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International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Original Research Article

Effect of Yogic Interventions on Serum Levels of -6 & Interleukin- 10 in Patients with Osteoarthritis Knee

Vandana Awasthi1, Ajai Singh1, Narsingh Verma2, G.K Singh1, Manish Yadav1, Abhinav Verma2

1Department of Orthopedic Surgery and 2Department of Physiology, King George‟s Medical University, Lucknow, UP

Corresponding Author: Ajai Singh

Received: 03/02/2017 Revised: 22/02/2017 Accepted: 27/02/2017

ABSTRACT

The present study was conducted to determine the role of Yoga on inflammatory markers Interleukin 6 (IL-6) and (IL-10) in subjects of KOA. One hundred and twenty patients of OA knee were randomized into two groups based on computer generated random table - Group A and Group B. Group A subjects were kept on conventional treatment along with an add-on integrated supervised yoga of 45 min duration in five days in a week of five set of Asanas. Group B subjects were kept on conventional treatment alone. Conventional treatment was in the form of Quadriceps drill , hot saline fomentation, paraffin wax bath `and analgesic drug on SOS basis. Patients were assessed at baseline and at 6-month interval by measurement of inflammatory biomarkers Interleukin 6 (IL-6) and Interleukin 10 (IL-10) of OA knee in both Group A & B. The Statistically significant fall in both biomarkers IL-6 and IL-10 level were found in the intervention Group A. Further there was a significant reduction in doses of analgesic drugs being given to the patients of Group A. level rose significantly in those patients who left practicing yoga. In Group B there was also a decrease in IL-6 and increase IL-10, levels. However this difference was statistically significant. Therefore it can be concluded that yoga therapy resulted in significant decrease in the requirement of analgesic drugs and has also shown to have even complete withdrawal of the drugs in some KOA patients.

Keywords: Yogic asana, , Osteoarthritis knee, Cartilage, Inflammation, ELISA

INTRODUCTION imbalance between the synthesis and Osteoarthritis (OA) is the most degradation of articular cartilage leading to common disease of joints in adults around classic pathological change of wearing and the world. [1] Worldwide, it is estimated to destruction of cartilage. [6] In the current be the fourth leading cause of disability. [2] studies available, no specific cure for OA Its prevalence increases gradually in appears to exist and the severity of individuals older than 40 years. Community condition varies from individual to survey data in rural and urban areas of India individual. Most of the patients have no shows the prevalence of osteoarthritis to be option but to undergo joint replacement in the range of 17 to 60.6%. [3-5] surgery which again is an option not without It is non-inflammatory disorder of risk and limitations. Therefore, there is need movable joint characterized by an for a treatment option which could avoid or

International Journal of Health Sciences & Research (www.ijhsr.org) 73 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee delay a joint replacement and make patient the cellular level. Because in vitro comfortable till surgery becomes an production of pro-inflammatory interleukin- absolute indication. A more generic 1 and decreases under approach to current treatment methods low-level intermittent fluid pressure, yoga revolves around some combination of non- may reduce fluid pressure, which, pharmacological and pharmacological in turn, preserves cartilage that would treatment modalities. [7] allegedly be lost by immobilization. [16] The zest to provide patients with There are sporadic reports and case viable options to accomplish their exercise series that have shown the usefulness of goals as part of the management protocol is Yoga for management of osteoarthritis knee unending and newer treatment modalities as patients. [17-19] Some researchers have also well as old existing modalities with a new evaluated the efficacy of Yoga as part of a perspective are being evaluated. Exploration combination therapy comprising Yoga, of alternative therapies for the management Naturopathy and Physiotherapy. [20] of chronic pain is one of these attempts. [8] Despite availability of such sporadic Although significant attention has focused literature, there is almost no systematic on stretching and strengthening the study available to evaluate the efficacy of quadriceps muscles for reducing symptoms Yoga in management of Osteoarthritis knee of knee OA. [9,10] Yoga is one of several and to compare it with other conservative practices that have the potential to be management techniques. Even if any study effective in OA as well. [11,12] Yoga is a is available, it is basically done at pilot level mind-body practice in complementary and do not have strong evidence. More so, medicine with origins in ancient Indian none of the studies has attempted to philosophy. The theory behind yoga practice understand the physiological route of is that the union of mind and spirit in benefit derived by Yogic asanas. exercise brings balance to the body and Radiological evaluations often do not promotes healing. [13] provide adequate information about the Although yogic philosophy change in patient status following treatment. addresses numerous aspects of well-being However, biochemical markers have been that might have an effect on health and reported to have a better sensitivity in order disease, the use of the physical postures, or to assess the severity of disease in addition asanas, can be used as a form of exercise. to monitoring of the efficacy and safety of Yoga improves both flexibility and strength disease-modifying OA drugs, with the and could theoretically be beneficial to potential to act as diagnostic tools. [21] The some musculoskeletal problems. Hatha yoga diagnostic power of in the emphasizes strength, flexibility, and interleukin family apart from other relaxation, with particular attention to biochemical markers such as tumor necrosis alignment of body structures (e.g., the factor-α, and vascular endothelial growth relationship of the distal to the proximal factor make these the best candidates for extremities and the extremities to the spine assessment. Evaluation of these pro- and torso). [13,14] The Yogic asanas inflammatory and inflammatory markers incorporate poses, breathing techniques, and helps to understand the mechanism and meditation, can theoretically reduce pain physiology through which a treatment and stiffness associated with OA by response is obtained. realigning the skeletal structure, In osteoarthritis, inflammation strengthening muscles around the joints, and occurs locally, within the synovium, and stretching tight joint structures. [15] systemically, with inflammatory agents It is believed that while practicing circulating in the blood. In the the Yoga, joint are frequently moved which pathophysiology of OA, proinflammatory are believed to cause physiologic effects at cytokines, such as IL-1 and IL-6 have been

International Journal of Health Sciences & Research (www.ijhsr.org) 74 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee shown to play important roles in the forces on joints needed to preserve integrity. destruction of cartilage, synovitis, and pain. [34] With this background, the current study [22-25] On the other hand anti-inflammatory is designed to analyze the serum markers Countering the proinflammatory (IL-1, IL-6 & IL-10) to evaluate the effect cytokines, antiinflammatory cytokines also of “add on yoga asana with conservative play a role in the pathophysiology of OA. In management of OA knee. Pro inflammatory particular, IL-10 and IL-4 contribute to the cytokine mediators have been reported to suppression of inflammation of the synovial contribute to OA pathogenesis by increasing membrane. [26,27] By reducing inflammation; cartilage degradation and inducing these mediators can support cartilage hyperalgesia via a number of direct and production, acting as anabolic effectors indirect actions TNFα activates sensory which can slow the progression of OA. neurons directly via its receptors and Osteoarthritis is considered a non- initiates a cascade of inflammatory reactions inflammatory arthritis, but there is evidence via the production of ILs 40. IL-6 is an that as the cartilage destruction proceeds, interleukin that acts as both a pro- change in the joint occurs that are associated inflammatory and anti-inflammatory with inflammation. [28] Once the synovium cytokine. It is secreted by T cells and is inflamed, the synoviocytes produce to stimulate immune response cartilage degradation enzymes, such as IL-6 is also a ",” a cytokine cytokines (IL-1, IL-6 and IL-10), which produced from muscle, and is elevated in contribute to further decreased cartilage response to muscle contraction. [36] It is volume. [29] Inflammation is a robust and significantly elevated with exercise, and reliable predictor of all-cause mortality in precedes the appearance of other cytokines older adults. [30] Pro inflammatory cytokines in the circulation. During exercise, it is such as interleukin-6 (IL-6), tumour thought to act in a hormone-like manner to necrosis factor-alpha (TNF- α), and C- mobilize extracellular substrates and/or reactive protein (CRP) play a role in augment substrate delivery. [37] cardiovascular disease, type II , With this background, the present arthritis, osteoporosis, Alzheimer‟s disease, study was planned with an aim to analyze , and frailty and the selected cytokine ( IL-6 & IL-10) levels functional decline. [31,32] Inflammation of the in serum of the symptomatic OA knee and synovial joint is an inseparable part of knee change in symptom patients managed by OA and leads to pain and disability. [33] In “add on” yogic asana and to compare it with addition to exercise and obesity, behaviour those being managed conservatively in a affects inflammation through other systematic planned study with adequate pathways; even relatively modest levels of number of patients. anxiety and depressive symptoms can raise pro- production. [33] MATERIALS AND METHODS In addition to pro-inflammatory cytokines, Study Subjects cytokines with predominantly counter- One hundred and twenty Patients inflammatory actions have been identified. with osteoarthritis knee were randomized in IL- 10 was first described as a product of the two groups i.e. Group A with TH2 lymphocytes that inhibits cytokine conventional treatment with add-on yoga production by activated macrophages. IL-10 and Group B with conventional treatment of is an anti-inflammatory cytokine. In humans Knee Osteoarthritis without involving yoga IL-10 is encoded by the IL10 . [34] In therapy. They were assessed by experimental settings, joint motion measurement of inflammatory biomarkers preserves cartilage that can be lost by (IL-6 and IL-10) by ELISA-kit method. immobilization. Correctly supervised yoga Clinical parameters of severity of may be one way to provide the motion and Osteoarthritis knee before and after giving

International Journal of Health Sciences & Research (www.ijhsr.org) 75 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee the add-on intervention of Yoga (follow up sterile needle following which the at the interval of 6 months). This biochemical examination was done by Randomized control trial consisted of men ELISA technique. The samples were stored and women above 40 years that fulfilled in the vials at -20 degree Celsius. American College of Rheumatology (ACR) Intervention for Yoga Group clinical and radiographic criteria for KOA. The study design was a randomized Sixty subjects in each Group A and B were controlled trial, total no of 120 patients who recruited from the outpatient clinic of the met our inclusion criteria were randomized Department of Orthopedics Surgery of King into two groups A & B. The patients under Georg‟s Medical University, Lucknow. The Group A were given 45 min of integrated patients in both the groups were matched for yoga therapy practice for five days in a age and sex. They were also profiled for week for 6 months Five day in week (120 demographic, clinical and radiological days) along with conventional clinical features. Age and sex were self reported. treatment including physiotherapy. Group B Patients were weighed with a calibrated patients were given only conventional balance beam scale to the nearest 0.1 kg in treatment including physiotherapy. minimum possible clothing and standing The integrated yoga therapy practice height was measured (without shoes and included Virbhadrasan, SuptaTadasan, shocks) with a Stadiometer in centimeters Uttanpadasana, Dandasana, (cm). Body Mass Index (BMI) was recorded Paschimotasana, Traditional treatment in by Quetelet index. Among the 20 male and form of strengthening exercise Quadriceps 40 female (including both groups) ages drill, hot fomentation and paraffin wax bath range from 40-60, mean age 48.80±6.48 and to knee were given to both groups. Tab- 50.12±5.74 years respectively. The protocol Paracetamol, orally in divided doses were for research work was approved by the given in both groups for initial ten days of human ethics committee of King George‟s treatment to relieve the initial pain before Medical University, Lucknow. Informed and after giving the treatment at interval of consent was obtained from the study 6th months. subjects for inclusion in the study before Statistical Tools Employed intervention. The both group patients were All data were collected and analyzed asked to fill up the detailed questionnaire using SPSS (Statistical Package for Social regarding their occupation, socioeconomic Sciences) Version 16.0 statistical Analysis status, medical history, life style habits. Software. The values were represented in In our study the data of the patients Number (%) and Mean±SD. Wilcoxon was recorded immediately after which they signed rank test was used to evaluate the were randomly allocated into two groups within group change. based on computer generated random table. After their first visit at OPD, a follow up RESULTS was performed at 6 months interval for the The mean age of subjects in both biochemical testing of inflammatory study group A and B was 48.80±6.48 and cytokines. 50.12±5.74 respectively. When we compare The selected biomarkers, the data after 6 months from baseline data in Interleukin-6 and Interleukin-10 levels were Group-A, statistically significant reduction analyzed in the enrolled patients at in serum levels of IL-6 and IL-10 were following intervals i.e. at 1st visit and at 6th found. In group B there was also a decrease month interval. The peripheral venous blood in IL6 and IL-10 levels but value was not (2 ml) was collected into EDTA coated vials statistically significant. between 9.00 AM to 11.00 AM by using a

International Journal of Health Sciences & Research (www.ijhsr.org) 76 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee

Table 1: Group wise distribution of patients SN Group Description No. of Percentage cases 1. I Group-A in whom management of knee osteoarthritis was done using add-on Yogic asana 60 50.0 2. II Patients in whom management of knee osteoarthritis was done without add-on Yogic asanas 60 50.0 Group-B

Table 2: Age wise comparison of patients in two groups SN Age Group (Years) Group A (n=60) Group B(n=60) No. % No. % 1. 40-50 Years 38 63.3 33 55.0 2. 51-60 Years 22 36.7 27 45.0 Mean Age±SD (Range) in years 48.80±6.48 (40-60) 50.12±5.74 (40-60) t=1.388; p=0.241 (NS)

Table 3: Gender wise comparison of patients in two groups SN Gender Group A (n=60) Group B (n=60) No. % No. % 1. Male 20 33.3 22 36.7 2. Female 40 66.7 38 63.3 2=0.147; p=0.702 (NS)

Table 4: Comparison of patients in two groups according to BMI SN BMI Category BMI Range (kg/m2) Group A (n=60) Group B (n=60) No. % No. % 1. Normal 18.5-24.9 14 23.3 10 16.7 2. Overweight 25.0-29.9 34 56.7 40 66.7 3. Obese >30 12 20.0 10 16.7 2=1.335 (df=2); p=0.513

Table 5: Comparison of patients in two groups according to Educational Status (Ref. lawmin.nic.in/ncrwc/final report) SN Educational Definition Group A Group B Status (n=60) (n=60) No. % No. % 1. Illiterate Those who are unable to read and write or can read but not write `12 20.0 5 8.3 2. Literate Those who has the ability to read and write with understanding in any 48 80.0 55 91.7 language 2=3.358 (df=1); p=0.067

Table 6: Comparison of patients in two groups according to Lifestyle (Activity Profile) (Ref. Jill A.Benneet:journal of aging and physical activity:2006, 14,456-77) SN Group A (n=60) Group B (n=60) Activity Profile No. % No. % 1. Sedentary Less than 20 to 150 minutes / week of physical activity 16 26.7 26 43.3 2. Moderate More than 150 to 300 mins/week 44 73.3 34 56.7 3. Heavy More than 300mins/ week 0 0 0 0 2=3.663 (df=1); p=0.056

Table 7: Comparison of patients in two groups according to analgesic (paracetamol 650 mg) intake at baseline and different follow up intervals SN No. of daily analgesic dosages Group A (n=60) Group B (n=60) No. % No. % Baseline 1. 0 0 0 0 0 2. 1 0 0 0 0 3. 2 60 100 60 100 2=0; p=1 6 months 1. 0 52 86.7 0 0.0 2. 1 8 13.3 43 71.7 3. 2 0 0.0 17 28.3 2=93.02 (df=2); p<0.001

Table 8: Comparison of two groups for different inflammatory markers at different study intervals SN Component Group A Group-B Statistical significance (n=60) (n=60) Mean SD Mean SD „t‟ „p‟ IL-6 Baseline 4.28 + 3.52 4.44 + 3.84 -0.247 0.806 4.28 + 3.52 4.44 + 3.84 6 months 1.25 + 1.03 2.37 + 2.33 3.396 0.001 1.25 + 1.03 2.37 + 2.33 IL-10 Baseline 0.80 + 0.48 1.43 + 0.93 0.060 0.952 0.80 + 0.48 1.43 + 0.93 6 months 2.75 + 2.25 2.73 + 2.15 -4.688 <0.001 International Journal of Health Sciences & Research (www.ijhsr.org) 77 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee

DISCUSSION In present study, among In present study, in both the groups demographic and lifestyle factors, literacy, females predominated over males. The male household work and sedentary to moderate to female ratio was 1:2. These findings are activity were quite commonly observed in the concurrence with the findings of among patients with knee osteoarthritis. As reported gender-associated higher risk of far as literacy is concerned, it primarily osteoporosis in women as compared to men. shows a shift from a more active to a Knee osteoarthritis is more common in sedentary lifestyle and as such could be women, with female-to-male ratios varying strongly correlated with the sedentary to between 1.5:1 and 4:1 and a dramatic rise in moderate activity profile of the patients. its prevalence has been reported around the With respect to dominance of household time of menopause. [38-42] There could be work as the occupation, it could be mainly several reasons to explain this gender attributed to the relatively higher proportion related association. One of them could be of females among study subjects. the posture of the house hold women in our In our study the doses of Analgesics environment where they usually works with were reduced significantly in both the knee bent position in their house. In a study groups, more so in the group practicing at Bangladesh, most of the house wives used yoga which is in accordance with the study to do their household works in the bent knee done by the name J Women‟s Health 2009 position. There is a significantly increased and also supported by Tai Chi study. The prevalence of osteoarthritis knee in road results of our study has shown the beneficial laborers and others engaged in knee- effects of yoga and similar studies done by bending occupations. Chenchen Wang, Christopher H. In present study, majority of patients Schmid, Patricia L. Hibberd Tai Chi has in both the groups were aged 40-50 years. shown that Yoga is effective in treating Mean age of patients in two groups was knee osteoarthritis. [48] Use of Yoga to 48.80 ± 6.48 and 50.12 ± 5.74 years reduce pain has been reported among respectively. The age profile of patients in different patient groups. The efficacy of present study was slightly lower as Yoga to reduce labour pain, [49,50] chronic compared to that reported in previous low back pain, [51] osteoarthritis [52] and studies which have reported majority of musculoskeletal pain [53] in general. Yoga patients to be older than 70 years. [43,44] One exercises consist of physical postures, of the reasons for relatively younger age breathing techniques and meditation [51] and profile of patients in present study was a as such affect the individual not only strict inclusion and exclusion criteria. In physically but psychologically and present study, individuals above 60 years of physiologically too. age were not included mainly because they The present study showed that there tend to fall in exclusion criteria like history is statically significant difference in the of prolonged analgesic and anti- levels of Interleukins at third and six inflammatory medication. months. In relation to this a number of In present study, majority of patients studies have done by van Valburg et al., in both the groups were overweight and have reported the positive association obese. In fact, only 20% of patients were in between the cellular effects of mechanical normal weight category. Obesity is one of and fluid pressure on structures such as the strongest and best-established risk cartilage which suggest that yoga postures factors of OA. [45-47] and the findings of might alter joint function. Low levels of present study tended to endorse this intermittent fluid pressure, as occurring relationship. during joint distraction, have been shown in vitro to decrease production of catabolic

International Journal of Health Sciences & Research (www.ijhsr.org) 78 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee cytokines, such as interleukin-1 and tumor on of yoga can even augment certain patho- necrosis factor-α. physiological processes involved in The present study demonstrates that progression of Osteoarthritis. after an interval of 3 and 6 months from the baseline, Group A showed a considerable Competing Interests: Authors have declared decrease in the levels of the inflammatory that no competing interests exist. markers as compared to the patients of Group B. This might be due to decrease in ACKNOWLEDGEMENTS The authors wish to thank Varun Arora who inflammation in response to yoga practices. helped us in conducting this study. We In present study, a significant gratefully acknowledge the help of all our decrease in pro-inflammatory markers IL-1 patients, family members and friends for their and IL-6 levels and a significant increase in cooperation in making this study successful. anti-inflammatory marker IL-10 levels as compared to baseline was observed in both REFERENCES the groups, however, mean values for pro- 1. Felson DT. Epidemiology of knee and inflammatory markers were significantly hip osteoarthritis. Epidemiol Rev. 1988; lower in Group A as compared to Group B 10:1–28. at both the follow up intervals (3 and 6 2. Marlene Fransen, Lisa Bridgett, Lyn months) whereas mean values of anti- March, Damian Hoy, Ester Penserga, Peter Brooks. The epidemiology of inflammatory marker IL-6 were osteoarthritis in Asia. International significantly higher in Group A as compared Journal of Rheumatic Diseases 2011; to Group B at both the follow up intervals. 14: 113–121. We observed that serum levels of IL- 3. Padda AS, Mohan V, Singh J, Deepti 6 had a twofold increase in patients when SS, Singh G, Dhillon HS. Health profile compared to controls, comparable to a study of the aged persons in urban and rural that showed increased IL-6 in patients with field practice areas of Medical College, more severe disease. [54] Similar Amritsar. Indian J of Community observations have also been made for IL-10 Medicine 1998;23:72-76. too. [55] 4. Kishore S, Garg BS. Sociomedical All these observations indicated that problems of aged population in rural area of Wardha District. Indian J of Yoga had a physiologic effect too that Public Health 1997;41:46-48. helped in providing an improvement in 5. Khan JA, Khan Z. A study of the functional quality of life of patients. Effect leading causes of illness & physical of Yoga module on pro-inflammatory and disability in an urban aged population. anti-inflammatory cytokines has also been Indian J Prev Soc. Med. 2000;32:121-24 enumerated by several other workers in 6. Mishra A, Sanghi D, Sharma AC, Raj S, different studies. [56, 54,57] Maurya SS, Avasthi S, et al. The present study demonstrates that Association of polymorphism in growth after an interval of 6 months from the and differenciation factor 5 Gene with baseline, Group A showed a considerable osteoarthritis knee. Am J Biochem decrease in the levels of the inflammatory Biotech. 2013;9(1):1–7 7. Bhatia D, Bejarano T, Novo M. Current markers as compared to the patients of interventions in the management of Group B. This might be due to decrease in knee osteoarthritis. Journal of Pharmacy inflammation in response to yoga practices. &Bioallied Sciences. 2013;5(1):30-38. 8. Bingchen An, Kerong Dai, Zhenan Zhu, CONCLUSION You Wang, YongqiangHao, Tingting On the basis of result of our study Tang et al. Baduanjin Alleviates the we can conclude that Yoga can serve as an Symptoms of Knee Osteoarthritis. The adjuvant with existing conventional Journal of Alternative and treatment of osteoarthritis and prolong add-

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Complementary Medicine 2008; 14:2, people. Int. J. Contemporary Surgery 167-174. 2015; 3(2): 44-49. 9. Hurley MV, Scott DL. Improvements in 21. Mabey T, Honsawek S. Cytokines as quadriceps sensorimotor function and biochemical markers for knee disability of patients with knee osteoarthritis. World Journal of osteoarthritis following a clinically Orthopedics. 2015;6(1):95-105. practicable exercise regime. Br J 22. Stöve J, Huch K, Günther KP, Scharf Rheumatol 1998;37:1181–1187. HP. Interleukin-1beta induces different 10. M E van Baar, J Dekkera, RAB of stromelysin, Oostendorp, D Bijla, ThB Voornd, JWJ aggrecan and tumor-necrosis-factor- Bijlsma. Effectiveness of exercise stimulated gene 6 in human therapy in patients with osteoarthritis of osteoarthritic chondrocytes in the hip or knee: a systematic review of vitro. Pathobiology. 2000;68:144–149. randomized clinical trials. Arthritis 23. Chadjichristos C, Ghayor C, Kypriotou Rheum 1999;42:1361–1369. M, Martin G, Renard E, Ala-Kokko Let 11. Kolasinski SL. The use of alternative al. Sp1 and Sp3 transcription factors therapies by patients with rheumatic mediate interleukin-1 beta down- diseases. J Clin Rheum 1999;5:1–2. regulation of human type II collagen 12. Kolasinski SL. Yoga for degenerative gene expression in articular joint disease.Altern Med Alert chondrocytes. J Biol Chem. 2003; 2001;4:28–31. 278:39762–39772. 13. Garfinkel M, Schumacher HR. Yoga. 24. E X, Cao Y, Meng H, Qi Y, Du G, Xu J, Rheum Dis Clin North Am 2000; et al. Dendritic cells of synovium in 26:125–131. experimental model of osteoarthritis of 14. Iyengar BKS. Light on Yoga. New rabbits. Cell Physiol Biochem. 2012; York: Schocken Books, 1979. 30:23–32. 15. Taylor MJ: Yoga therapeutics: an 25. Hammacher A, Ward LD, Weinstock J, ancient, dynamic systems theory. Tech Treutlein H, Yasukawa K, Simpson RJ. Orthop.2003, 18: 115-125. Structure-function analysis of human 16. Grober JS, Thethi AK: Osteoarthritis: IL-6: identification of two distinct when are alternative therapies a good regions that are important for receptor alternative?.Consultant.2003, 43: 197- binding. Protein Sci. 1994;3:2280– 202. 2293. 17. Kolasinski SL, Garfinkel M, Tsai AG, 26. Ritchlin C, Haas-Smith SA. Expression Matz W, Dyke AV, Schumacher HR. of interleukin 10 mRNA and protein by Iyengar Yoga for Treating Symptoms of synovial fibroblastoid cells. J Osteoarthritis of the Knees: A Pilot Rheumatol.2001;28:698–705. Study. The Journal of Alternative and 27. Miossec P, Briolay J, Dechanet J, Complementary Medicine 2005; 11(4): Wijdenes J, Martinez-Valdez H, 689-693. Banchereau J. Inhibition of the 18. Subramanian SS. Case Study on Knee production of proinflammatory Osteoarthritis using Yoga and cytokines and immunoglobulins by Physioball Exercises. IOSR Journal of interleukin-4 in an ex vivo model of Dental and Medical Sciences (IOSR- rheumatoid synovitis. Arthritis JDMS) 2015; 14(9): 49-50. Rheum. 1992;35:874–883. 19. Ghasemi GA, Golkar A, Marandi SM. 28. Meyers JF, Caspari RB, Cash Effects of Hata Yoga on Knee JD, Manning JB. Arthroscopic Osteoarthritis. Int J Prev Med. 2013 evaluation of allograft anterior cruciate Apr; 4(Suppl 1): S133–S138. ligament reconstruction. Arthroscopy. 20. Nair R, Kaushik G, Gaur VN, 1992;8(2):157-61 Bhatnagar RK. Efficacy of Yoga, 29. Guilak F, Ratcliffe A, Mow VC. Naturopathy and Physiotherapy in Chondrocyte deformation and local Improving Morning Stiffness, Pain tissue strain in articular cartilage: a (VAS), SF-12, MMT and Vitamin D3 in confocal microscopy study. J Orthop the osteoarthritis of knees for elderly Res. 1995 May;13(3):410-21.

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30. Pedersen BK, Febbraio MA. Muscle as done by Prognosis Management & an endocrine organ: Focus on muscle- Research Consultants Pvt. Ltd in derived interleukin-6. Physiol Rev Association with IOACON Agra Jun – 2008;88:1379–406. Nov 2013, 2013. 31. Kiecolt-Glaser JK, McGuire L, Robles 41. Ganvir SD, Zambare BR. Prevalence TR, Glaser R. Emotions, morbidity, and and Identification of Risk Factors for mortality: new perspectives from Knee Osteoarthritis among Elderly Men . Annu Rev and Women. Sch. J. App. Med. Sci., Psychol 2002; 53:83–107. 2013; 1(6):700-703. 32. Raison CL, Capuron L, Miller AH. 42. Srikanth VK, Fryer JL, Zhai G, Cytokines sing the blues: Inflammation Winzenberg TM, Hosmer D, Jones G. A and the pathogenesis of . metaanalysis of sex differences in Trends Immunol 2006;27:24–31 prevalence, incidence and severity of 33. Howren MB, Lamkin DM, Suls J. osteoarthritis. Osteoarthritis Associations of depression with C- Cartilage.2005; 13:769–781. reactive protein, IL-1, and IL-6: a meta- 43. Hicks K , Foye P M, Stitik T P, analysis. Psychosom Med 2009;71:171– Malhotra G , Sangnil M S. Risk of Knee 86 Osteoarthritis in Runners. Physical 34. Eskdale J, Kube D, Tesch H, Gallagher Medicine 2011;2(10); 1-8. G. Mapping of the human IL10 gene 44. Altman RD. The syndrome of and further characterization of the 5' osteoarthritis. J Rheumatol 1997;24:766 flanking sequence. Immunogenetics –7. 1997;46 (2): 120–8. 45. Lawrence RC, Helmick CG, Arnett FC, 35. Fam AG, Schumacher HR Jr, Deyo RA, Felson DT, Giannini EH, et Clayburne G, Villanueva T, Baker D, al. Estimates of the prevalence of Jimenez SA. Effect of joint motion on arthritis and selected musculoskeletal experimental calcium pyrophosphate disorders in the United States. Arthritis dihydrate crystal induced arthritis. J Rheum 1998;41:778 –99. Rheumatol 1990;17(5):644-655 46. Litwic A, Edwards M, Dennison E, 36. Eskdale J, Kube D, Tesch H, Gallagher Cooper C. Epidemiology and Burden of G. Mapping of the human IL10 gene Osteoarthritis. British Medical Bulletin. and further characterization of the 5' 2013;105:185-199. flanking sequence". Immunogenetics 47. Pal CP, Khanvikar A, Deshpande A, 1997;46 (2): 120–8. Agashe A, Mankar A, Pathak D. Study 37. vanValburg AA, Van Roy HL, Lafeber to Find the Prevalence of Knee FP, Bijlsma JW. Beneficial effects of Osteoarthritis In the Indian Population intermittent fluid pressure of low and Factors Associated with it. Study physiological magnitude on cartilage done by Prognosis Management & and inflammation in osteoarthritis. An Research Consultants Pvt. Ltd in in vitro study. J Rheumatol 1998;25 Association with IOACON Agra Jun – (3):515-520 Nov 2013, 2013. 38. Litwic A, Edwards M, Dennison E, 48. Margreth Grotle, Kare B Hagen, Bard Cooper C. Epidemiology and Burden of Natvig, Fredrik A Dahl, Tore K Kvien. Osteoarthritis. British Medical Bulletin. Obesity and osteoarthritis in knee, hip 2013;105:185-199. and/or hand: An epidemiological study 39. Bijlsma JWJ. Strategies for the in the general population with 10 years prevention and management of follow-up. BMC Musculoskeletal osteoarthritis of the hip and knee. Best disorders. 2008;9:132. Pract Res ClinRheumatol. 2007;Vol. 49. Tournaire M, Theau-Yonneau A. 21(No. 1):59e76. Complementary and Alternative 40. Pal CP, Khanvikar A, Deshpande A, Approaches to Pain Relief During Agashe A, Mankar A, Pathak D. Study Labor. Evidence-based Complementary to Find the Prevalence of Knee and Alternative Medicine: eCAM. Osteoarthritis In the Indian Population 2007;4(4):409-417. and Factors Associated with it. Study

International Journal of Health Sciences & Research (www.ijhsr.org) 81 Vol.7; Issue: 3; March 2017 Vandana Awasthi et al. Effect of Yogic Interventions on Serum Levels of Interleukin-6 & Interleukin- 10 in Patients with Osteoarthritis Knee

50. Smith CA, Levett KM, Collins Tania Regina Tozetto-Mendoza, Janini CT, Crowther CA. Relaxation Chen, et al. Serum Levels of techniques for pain management in Proinflammatory Cytokines in Painful labour. Cochrane Database Syst Knee Osteoarthritis and Sensitization. Rev. 2011 Dec 7;(12):CD009514. International Journal of Inflammation. 51. Robert B, MPH, Karen J. Sherman, 2015;2015:329792. Larry Culpepper. Yoga for chronic low 55. Kiecolt-Glaser JK, Christian L, Preston. back pain in a predominantly minority , Inflammation, and Yoga population: a pilot randomized Practice. Psychosomatic medicine. controlled trial. Altern Ther Health 2010;72(2):113. Med. 2009;15(6):18-27. 56. Rajbhoj PH, Shete SU, Verma A, 52. Park J, McCaffrey R, Dunn D, Bhogal RS. Effect of Yoga Module on Goodman R. Managing osteoarthritis: Pro-Inflammatory and Anti- Comparisons of chair yoga, Reiki, and Inflammatory Cytokines in Industrial education (pilot study). Holist Workers of Lonavla: A Randomized NursPract2011; 25: 316-326. Controlled Trial. Journal of Clinical and 53. Luke J. Michelle C. Janelsins Charles Diagnostic Research : JCDR. 2015;9(2): Kamen Supriya G. MohileLisa K. CC01-CC05. SprodJennifer S. GewandterJeffrey J. 57. Vijayaraghava A, Doreswamy V, Kirshner Rakesh et al. The effect of Narasipur OS, Kunnavil R, YOCAS yoga for musculoskeletal Srinivasamurthy N. Effect of Yoga symptoms among Practice on Levels of Inflammatory survivors on hormonal therapy. Breast Markers After Moderate and Strenuous cancer research and treatment. Exercise. Journal of Clinical and 2015;150(3):597-604. Diagnostic Research: JCDR. 2015;9 54. Marta Imamura, Fernando Ezquerro, (6):CC08-CC12. Fábio Marcon Alfieri, Lucy Vilas Boas,

How to cite this article: Awasthi V, Singh A, Verma N et al. Effect of Yogic interventions on Serum levels of Interleukin-6 & Interleukin- 10 in patients with Osteoarthritis knee. Int J Health Sci Res. 2017; 7(3):73-82.

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International Journal of Health Sciences & Research (www.ijhsr.org) 82 Vol.7; Issue: 3; March 2017