Last weekend I was at 'Florida Society of Rheumatology" conference in Orlando. Despite having many interesting lectures, one specific lecture about 'Physician burn out and wellness' caught my attention the most. We hear a lot about wellness now a days, but what does it really mean in terms of rheumatic diseases and immunology. I have come to conclusion that the word wellness should always go together with rheumatology. The effects of wellness in immunology is very specific and has been well documented for past many years. It’s a conscious choice that people make and it requires ongoing efforts from patients and their physicians to maintain. It not only involves physical but emotional well being. There are 5 basic elements that are modifiable - diet, sleep, mindfulness, social connections and exercises. Rheumatic diseases affect entire body and not just only joints. There are studies showing that likelihood of immunologic diseases doubles in patients with PTSD. In Japan, there is something called ‘Forest bathing’ or ‘shinrin-yoku’. It is simply being in nature, connecting with it through our senses. It increases body’s natural killer cells (NK cells) and they have effects in inflammation. Psychoneuroimmunology studies have shown effects of chronic stress in immune system. There has been growing evidence suggesting ‘modern stress and stressors’, that were not present before, have been one of the reasons for the increase in autoimmune diseases over the past few decades. Emerging data have begun to identify the impact of unchecked stress on a variety of chronic conditions, especially within the field of autoimmune diseases. There are therapies now designed to dampen this stress response through parasympathetic stimulation and through vagal nerve stimulation that are now in phase 2 trials.
Exercises has direct anti-inflammatory effects in immune system. Patients with arthritis may be limited in exercises and may need personal coaching and tailored plan to their needs. In regards to diet, there is not one anti-inflammatory food but Mediterranean diet can have anti-inflammatory effects. Read my blog on anti inflammatory diet here.
Sleep and the circadian system exert a strong regulatory influence on immune function. Patients with RA who have interrupted sleep had higher pain level. Mindfulness and social connection have effects in immune system and has beneficial anti-inflammatory effects. There are apps for mindfulness that you can use. Combining traditional medications with wellness is important for patients’ positive outcome.
Talk to your rheumatologist more about how you can implement these changes to achieve wellness in addition to your standard therapy for your rheumatic diseases.