Competing interests None.
Ethics approval The NorthernXEthics Committee approved the study, and all
patients provided written consent.
Provenance and peer review Not commissioned; externally peer reviewed.
As far as I know the externally peer reviewer  has not been published because 
of the confidential rules.In the hope not breaking this confidential rules may 
I note here :
Yoga exercises should be performed with caution by people with RA who have 
limited mobility or spinal problems.No dietary supplement has shown clear 
benefits for RA, but there is preliminary evidence for a few, particularly fish 
oil, gamma-linolenic acid, and the herb thunder god vine.(Tripterygium 
wilfordii- has been used for centuries in traditional Chinese medicine)
To be aware:
 Do not replace proven conventional treatments for RA with unproven health 
products and practices. Do not change your use of prescribed RA medications 
without consulting your health care provider. Going without effective treatment 
for RA could lead to permanent joint damage. Be aware that some complementary 
health approaches—particularly dietary supplements—may interact with 
conventional medical treatments. Also consider the possibility that what’s on 
the label of a dietary supplement may not be what’s in the bottle..)
 "There were no differences, however, in objective measures of disease activity 
like C-reactive protein levels and number of swollen joints between the MBSR 
and comparison groups.
 The authors conclude that MBSR likely helped participants by changing their 
“experience” of the disease."which helps regulate emotions, improved 
participants’ ability to cope with pain.
From research text:

 "Mindfulness training involves the cultivation of non-judgemental attention to 
unwanted thoughts, feelings and bodily experiences via meditation and may help 
ameliorate both psychological and physical symptoms of chronic disease.1 
Clinical trials have shown that mindfulness training improves the psychological 
well-being of people with rheumatoid arthritis (RA).2–4 However, there is 
limited evidence for its efficacy on disease activity outcomes in RA. Given 
evidence linking increased mindfulness to improved immune markers,5 mindfulness 
training may reduce disease activity in patients with RA by enhancing their 
immune function. The aim of this randomised controlled trial was to examine the 
effects of a standardised mindfulness-based stress reduction (MBSR) 
intervention on RA disease activity. 
 Fifty-one patients with RA, according to the 1987 American College of 
Rheumatology classification criteria6 and without any prior meditation 
experience, were recruited from two public hospitals in Auckland, New Zealand. 
After completing baseline assessments, 26 and 25 participants were randomised 
to the MBSR and control groups, respectively. The MBSR group received the 
standardised 8-week programme developed
by the University of Massachusetts Medical School,and the control group agreed 
that they could participate free of charge
in MBSR after all data collection was completed. Follow-up assessments were 
completed after 2, 4 and 6 months.
Assessments were conducted by a trained research assistant who
was blinded to treatment allocation. At each study visit, RA
disease activity was assessed using the four-variable Disease
Activity Score in 28 joints-C-reactive protein (DAS28-CRP).
Individual components of the DAS28-CRP include numbers of
tender and swollen joints, CRP and patients’ assessment of
disease activity on a 100 mm visual analogue scale.
Duration of early morning stiffness (minutes) and pain (0–100 mm visual
analogue scale) was also measured. The change over time, treat-
ment differences and their interaction were analysed in the 42
participants who completed the interventions using multivariate
analysis of covariance (PASW Statistics V.18.0) analyses. Baseline
levels were included as covariates. The sphericity assumption
was verified for all main (group or time) and significant inter-
action (group by time) effects, and significant effects were exam-
ined using Fisher’s least significant difference to preserve a 5%
significance level. Partial η 2 was calculated as a measure of effect.."
 To cite Fogarty FA, Booth RJ, Gamble GD, et al. Ann Rheum Dis Published Online
First: [please include Day Month Year] doi:10.1136/annrheumdis-2014-205946

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