Role of yoga and naturopathy interventions in the management of rheumatoid arthritis: A mechanistic review

Abstract

Rheumatoid arthritis (RA) is an autoimmune chronic systemic inflammatory disease characterized by polyarticular joint involvement associated with extra-articular manifestations. It affects 0.1%–2.0% of the population worldwide.¹ Despite advances in targeted biological and pharmacologic interventions, many patients with RA continue to have an inadequate response to therapies, or intolerable side effects, with the resultant progression of their disease. In complementary and alternative medicine, yoga, and naturopathy are commonly employed to treat various diseases including RA.² Examining the multi-modular, drugless approach of yoga and naturopathy to this autoimmune disease is equally important as it enables physicians to provide better care. Hence, the current review was undertaken to present an overview of the available scientific evidence on the mechanism of yoga and naturopathy (that are followed in India) therapeutic modalities in treating RA.

Online databases like PubMed/Medline, PubMed Central, Google Scholar, and IndMed were searched till December 2023. The list of keywords used was naturopathy, yoga therapy, hydrotherapy, balneotherapy, mud therapy, color therapy, acupuncture, diet therapy, and rheumatoid arthritis. Boolean operators such as queries (OR), (AND) were used appropriately. Randomized controlled trials, quasi-experimental studies, case reports, Case series, review articles published in English, and contain substantial mechanism of actions of effect of yoga and naturopathy in RA or the pathophysiology involved in RA were included in this review. The letter to the editor, comments, health news, studies with lack of sufficient information, and article published other than English were excluded from this review. The findings of studies included in the review are discussed based on their efficacy of each treatment with mechanism in the management of RA.

Yoga therapy, a philosophical approach involving asanas, pranayama, and meditation, can help reverse harmful epigenetic alterations, improve RA symptoms, and reduce the risk of relapse when combined with other healthy lifestyle behaviors.³ Symptomatically RA is presented with morning stiffness, tenderness, symmetrical joint pains, swelling, and fatigue, affecting the quality of life of an individual. Endogenous opioids produced during sustained stretching of muscles in the practice of yoga help to relieve pain.⁴

Auto-inflammation and autoimmunity in RA are linked to psychological stress and depression due to malfunctioning neuroendocrine systems, systemic inflammation, accelerated immunological aging, and abnormal Deoxyribonucleic acid (DNA) damage sensing and repair machinery.⁵ Yoga likely works through the psycho-neuro-immunological axis, balancing the sympathetic and parasympathetic branches of autonomic nervous system. This reduces the hypothalamic pituitary adrenal (HPA) axis response during aggressive symptoms, decreasing markers associated with the axis, supporting normalization of flare-ups and RA remission.⁶

According to this review, practicing yoga and naturopathy as therapeutic modalities may be beneficial in RA patients by reducing pain through stimulation of opioids and serotonin secretions, pain mediators, and gate control theory; preventing inflammation by decreasing pro-inflammatory cytokines and oxidative stress and increasing anti-inflammatory cytokines, and anti-oxidants; downregulation of HPA-axis; and improving immune function by psycho-neuro-immunological axis, gut microbiota, and sympathetic modulation.

Conceptualization: G. B. S., B. S., and P. S. Methodology: G. B. S., B. S., A. V., and A. M. Data curation: G. B. S., B. S., and A. V. Supervision: P. S. Project administration: P. S. and B. S. Writing—original draft preparation: G. B. S. and B. S. Writing—reviewing and editing: A. V. and A. M.

The authors have none to declare.