Lifestyle interventions can often ameliorate disease-related symptoms, such as pain, fatigue, and insomnia, and they may have beneficial “off-target” effects, such as reduced risk of cardiovascular disease and depression.
“Conventional pharmacologic approaches are lifesaving, in many cases, but they have important limitations,” said Sarah Patterson, MD, Assistant Professor at the University of California, San Francisco (UCSF), who presented a patient-centered lecture focusing on three lifestyle modifiers: healthy diet, physical activity, and stress resilience.
ARP Keynote: Lifestyle Medicine: Improving Quality of Life while Living with a Rheumatic Condition is available on demand for registered ACR Convergence 2023 participants through Oct. 31, 2024, on the meeting website.
Dr. Patterson noted that many of the studies on lifestyle intervention approaches to medicine include smaller sample sizes, possibly because of less funding.
The dietary pattern most studied is the Mediterranean diet, which includes an abundance of vegetables, fruit, beans, olive oil, and whole grains, and moderate amounts of fish, low-fat dairy, poultry, and nuts. It limits added sugar, especially sugary drinks, processed food, and red meat.
Evidence shows a plant-based, Mediterranean-style diet reduces pain, Dr. Patterson reported, and data also suggest that such a diet may also reduce disease activity in patients with rheumatoid arthritis (RA). Studies demonstrated that people with systemic lupus erythematosus (SLE) experience an improvement in symptoms after adopting a plant-based, whole-food diet, although more randomized, controlled trial data is needed.
Trials that studied omega-3 polyunsaturated fatty acid supplementation via fish oil demonstrated improvement in disease activity in both lupus and rheumatoid arthritis.
Dr. Patterson offered a resource-laden website she developed with colleagues at other institutions that features nutrition resources for patients and clinicians, including a section with tips for making dietary changes.
Physical activity as a lifestyle modifier showed notable improvements for people with rheumatic disease, despite past concerns that it could exacerbate joint symptoms or cause joint damage.
“We now know that when this is done appropriately, it’s absolutely safe. It doesn’t make disease activity worse,” Dr. Patterson said.
Across several studies, data showed that physical activity reduced fatigue, improved quality of life, and improved sleep disturbance in people with RA and lupus. Dr. Patterson also showed molecular mechanistic data from UCSF demonstrating that RA and lupus patients who were more physically active had down-regulation of pathogenic innate and adaptive immune signaling genes.
A 21-week randomized controlled trial that studied walking showed notable improvements in fatigue for patients with RA.
In 2022, the ACR came out with a guideline about exercise and integrative interventions for RA.
“The only strong recommendation that came out of this guideline was the recommendation for people with RA to consistently engage in exercise over no exercise,” Dr. Patterson said. “So, I think this is something we can all agree on, and it seems to be a really important focus in our patient care.”
Mindfulness plays a role in stress resilience in patients with rheumatic disease. Psychological stress occurs when an individual perceives that environmental demands tax or exceed their adaptive capacity.
Dr. Patterson presented studies that showed baseline psychological stress predicts worse long-term disease activity and physical disability in RA. SLE patients who experienced an increase in stress had worse disease activity, according to a study that looked at self-reported stress in follow-up visits between years two and three of diagnosis.
Mind-body medicine can come into play in reducing stress and improving patient outcomes, said Dr. Patterson. Mind-body medicine encompasses practices that focus on the interaction among the brain, mind, and body with the intent to use the mind to affect physical function and promote health.
She summarized 30 randomized controlled trials that looked at the impact of mindfulness-based interventions versus other nonpharmacologic interventions on pain severity in people with chronic pain.
“What they found was a significant reduction in the severity of pain among patients in the mindfulness groups compared to the control,” Dr. Patterson said. “Some other benefits of mindfulness-based interventions that have been observed are improvements in mood symptoms, like depressive symptoms and anxiety, as well as improvement in physical function, quality of life, and sleep disturbance.”