Discussion
reduced disease, RA
INFLAMMATION, DISEASE, IMMUNOLOGICAL TOLERANCE, REMISSION, JOINT INFLAMMATION
Our study is the first to highlight the positive impact of yoga on modulation of the T cell subsets, T cell aging markers, epigenetic alterations and associated transcription factors in RA. We found that 8 weeks of yoga practice significantly reduced disease activity, normalized the biomarkers associated with inflammation, and maintained Th17/Treg cell homeostasis. Further, yoga reduced the rate of immunological aging as seen by the reduction in the aged Th17 cell population (CD3+ CD4+ IL17+ RORγt+ CD28-T cells) and aged Treg cell population (CD3+ CD4+ CD25+ CD127-Foxp3+ CD28-T cells). Our findings suggest that yoga positively modified epigenetic changes such as global methylation levels, global hydroxyl methylation levels, and HDAC1 levels which may regulate gene expression patterns. The yoga group showed the downregulation of In the present study, the impact of regular practice of yoga was beneficial as there was a significant reduction in the systemic levels of pro-inflammatory markers (IL-6 and IL-17) and various transcripts associated with pro-inflammatory cytokines. IL-6 is essential for the development of RA's systemic(lung, heart skin, brain) and joint inflammation, immune system abnormalities, and joint swellingYoga is a centuries-old method of unifying the mind, body, and soul. The Patanjali’s ashtanga (eight limb) Yoga includes yama (abstinences), niyama (observances), asana (yoga postures), pranayama (breath control), pratyahara (withdrawal of the senses), dharana (concentration), dhyana (meditation) and samadhi (absorption)The immune dysregulation in RA is attributed to increased secretion of inflammatory cytokines by effector Th17 cells and a loss of Treg cells suppressor function. Yoga's anti-inflammatory properties work to restore immune homeostasis to its ideal state and promote natural immunological tolerance to treat autoimmune diseasesInflammatory changes may be influenced by epigenetic mechanisms that subsequently lead to gene expression alterations and, eventually, protein expressionLack of an active control group was one of the study's shortcomings because the non-yoga group had no equal attention control intervention and only received medication therapy in comparison to the active yoga intervention group. Therefore, including such a group would further rule out the therapeutic results that were specifically linked to the yoga intervention. In both the yoga and non-yoga groups, there were fewer men, which was explained by the fact that women had a higher prevalence of RA than men (3:1). It is challenging to maintain a regular schedule for a long-term RA management or home practice regimen because each session of yoga lasted for 120 min every day while being supervised by a certified yoga instructor. Also, the lack of long-term follow-up of the participants made it difficult to predict how quickly participants returned to their baseline levels. In order to investigate the long-term advantages of the yoga practice, we intend to conduct additional research with a large sample size and long-term follow-ups and practice of yoga for shorter duration.In conclusion, our study findings highlight that yoga possesses an immune-modulatory potential which induces molecular remission and reestablishes immunological tolerance in RA by influencing its pathobiology by optimizing inflammatory markers, maintaining immune-homeostasis, reducing the rate of immune-aging and improving RA health outcome. The 8 weeks of yoga practice significantly reduces disease activity, maintains Th17/Treg cell homeostasis and reduces inflammatory processes by optimizing the levels of various pro-inflammatory cytokines, and anti-inflammatory cytokines with changes in gene expression patterns. Yoga positively modifies the epigenome by elevating global methylation levels, reducing global hydroxyl methylation levels, and HDAC levels which may cause the normalization of dysregulated gene expression. Hence, yoga can be used as an adjuvant therapy in RA as it boosts physical functioning, enhances psychological wellbeing and reestablishes immunological tolerance.