Yoga guide

Yoga for rheumatoid arthritis: joints, fatigue and flares, the hands, feet and neck, what the trials show, and a gentle class

Yoga is a gentle way to do some of the exercise that's part of rheumatoid arthritis (RA) care. In a review of 5 small trials, yoga added to treatment lowered disease activity a little and improved everyday function, though pain didn't clearly change, and exercise of all kinds eased fatigue and low mood. The American College of Rheumatology conditionally recommends mind-body exercise such as yoga, and European guidance finds no disease-specific reason to avoid being active.

Yoga goes alongside your medicines and your rheumatology team, never instead of them. This guide covers what RA means for yoga, what the trials found and how far to trust them, flares and fatigue, the hands, feet and neck, steroids and your bones, poses to adapt, the warning signs that need help the same day, and a 30-minute breathe, move and rest class, mostly in a chair, with a 15-minute flare-day version and 3D demos.

The short version

Exercise is part of RA care, and yoga counts

The American College of Rheumatology strongly recommends regular exercise and conditionally recommends mind-body exercise such as yoga. The European Alliance of Associations for Rheumatology (EULAR) makes activity part of standard care, with no disease-specific reasons to avoid it. The National Institute for Health and Care Excellence (NICE) doesn't mention yoga, but asks for physiotherapy to encourage regular exercise.

Sources 1, 2, 3

Small gains, from few and small trials

In 5 small trials (718 people), yoga added to treatment lowered disease activity and improved function by small to moderate amounts, with moderate certainty; pain didn't clearly improve. Few trials were blinded, trials from India were more likely to report positive results, and one Indian trial was published in five papers, which another review counted as five studies.

Sources 4, 5

Tiredness and mood

Physical activity eased RA fatigue by about 14 points on a 100-point scale, and exercise eased low mood by a moderate amount, mind-body exercise as much as other kinds.

Sources 6, 7, 8

In a flare, move gently rather than stop

In a flare, rest the inflamed joints but keep them moving gently, then build back up.

Breathing, gentle range and supported rest fit flare days.

Sources 9, 10

Hands, feet and neck need care

A daily hand programme improved hand function a little, and about 9 in 10 people with RA have foot problems. Long-standing RA can affect the top of the neck, so leave out headstands, shoulder stands and plough (our editorial advice).

Sources 11, 12, 13

Know the warning signs

Get help the same day for a hot, swollen joint with a fever, or for pins and needles, weakness, unsteadiness or clumsy hands, especially with neck pain. Call 999 for new problems walking or loss of bladder or bowel control.

Sources 3, 14

What RA means for yoga

What rheumatoid arthritis is

An autoimmune condition: the immune system attacks the lining of the joints, which become painful, swollen and stiff, often starting in the small joints of the hands and feet. Morning stiffness often lasts longer than 30 minutes. About 450,000 people in the UK have it, many more women than men, and most are diagnosed at around 50. Symptoms come and go, with flares when they "become a lot worse and harder to control", as the National Rheumatoid Arthritis Society (NRAS) puts it.

Sources 15, 16, 17, 18

Joints that go loose

Arthritis UK: "When the joint inflammation from rheumatoid arthritis goes down, the capsule can remain stretched. It can no longer hold the joint in its proper position, so it becomes less stable." That's one reason not to force joints to the end of their range in yoga.

Source 17

Tiredness is common

In an NRAS survey, 89% of people with RA had fatigue, 40% of them persistent and severe. EULAR notes fatigue in remission too, "severe in about half of the cases".

Sources 19, 7

Medicines first, yoga alongside

Disease-modifying medicines control RA and protect the joints. NICE starts with one (methotrexate, leflunomide or sulfasalazine), uses short courses of steroids for flares, and keeps long-term steroids for when other options haven't worked; physiotherapy, occupational therapy, podiatry and psychological support sit beside them. NICE says complementary therapies "should not replace conventional treatment". Never stop or change your medicines because of yoga.

Sources 3, 20

How yoga classes ran in the trials

In the Johns Hopkins trial, each class ran: 5 minutes of questions, 5 of breathing and chanting, 15 of warm-up and moving poses, 20 of held poses, 10 of deep relaxation and 5 of meditation, twice a week for 8 weeks plus a home session, with blocks, straps, blankets and chairs. Across the programmes that helped, sessions were supervised and in groups, ran for a median of 8 weeks at about 68 minutes, and every one included breathing and relaxation as well as poses.

Sources 21, 4

What the guidelines say

American College of RheumatologyStrong evidence

"Consistent engagement in exercise is strongly recommended" over no exercise, with moderate certainty for function and pain. Mind-body exercise (yoga, tai chi, qigong) is conditionally recommended over no exercise, based on "very low to low certainty evidence of improvement in physical function but no difference in pain". Breathing and relaxation are conditionally recommended for depression, anxiety, fatigue and sleep.

Source 1

EULAR's 2025 updateStrong evidence

Promoting physical activity "should be an integral part of standard care", and the general activity guidelines are "applicable (feasible and safe)". The 2018 version's recommendation on contraindications was removed, because there are "no disease-specific contraindications" to activity, though how hard you go should match how you are. In trials, side effects were "transient and mild", with no harm to disease activity.

Sources 2, 22

NICEStrong evidence

NICE's guideline (reviewed in November 2024, with no update planned) asks for specialist physiotherapy "to improve general fitness and encourage regular exercise", psychological help such as relaxation, a hand exercise programme and a podiatrist for foot problems. It doesn't mention yoga, and says complementary therapies may give "short-term symptomatic benefit" but "should not replace conventional treatment".

Source 3

Arthritis UK

Arthritis UK (Versus Arthritis until October 2025) says yoga "involves slow, gentle movements which can be easier for people with joint pain", can help fitness, range of movement and mood, and builds strength and balance. It suggests finding an instructor who can adjust movements for your condition, "especially if you have had any joint replacements".

Sources 23, 24

What the trials show

Yoga trials in RA are small, mostly unblinded and often from one country, and one trial was published five times. Treat the details as promising rather than proven.

The best review: small gains in disease activity and functionEmerging evidence

In 5 randomised trials (718 people, 83% women), yoga added to usual treatment lowered disease activity and improved everyday function, by standardised amounts of about 0.46 and 0.42: small to moderate effects, with moderate certainty. Pain didn't clearly improve (very low certainty). Most trials didn't report side effects from yoga.

Source 4

Why the certainty isn't higherMixed evidence

The trials are few and small, and the people in them knew which group they were in. Trials from India were more likely to reach positive conclusions. One Indian trial (a yoga-based lifestyle programme of 120 minutes, 5 days a week for 8 weeks, against usual care) was published in five papers. A 2025 network analysis counted those papers as five studies, so its yoga estimate is double counted, and a 2026 review of 8 trials may have done the same (we could read only its summary).

Sources 4, 25, 26, 5, 27

Earlier reviews agree, cautiouslyEmerging evidence

A 2020 review of 10 trials (840 people) found small gains in function and disease activity and better grip, with no effect on pain, joint counts or blood markers, and its authors drew a "very cautious conclusion". In 2013, 2 trials gave very low-quality evidence on pain and no safety data. An umbrella review rated yoga's benefit for function as very low certainty.

Sources 28, 29, 30

What the single trials foundMixed evidence

In 75 sedentary adults, about half with RA, yoga improved physical health, walking distance and mood, and RA joint counts were no worse. In 26 young women, quality of life, fatigue and mood improved, but not pain or disease activity. A 26-person pilot found no differences between groups, and in 57 people, fatigue and depression improved but not disease activity. Two larger trials, of 166 newly diagnosed people and of 100 people, reported lower disease activity. In 74 women in remission, yoga eased pain more than combined aerobic and strength exercise, in a trial registered only after it had run.

Sources 21, 31, 32, 33, 34, 35, 36

No Cochrane review yetMixed evidence

A Cochrane review of yoga for RA has been planned (its protocol was published in January 2025) but not yet completed.

Source 37

Is it safe?

Exercise doesn't make RA more activeStrong evidence

EULAR's review found side effects of exercise "transient and mild", with no harm to disease activity. A Cochrane review of aerobic and strength training found "no deleterious effects", and strength training raised grip strength with no more side effects than usual care.

Sources 2, 38, 39

Harder isn't clearly betterEmerging evidence

High-intensity training didn't improve function or disease activity more than gentler training, though it built a little more strength. Across the American guideline's trials, exercise improved function and pain on average, though future trials could still find little effect.

Sources 40, 41

Badly damaged large joints are the exceptionEmerging evidence

In a 2-year high-intensity exercise trial, damage to the large joints didn't increase overall. But in 59 people whose large joints were already badly damaged, damage progressed in 85% with high-intensity weight-bearing exercise against 48% with usual care, so avoid loading a badly damaged joint heavily.

Sources 42, 43

Yoga itselfEmerging evidence

Across 94 trials, yoga had no more side effects than usual care or other exercise. In the Johns Hopkins arthritis trial, no side effects were linked with yoga, and RA joint counts didn't worsen. In published case reports of harm after yoga, headstand was the practice most often involved (15 of 84).

Sources 44, 21, 45

Fatigue and mood

Activity eases RA fatigue a littleEmerging evidence

Physical activity eased RA fatigue by about 14 points on a 100-point scale (6 trials, 388 people, moderate quality), and aerobic exercise helped at 12 weeks, though not clearly at 24. EULAR's fatigue recommendations say people with fatigue "should be offered access to tailored physical activity interventions and encouraged to engage in long-term physical activity"; its review found a small effect.

Sources 6, 46, 7, 47

MoodEmerging evidence

Exercise eased depressive symptoms in RA by a moderate amount (11 trials, moderate certainty), and mind-body exercise did as well as conventional exercise. Across rheumatic diseases, yoga eased depression, anxiety and poor sleep, though most trials had a high or unclear risk of bias.

Sources 8, 48

In the yoga trialsMixed evidence

Two small yoga trials in RA reported less tiredness and better mood.

Sources 31, 33

Pace it

Shorter sessions on tired days and longer ones on good days, with breathing and relaxation in every session (our suggestion).

Flares

Move gently, don't stopEmerging evidence

In a flare, rest the inflamed joints but keep them moving gently, then build back up.

The NHS says rest makes inflamed joints more comfortable, "but without movement your joints will stiffen and your muscles will become weaker". Arthritis UK says to focus on "slow and gentle movement during a flare up, rather than stopping altogether". NRAS's steps:

  • Relative rest: do less than usual, but not bed rest.
  • Ice for 15 to 20 minutes, wrapped, for a hot, inflamed joint, or heat for a stiff, aching one.
  • Keep the joints moving with gentle range-of-movement exercises.
  • As it settles, restart your usual exercise with only a few repetitions for a few days.
  • Build back up each day to where you were.

Sources 9, 10, 14

Yoga on a flare dayMixed evidence

No trial has tested yoga during flares. A review of yoga in rheumatic diseases suggests restorative yoga "may be especially appropriate during flares or periods of fatigue". Our class's flare-day version keeps to breathing, gentle hand and ankle glides and supported rest: about 15 minutes.

Source 49

What to drop

Arthritis UK: "If your joints are hot or swollen because of your condition, it's sometimes a good idea to focus on stretching exercises and avoid strengthening exercises until they settle down." Leave the standing strength poses and the ball squeeze until hot joints settle.

Source 23

When to call your team

NICE says everyone with RA should have rapid access to specialist care for flares. If a flare doesn't settle, or comes with feeling unwell, call your rheumatology advice line rather than pushing through.

Source 3

Hands and wrists

A hand programme helps a littleStrong evidence

In the SARAH trial (strengthening and stretching for rheumatoid arthritis of the hand) of 490 people, up to 6 sessions with a therapist and daily home exercises improved hand function by 4.3 points on a 0 to 100 scale at a year, but not pain. By about 26 months the difference had faded as fewer people kept exercising. A Cochrane review says hand exercise "probably slightly improves hand function". NICE suggests a tailored hand programme taught by a trained practitioner once your medicines have been stable for 3 months.

Sources 11, 50, 51, 3

In poses, keep weight off bent-back wristsMixed evidence

No yoga trial has looked at RA hands on their own, though grip improved in two pooled trials. A review's prop guide swaps weight on bent-back wrists for a wedge under the palms, and the Johns Hopkins team suggests fists or elbows when palms can't go flat. Use forearms, fists, a wedge, a wall or a chair instead of flat hands.

Sources 28, 49, 52

Our hand routine

Our hand exercises for rheumatoid arthritis follow the SARAH programme: do them daily if your hands are affected. If a joint is hot and swollen, do the stretches only, gently, until it settles.

Feet

Most people with RA have foot problemsEmerging evidence

An expert group says about 9 in 10 people with RA have foot problems. In a survey of 413 people, most had a current foot problem, and 30% had never had foot care.

Sources 12, 53, 54

See a podiatristStrong evidence

NICE says everyone with RA and foot problems should see a podiatrist, with insoles and footwear if needed.

Source 3

Foot and ankle exercise helpsEmerging evidence

In 13 studies, foot and ankle exercise eased foot pain and improved walking. Ankle circles and calf raises are a simple start; do standing poses in supportive shoes when your feet hurt (our suggestion).

Source 55

The neck

What can happen in the neckEmerging evidence

The NHS: "If you've had rheumatoid arthritis for some time, you're at increased risk of developing a problem at the top of your spine known as cervical myelopathy", which is uncommon but serious. A review puts X-ray signs of neck instability at 17% to 86% of people with long-standing RA, with signs of pressure on the nerves or spinal cord in 7% to 34%, and 40% to 50% of those with X-ray changes have no symptoms. Newer medicines cut new damage but don't reliably stop it once it's there, and a 10-year cohort found instability getting worse over time.

Sources 13, 56, 57

Signs to tell your team aboutStrong evidence

Long-standing RA can affect the joints at the top of the spine, which can slip and press on the spinal cord (cervical myelopathy). It is uncommon but serious: NICE asks for an urgent MRI scan and a surgeon's opinion for symptoms such as pins and needles, weakness or unsteadiness, and you may need a neck check before a general anaesthetic.

Tell your team about an electric-shock feeling down your back or arms when you bend your neck forward, or a feeling of your head clunking forward: these can be signs of the neck problem.

Sources 3, 56

Poses to leave out: our editorial advice

No NHS, NICE, Arthritis UK, NRAS, EULAR or American College of Rheumatology source advises on headstands, shoulder stands or plough in RA, so this is our reading of the NHS's warning. The Johns Hopkins team says to keep backbends small, without tipping the head back, and that standing on your head is "only recommended for very advanced practitioners". Headstand was the practice most often involved in published reports of harm after yoga. One small trial in young women with RA used a rope-supported headstand without reported harm, but it was far too small to show it's safe.

Our editorial advice: leave out headstands, shoulderstands and the plough pose, and don't force neck circles. Gentle neck movement is fine unless your team says otherwise.

Sources 52, 45, 31

Steroids, bones and your heart

RA thins bones, with or without steroidsStrong evidence

RA raises fracture risk whether or not you take steroids, with about 2.2 times the risk of a hip fracture. 27.6% of people with RA have osteoporosis, and spine fractures were about three times as common.

Sources 58, 59, 60

Steroids and bone checksStrong evidence

UK osteoporosis guidance starts bone protection alongside steroid tablets for people over 50, and some others, who take 7.5 mg or more of prednisolone a day for 3 months or more. The Royal Osteoporosis Society says even 2.5 to 7.5 mg a day may raise fracture risk. If you take steroid tablets, ask your team about your bones. Never stop or change steroids yourself.

Sources 61, 62, 63, 64

Bone-safe yogaStrong evidence

The UK consensus on exercise for osteoporosis: "Movements or exercise that involve sustained, repeated or end-range flexion should be modified or avoided", while "Rotation (twisting) movements should be safe if performed smoothly and comfortably"; it counts yoga as balance and strength work. Fold from your hips with a long back, and twist smoothly.

Source 65

Your heart needs more than yogaStrong evidence

RA raised the risk of heart disease and stroke by about half (heart attacks by 68%, strokes by 41%). Most yoga is light activity, so add walking, cycling or swimming, building towards 150 minutes a week.

Sources 66, 67

Which style, and how much

Gentle styles, with propsMixed evidence

The Johns Hopkins team recommends gentle styles that use props, such as Iyengar and Integral yoga, for most people with arthritis; it doesn't recommend hot yoga, because of the extreme heat, or Ashtanga, because it's so strenuous. The Arthritis Foundation's rule: "Don't do anything that hurts." Chair and restorative yoga suit tired days. Tell your teacher you have RA.

Sources 52, 49, 68

How much: our editorial starting point

Two or three sessions a week for 8 to 12 weeks to start, as the trials ran, with breathing and relaxation in every session. Add aerobic activity for your heart and strengthening on 2 days a week, which yoga can count towards.

Sources 4, 67

Breathe and rest: in every session

Slow breathing: 3 minutes, seated or lying (our yoga for arthritis class; the move's page says at least 5 minutes as a practice on its own). Breath reach: 5 breaths, arms only as high as is comfortable; alternate nostril breathing: 2 minutes of slow rounds with no holds (our chair yoga for seniors class), building to the move page's 3 to 5 minutes. Reclining bound angle: 2 minutes with a cushion under each thigh (our yoga for arthritis class; the move's page gives 2 to 5). Corpse pose: 5 minutes, cushions under your knees and arms (our yoga for arthritis class; the move's page).

Hands and wrists: daily if your hands are affected

Tendon glides: 5 of each position with 5-second holds; ball squeeze: 10 squeezes of 2 seconds, as hard as you comfortably can (our hand exercises for rheumatoid arthritis). The tendon glides move page gives 4 to 6 of each position, up to 4 times a day. Wrist and forearm flow: 60 seconds, forearm resting on a table (our yoga for arthritis class). If a joint is hot and swollen, do the stretches only, gently, until it settles.

Feet and ankles

Ankle circles: 5 slow circles each way, each ankle (the move's page). Seated march: 1 minute, holding the sides of the seat (our yoga for arthritis class; the move's page gives 1 to 2 minutes). Slow calf raise: 8 to 10, hands on the back of a chair, in supportive shoes if your feet hurt (our chair yoga for seniors class).

Gentle spine, seated

All seated (our chair yoga for seniors class): upper back lift, 5 holds of 3 to 5 seconds; cat-cow, 6 slow rounds with your hands on your knees, on all fours only if your wrists and knees are happy; twist, 5 each side with 5-second holds, turning smoothly; chin tuck, 5 holds of 3 seconds, with no neck circles.

Standing with a chair: strength and balance

With a chair (our yoga for arthritis class): mountain pose, 5 breaths, one hand on the chair; chair pose, 3 holds of 10 to 15 seconds with a small knee bend; warrior II, 3 breaths each side with a short stance; tree pose, 3 breaths each side, heel at your ankle; sit to stand, 8 to 10 slow reps from a higher seat, using your hands at first; side stepping, 10 steps each way next to a counter (also the move's page).

Lying, on a mat or your bed

Heel slides: 10 each side (the move's page; our yoga for arthritis class), gentle enough for flare days. Glute bridge: 8 to 10 slow lifts; lying twist: 3 to 5 breaths each side, small range, a cushion under your knees (our yoga for arthritis class).

Poses to change or leave out

These follow our arthritis and osteoporosis guides, a review of yoga in rheumatic diseases and the move pages' cautions.

Sore wrists or fingers

Avoid weight on bent-back wrists and flat hands (downward dog, plank, all-fours cat-cow, sun salutations and upward dog) while your wrists or fingers are sore. Use forearms, fists, a wedge under the palms, or your hands on a chair or wall.

Source 49

Sore knees, or a knee replacement

Pad or skip kneeling (hero pose, child's pose, camel and kneeling lunges), or use seated and standing versions, and ask your team before kneeling on a new knee (our yoga for arthritis guide).

If RA affects your neck

Our editorial advice: leave out headstands, shoulderstands and the plough pose, and don't force neck circles. Gentle neck movement is fine unless your team says otherwise.

Fish pose with the head dropped back belongs on the same list (our reading).

Source 13

Thin bones or long-term steroids

Fold from your hips with a long back rather than rounding deeply or repeatedly (a wide-legged forward fold, head-to-knee pose or a seated forward fold pulled deep), and twist smoothly.

Source 65

Never force a joint

Inflamed joints can be left less stable, so move within comfort, not to the end of your range. A review warns that long, passive yin yoga holds carry a "potential for overstretching and tendon inflammation".

Sources 17, 49

A hot, swollen joint

Some pain when you start is common and isn't a sign of harm if it settles. A hot, swollen joint is different: rest it from strengthening.

Source 23

Badly damaged joints, or joint replacements

Don't load a badly damaged joint heavily, and ask your team which positions to avoid after a joint replacement. NRAS advises supervision by a physiotherapist or an exercise professional before starting a new exercise programme if you have badly damaged joints.

Sources 43, 69

Hot yoga and Ashtanga

The Johns Hopkins team doesn't recommend either, and no trial has tested them in RA.

Source 52

Classes to follow

Our 30-minute class 2 or 3 times a week, with its 15-minute flare-day version on bad days (our editorial starting point). Do the hand exercises daily if your hands are affected.

Breathe, move and rest: a 30-minute gentle yoga class for rheumatoid arthritis, mostly in a chair, with a flare-day version

A gentle 30-minute yoga class for rheumatoid arthritis: slow breathing, hand, foot and spine moves in a chair, standing poses with a chair, then supported rest.

30 minBeginner19 movesA bench or box, Other / check instructions

Yoga for arthritis: a 30-minute joint-friendly class with a chair

A 30-minute joint-friendly yoga class for arthritis: seated breathing and joint warm-ups, standing poses with a chair, gentle lying poses and a long relaxation.

30 minBeginner17 movesA bench or box, A wall

Hand exercises for rheumatoid arthritis (the SARAH programme)

The daily stretches and strengthening moves from the SARAH hand trial and NHS hand therapy leaflets: finger bends, finger walking, wrist circles, squeezes and pinches.

15 minBeginner7 movesA dumbbell, A bench or box

Chair yoga for seniors

A free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.

20 minBeginner18 movesA bench or box, Something with weight

Seated chair yoga: 15 minutes, no standing

A 15-minute chair yoga routine done entirely sitting: slow breathing, neck, shoulder and wrist stretches, seated twists and side bends, and a calm finish.

15 minBeginner16 movesA bench or box

Chronic pain flare-up routine: gentle movement for a bad day

A 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.

10 minBeginner10 movesA band, A bench or box

Restorative yoga sequence: 45 minutes of supported rest

A 45-minute restorative yoga sequence: five fully supported poses held for 4 to 10 minutes each, with slow breathing and a long final rest.

45 minBeginner6 movesFirm cushion, A wall

Yoga for osteoporosis: a 30-minute class with the safe swaps built in

A 30-minute yoga class for osteoporosis: standing strength, balance at a wall, back-strengthening holds and hip hinges in place of deep forward folds.

30 minBeginner19 movesA bench or box, A wall

Add walking for your heart

Yoga is mostly light activity; a walking plan builds towards the 150 minutes a week that help your heart.

Warning signs: when to get help

These are the warning signs from our rheumatoid arthritis, Pilates for rheumatoid arthritis, arthritis and neck pain guides, word for word. This is general information, not a diagnosis. A&E means accident and emergency. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.

Get urgent advice the same day

Contact your rheumatology advice line, GP or NHS 111 the same day for:

  • Pins and needles, weakness, unsteadiness, clumsy hands or loss of power, especially with neck pain: these can be signs of pressure on the spinal cord, which NICE treats as urgent.
  • A hot, swollen joint with a fever or feeling unwell, especially a replaced joint: it could be an infection.
  • A flare that won't settle.

Sources 3, 13, 17

New problems walking or a sudden loss of coordination: call 999

Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.

Sources 13, 3

Your neck

Long-standing RA can affect the joints at the top of the spine, which can slip and press on the spinal cord (cervical myelopathy). It is uncommon but serious: NICE asks for an urgent MRI scan and a surgeon's opinion for symptoms such as pins and needles, weakness or unsteadiness, and you may need a neck check before a general anaesthetic.

Tell your team about an electric-shock feeling down your back or arms when you bend your neck forward, or a feeling of your head clunking forward: these can be signs of the neck problem.

Sources 3, 56

A hot, swollen joint

Get help the same day for a hot, swollen joint with a fever, or severe pain and swelling that came on suddenly in one joint.

Some pain when you start is common and isn't a sign of harm if it settles. A hot, swollen joint is different: rest it from strengthening.

Source 14

In a flare

In a flare, rest the inflamed joints but keep them moving gently, then build back up.

NICE says everyone with RA should have rapid access to specialist care for flares. If a flare doesn't settle, or comes with feeling unwell, call your rheumatology advice line rather than pushing through.

Sources 9, 3

Contact your rheumatology team soon

  • An activity always makes your joints warm and swollen or causes severe pain.
  • New breathlessness or a dry cough that won't go away if you take methotrexate, or frequent infections on biological treatment.
  • A tendon that suddenly stops working, or numbness and tingling in your hand.
  • Before a new programme, if you have badly damaged joints, joint replacements, heart disease or another condition that needs monitoring.

Sources 14, 20, 3, 13

A possible spinal fracture

Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.

Source 61

Steroids and your bones

If you take steroid tablets, ask your team about your bones. Never stop or change steroids yourself.

Source 61

Chest pain or fainting: call 999

Call 999 if:

  • You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
  • The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
  • You have chest pain and feel sweaty, sick, light-headed or short of breath.
  • Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 70, 71

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 72

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Never stop or change your RA medicines because of exercise or a flare without your team.

During yoga

"If it hurts, stop", the Johns Hopkins arthritis team says. Stop and rest if a pose makes a joint warm and swollen or causes severe pain, and ease off next time if a joint aches more the next day.

Arm symptoms are the exception, as in our neck pain guides. If a pose sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or leave it out.

Source 52

Myths

"Exercise makes rheumatoid arthritis worse"Strong evidence

Side effects in trials were mild and short-lived, with no harm to disease activity; in yoga trials, disease activity fell a little. Even 2 years of high-intensity training didn't increase large-joint damage overall. The exception is heavy loading of large joints that are already badly damaged.

Sources 2, 4, 42, 43

"Rest is best in a flare"Emerging evidence

Relative rest, not bed rest: keep the joints moving gently, then build back up.

Sources 9, 14, 10

"Yoga can cure RA, or replace medicines"Strong evidence

Disease-modifying medicines control RA; yoga goes alongside them, never instead. NICE says complementary therapies "should not replace conventional treatment".

Source 3

"Yoga eases RA pain"Mixed evidence

Pain hasn't clearly improved when the trials are pooled (very low certainty), though one small trial in women in remission found less pain with yoga than with combined exercise. Function and disease activity improved a little.

Sources 4, 28, 36

"You should avoid yoga with RA"Strong evidence

The American College of Rheumatology conditionally recommends mind-body exercise such as yoga, EULAR finds no disease-specific reasons to avoid activity, and Arthritis UK suggests yoga. Adapt it, rather than avoid it.

Sources 1, 2, 23

"Hot yoga loosens stiff joints, so it's better for RA"Mixed evidence

No trial has tested hot yoga in RA, and the Johns Hopkins team doesn't recommend it because of the extreme heat. A warm shower or a slow warm-up eases stiffness in a normal room (our suggestion).

Source 52

"Stretch your joints as far as they'll go to keep them moving"Emerging evidence

Inflamed joints can be left less stable. Move within comfort, and never force a joint.

Sources 17, 10, 49

"With RA fatigue, exercise will only drain you"Emerging evidence

Physical activity eased fatigue by about 14 points out of 100, and EULAR recommends it for fatigue. Pace it, with shorter sessions on tired days.

Sources 6, 7

Questions people ask

Is yoga good for rheumatoid arthritis?

For most people, yes, alongside medicines. In a review of 5 small trials, yoga lowered disease activity a little and improved everyday function, though pain didn't clearly improve, and the trials had weaknesses. The American College of Rheumatology conditionally recommends it.

Can you do yoga with rheumatoid arthritis?

Yes. European rheumatologists found no disease-specific reasons to avoid activity, only adjustments. Choose gentle, chair or restorative styles, use props, and leave out headstands, shoulder stands and plough (our editorial advice).

Is yoga safe for RA?

In trials, side effects of exercise were mild and short-lived, and yoga didn't worsen joint counts. Take care with large joints that are already badly damaged and with RA in the neck, and stop and rest if a pose makes a joint warm and swollen.

Can I do yoga during a flare?

Gently: rest the inflamed joints but keep them moving, with breathing, gentle range and supported rest, then build back up. Call your rheumatology advice line for a flare that won't settle or comes with feeling unwell.

Will yoga help RA fatigue?

Physical activity eased RA fatigue a little, about 14 points on a 100-point scale, and small yoga trials reported less tiredness. Pace it, with short sessions on tired days.

Which yoga poses should I avoid with RA?

Weight on bent-back wrists while they're sore, deep kneeling on sore knees, deep forward folds with thin bones or long-term steroids, and headstands, shoulder stands and plough with long-standing RA. Never force a joint.

Can yoga help RA in the hands?

Hand exercises improved hand function a little in a large trial, with the benefit fading when people stopped, so do our hand routine daily if your hands are affected. In poses, use forearms, fists, a wedge or a chair instead of flat hands.

Is chair yoga good for rheumatoid arthritis?

Yes: it keeps weight off sore wrists and knees, and RA trial programmes used props and seated versions. Add standing poses at a chair when you can, for balance and leg strength.

Is hot yoga OK with rheumatoid arthritis?

We found no trial of hot yoga in RA, and the Johns Hopkins arthritis team doesn't recommend it because of the extreme heat. A warm shower before a normal class does the warming.

Can yoga replace my RA medicines?

No. Disease-modifying medicines control RA and protect your joints; yoga goes alongside them. Never stop or change your medicines because of exercise or a flare without your team.

Is yoga or Pilates better for rheumatoid arthritis?

Neither has been shown to be better: yoga has more trials, and Pilates three small ones. Choose the one you'll keep doing, and add walking or cycling for your heart.

When should I get help?

The same day for a hot, swollen joint with a fever, or for pins and needles, weakness, unsteadiness or clumsy hands, especially with neck pain. Call 999 for new problems walking or loss of bladder or bowel control.

Sources

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Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.