Mindfulness para pacientes com artrite reumatoide. Revisão sistemática da literatura

Abstract

Introduction: Rheumatoid arthritis (RA), characterized as an autoimmune systemic disease, progressive chronic inflammation that causes deformity and destruction of the joints, has a negative impact on the autonomy to perform daily activities, quality of life, and triggers cardiovascular, pulmonary, and increased mortality. Mindfulness meditation is one of the practices that assists in the search for integral care and in recent years has attracted the attention of researchers who, gradually, begin to value non-medicamentalized practices capable of promoting physical and mental well-being. Objective: To evaluate the effectiveness of mindfulness as a complementary therapy for patients with rheumatoid arthritis. Method: This is a systematic review of the literature of randomized clinical trials. The electronic databases searched were: CENTRAL, MEDLINE, PEDro, PsycoINFO, LILACS, Web of Science, clinical trials.gov, WHO-ICTRP. The gray literature was accessed through the Open Gray base. Primary studies evaluating intervention with mindfulness compared to placebo, psychotherapy, or other equivalent strategies in patients with rheumatoid arthritis were included. Primary outcomes included: symptom management, quality of life, and patient satisfaction. The quality of each study was assessed using the bias evaluation tool provided by the Cochrane Collaboration. Results: Four studies (249 participants) comparing mindfulness with waiting list, cognitive therapy and education were included. All studies were classified as having a high risk of bias in at least one of the domains of the Cochrane Collaboration tool. Studies have shown improvements in the disease activity scores (DAS-28-CRP), morning stiffness, pain, overall patient assessment, depressive symptoms, psychological stress, well-being, improvements in positive and negative affect, decrease in joint counts inflammatory reactions, stress reactivity and catastrophic pain, improvements in reported pain, fatigue, morning dysfunction, anxious and serene affect. Conclusion: Evidence from the present review studies is of low quality, therefore, more robust clinical trials with larger samples are needed in order to know the efficacy of mindfulness for patients with rheumatoid arthritis and this technique can be adopted in the clinical practice.