AB1317-HPR YOGA-THERAPY: IMPROVEMENT IN PSORIATIC ARTHRITIS PROMS AT 4 MONTHS
Authors: C. B. Colaco, V. Sadana, K. Anie
Journal: Annals of the Rheumatic Diseases (2020)

Background: Psoriatic Arthritis and Psoriasis have a major impact on QOL with associated mood disorders and Cardiovascular disease and Cancer as inter-related co-morbidities 1 . Yoga therapy (Y-T) has been used in several Long Term Conditions 2 and we have reported Rapid improvement in Proms in RA (RCP 2018) and so compared results of a PsA cohort offered the same Y-T intervention. Objectives: This first in UK PsA study investigated: a) impact of a 16 week Y-T intervention on functional outcomes and QOL in 10 PsA patients, b) acceptability and experiences of the intervention. We present results in comparison to a previously reported RA cohort n=10. Methods: Ten adult PsA patients (2 M 8 F Age 32-67 Avg: 53.7 Y; PsA diagnosis: 6.45 yrs:1 Juvenile onset) consented to 10 individual Y-T sessions (weekly x 4; biweekly x 6) with a yoga therapist in a standard consulting room. The intervention was tailored to the needs and abilities of each patient and included: breath-centered physical yoga postures, breathing and visualization techniques, mantras and meditation, with supportive Lifestyle/behavioural strategies. All participants completed measures pre- and post-intervention (EQ-5D HAQ HADS PGIC) to assess change in health status. Results: A 10 session course of Y-T over 16 weeks was completed with 92/100 PsA YT sessions. Note 1 patient had unrelated Trauma and withdrew after 2 sessions. This confirms acceptability of delivery in a clinic setting and all participants reported strong adherence to practices (0-1) and strong belief (0-2) in impact of yoga. (Likert 5 point 0-4 scale). Further data on only 9 PsA participants will be presented in comparison to the previous RA cohort of 10. PsA patients n=9: Pain reduced 25 % HADs Depression reduced 39% Anxiety reduced 25% HAQ health score improvement was significant at P&lt;0.04 (ANOVA). EQol 5d(3L) improved 24% but overall QOL remained below 50% max calculated TTO. RA patients had recorded stable overall TTO at a higher level 0.63 pre and post Y-T. PGIC record of positive change is recorded as a reduction on VAS from 5/5 to 2.4/5. We will add 12 month FU data set in PsA to compare with 24 month data in the RA cohort. Conclusion: Yoga-Therapy is deliverable and acceptable in a NHS clinic setting for PsA. Improved PROMS begs further larger studies of mechanisms of bio-psychosocial intervention in long term inflammatory conditions. The outcomes support the Poly Vagal Theory 3 as an effector model, via the bio-mechanistic neuro-inflammatory reflex 4. We propose further Health Economic analysis of this 2500 yr old Yoga model for long term conditions to examine any long term cost benefit to the NHS. References: [1]Coates LC et al Rheumatology 2018;57:1321-1331 Remission in psoriatic arthritis-where are we now? [2]Khalsa, SB, Cohen, L, McCall, T &amp; Telles, S (2016) (Eds). The Principles and Practice of Yoga in Health Care. Handspring Publishing. [3]Sullivan M B Porges SW et alFront. Hum. Neurosci., 2018 Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience [4]Pavlov V Tracey K Nat Rev Endocrinol. 2012 Dec; 8(12): 743–754. The vagus nerve and the inflammatory reflex—linking immunity and metabolism Table 1. PsA vs RA post Yoga Therapy PROMs at 4 mth. PsA n=9 pre PsA 4 m PsA 4 m % RA n=10 Pre RA4m FU RA 4m % HADS m Depression 6.33 3.88 -39 6.7 2.3 - 65 HADS m Anxiety 8.56 6.44 -25 9.4 4.8 - 48 Mean HAQ 0.79 0. 75 - 2 0.78 0.48 - 26 M Pain Score (HAQ) 60 45.00 -25 57 24 - 58 M Health Score (HAQ) 60 42.7 -29 p&lt;0.04 51 17.2 - 66 M H Utility TTO (EQol5d) 0.41 0.5 +24 0.63 0.63 0 PGIC 5 2.4 Acknowledgments: CMH Rheumatology Support Group Disclosure of Interests: C Bernard Colaco Grant/research support from: Travel Support for Conference attendance, Speakers bureau: Menarini, Vidhi Sadana: None declared, Kofi Anie: None declared