and
preventing joint and bone destruction. Some RA
patients continue to report distressing patient-reported
outcomes (PROs) such as pain, fatigue, depression or
functional impairment despite clinically controlled inflammation
(controlled RA) according to the physician.
The best approach to improve PROs in these patients is
currently unknown.
In a pragmatic pilot study,1 we offered free participation
to group mindfulness-based stress reduction (MBSR)
sessions led by a certified therapist. MBSR is an 8-week
group intervention shown to be effective to help patients
with a number of diseases.2 We included patients with
controlled RA (2 swollen joints or less; normal C-reactive
protein [CRP]) coming to their regular follow-up visit who
had high depressive symptoms (Centre for Evaluation
Studies-Depression [CES-D] scores ≥16) and/or Patient
General Assessment of disease activity (PGA) at least 2/10
higher than Evaluator General Assessment (EGA). Evaluations
were completed before and 6 and 12 months after
MBSR and included CES-D, PGA, the Modified-Health
Assessment Questionnaire (M-HAQ), Simplified Disease
Activity Index (SDAI), and measures of anxiety (General
Anxiety Disorder 7 [GAD-7]), coping strategies (Coping
with Health Injuries and Problems [CHIP]), and 0-10 Visual
Analog Scales for sleep disturbance and pain.
Out of 306 screened patients, 65 (about 50% of those
potentially eligible according to chart data from their
previous visit) were referred by their rheumatologist to
research personnel, 39 (60%) signed consent, 29 (45%)
participated in at least one session and 28 (43%) completed
the 8 MBSR sessions. Anticipated burden, timing
and frequency of weekly group meetings, commuting
issues, age extremes, and comorbidities were barriers to
participation.
The proportion of patients with CES-D ≥16 decreased
from 67.9% at baseline to 36% (p=0.01) and 11.8%
(p=0.002) at 6 and 12 months, respectively. M-HAQ≥1,
indicative of at least moderate disability, decreased from
57.1% at baseline, to 32.1% at 6 months (p=0.007), and
26.1% at 12 months (p=0.008). At 12 months after completion
of MBSR, anxiety, emotion-oriented coping and
sleep also significantly improved. Yet, no significant impact
was observed on pain, PGA or SDAI. Interviews of
9 patients at 6 months after completion of MBSR sessions
revealed that benefits to patients including integration
of effective coping strategies into regular activities were
maintained.
We addressed MBSR feasibility issues and the selection
of outcomes in patients with controlled RA patients still
expressing distressing PROs. For patients who chose to
participate in group MBSR, lasting benefits were evident
for anxiety, depression, sleep, and function. Less demanding
interventions, such as web-based MBSR groups,
might allow better participation. Larger studies will be
required to evaluate the weaker impact of the intervention
on pain and PGA.
References:
1. Gaboury I, Dobkin PL, Gendron F, Roberge P, Beaulieu MC, Carrier N, Dagenais P, Roux S, Boire G.
Mindfulness-based stress reduction to improve depression, pain and high patient global assessment
in controlled rheumatoid arthritis. Rheumatol Adv Pract. 2022 Sep 5; 6(3):rkac074. doi:
10.1093/rap/rkac074.
2. The Center for Mindfulness in Medicine, Health Care, and Society. Mindfulness-based stress reduction
(MBSR): standards of practice. Available at https://mindfulness.au.dk/
fileadmin/mindfulness.au.dk/Artikler/Santorelli_mbsr_standards_of_practice_2014.pdf. Accessed February 27, 2023.
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