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<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 & 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

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