- Design
- Systematic review and meta-analysis of randomised trials (one database searched)
- Population
- Eight randomised trials, 651 participants with rheumatoid arthritis
- Primary outcome
- DAS28, HAQ-DI and inflammatory markers
- Effect
- DAS28 SMD -0.44 (95% CI -0.56 to -0.31); HAQ-DI SMD -0.23 (-0.81 to 0.36); IL-6 SMD -0.65 (-1.17 to -0.13)
A meta-analysis of eight randomised trials with 651 participants examined yoga in rheumatoid arthritis. Compared with control, yoga was associated with a lower DAS28 (standardised mean difference -0.44, 95% CI -0.56 to -0.31). Function by HAQ-DI did not change significantly (-0.23, -0.81 to 0.36). Serum IL-6 fell (-0.65, -1.17 to -0.13) but TNF-alpha did not significantly change (-0.71, -1.74 to 0.33).
The authors report improved mental health and lower inflammation through IL-6, but also that the effect on physical health was inconsistent. Only one database was searched, which risks missing trials. DAS28 includes a patient global score and joint tenderness, both of which are influenced by mood and perceived wellbeing, so an effect on the score does not necessarily mean less joint inflammation.
Yoga is widely practised in India and generally low risk, which makes it an easy adjunct to suggest. It does not replace disease-modifying treatment.
- Yoga was linked to a lower DAS28 (SMD -0.44) across eight trials.
- IL-6 fell, but TNF-alpha and HAQ-DI did not change significantly.
- Only one database was searched, so trials may be missing.
- DAS28 includes patient-rated components that mood can influence.
- Suggest yoga as an adjunct to, never a replacement for, disease-modifying therapy.
Why it matters
Patients often ask about yoga, and this gives a measured answer: modest benefit, not a substitute for drugs.
Don't overread it
A single-database meta-analysis of eight small trials cannot show that yoga reduces joint damage.
The statistics, in plain English
A standardised mean difference of -0.44 is a small-to-moderate effect. The narrow interval for DAS28 contrasts with the wide interval for HAQ-DI, which spans no effect, so function was not shown to improve.
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