"Mindfulness" exercises, which focus on experiencing the present moment, no matter how difficult, can help curb the stress and fatigue associated with painful rheumatoid joint disease. Heidi A Zangi, from Diakonhjemmet Hospital (Sweden), and colleagues enrolled 73 men and women, ages 20 to 70 years, all of whom had had painful joint disease, caused by rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis for at least a year.  Half of them were randomly allocated to scheduled "mindfulness" exercises – facilitated by healthcare professionals and focused on particular topics, such as recognizing individual limitations, and strong emotions, such as anger, joy, and sorrow – which took place in 10 group sessions over a period of 15 weeks, plus a booster session around six months after the course had completed. Participants were also given creative exercises, such as guided imagery, music and drawing, and shared their experiences with other members of the group. The rest of the volunteers randomly allocated to the comparison group were given standard care plus a CD containing similar exercises for use at home, as and when they wanted. Stress levels, coping abilities, and symptom control, including pain and fatigue, were assessed, using validated scores, immediately after all 10 sessions had finished, and again 12 months later. In total, 67 participants completed all the assessments. These showed no differences in pain levels, disease activity or the ability to talk about feelings.  But there were significant differences in levels of stress and fatigue.  The number of participants with a high stress score of above 23 in the GHQ-20 questionnaire fell from 13 at the start of the study to two, just 12 months after the sessions had finished. Comparable figures in the comparison group were 10 and eight, respectively.  There was, however, a tangible fall in measured levels of fatigue in the intervention group: no such change was evident in the comparison group.  Writing that: “The [mindfulness exercise]  improved most primary and secondary outcomes,” the study authors conclude that: “Improvements were maintained at 12 months, suggesting that [mindfulness exercise]  is a beneficial complement to existing treatments for patients with inflammatory rheumatic joint diseases.”