Tai Chi Offers Additional Option
for OA Sufferers
Osteoarthritis develops when cartilage deteriorates and the space between bones at the joints narrows, eventually causing pain as the bones change shape.
The first symptom is often pain in a joint after strenuous activity. The joint may be stiff in the morning, but loosen up after a few minutes of movement. Sometimes moving the joint may cause a grating sensation.
When osteoarthritis affects the knee, pain, swelling and stiffness develop. Discomfort can progress to difficulty walking, bathing and even getting in and out of bed. When osteoarthritis affects the hip, pain may be felt in the groin, down the inside thigh or as far away as the knee. When it affects the lower spine, pain can spread to the buttocks or legs.
The knee is the most commonly affected joint. In fact, almost half the population will have knee pain due to osteoarthritis by age 85. There is no cure; the only permanent treatment is a total knee replacement. According to Harvard Health Publications, more than 700,000 of these operations are performed in the U.S. each year, and the rate of knee replacement surgery has nearly doubled between 2000 and 2010.
Short of surgery, traditionally clinicians have relied heavily on NSAIDs to treat OA. But the cardiovascular, gastrointestinal and renal toxicities of NSAIDs have limited their use.
Acetaminophen (an analgesic, such as Tylenol or Anacin, without anti-inflammatory properties) is still widely recommended as an initial therapy due to its relative safety. In a recent meta-analysis reviewing drug efficacy published in The Lancet, however, acetaminophen was found to be no better than placebo. The NSAIDs diclofenac, etoricoxib and rofecoxib were associated with the greatest pain reduction for patients with knee or hip osteoarthritis. But etoricoxib is not available in the U.S., while rofecoxib was withdrawn worldwide in 2004.
In another study published in BMJ, acetaminophen—though recommended as a first-line analgesic for lower back pain and pain related to hip and knee OA—was again found to be no more effective than placebo for lower back pain and disability in the immediate term (less than or equal to two weeks) or for pain, disability and quality of life for up to three months. In addition, acetaminophen users were more likely to have abnormal results on liver function tests.
There is the potential for adverse events with NSAIDS as well, including exacerbation of heart failure, heart attack risk, GI upset, and bad interactions with the anticoagulant warfarin, which treats and helps prevent blood clots. All of this severely limits drug options for OA-related pain management.
Non-pharmacologic approaches are therefore often sought after, and they also help avoid the side effects from simultaneously using multiple drugs, a situation known as poly-pharmacy that is common among the elderly.
As is so often the case, the treatment with the least side effects and the most promise for OA sufferers, if not quite a magic bullet, appears to be physical activity.