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Tai Chi for Rheumatoid Arthritis

Uncategorized Sep 21, 2020

Public Health Report by: Eric L. Zielinski

Introduction

Being both autoimmune and idiopathic in nature, rheumatoid arthritis (RA) has confounded health care professionals for centuries. This painful disorder seems to wax and wane in unpredictable ways and frustrates even the most skilled physician. Subsequently, various treatments have been employed with little certainty to their efficacy and long-standing consequences.

Rheumatoid arthritis is so named after the rheumatoid factor (RF) autoantibody that is prevalent in up to 70 – 80 percent of people with RA. The RF blood test generally helps differentiate RA from other types of arthritic conditions like osteoarthritis (OA), psoriatic arthritic (PA), and ankylosing spondylitis (AS). Affecting more women than men, this painful disorder usually has an onset age between 25 and 55 years. Since it is an inflammatory process, people suffering from it will oftentimes experience swollen joints, limited range of motion, severe pain, and deformity due to joint destruction. Interestingly, it first attacks the hands and wrist, although it can eventually spread to most joints in the body.

According to the Atlanta-based Centers for Disease Control and Prevention (CDC) some of the epidemiological data is as follows:

Approximately 50 million adults in the United States have been diagnosed with some form of arthritis including rheumatoid arthritis and other similar conditions.
An estimated 1.5 million adults were specifically diagnosed with rheumatoid arthritis in 2007.
Up 294,000 children under age 18 have some form of arthritis or rheumatic condition, representing approximately 1 in every 250 children in the U.S.
Arthritis and other rheumatic conditions have the most common cause of disability among U.S. adults for the past 15 years.
There were 78 million ambulatory care visits with a primary diagnosis of arthritis or other rheumatic conditions.
Three categories of arthritis and other rheumatic conditions (AORCO) account for almost 80 percent of deaths: Diffuse connective tissue diseases (34 percent), other specified rheumatic conditions (23 percent), and rheumatoid arthritis (22 percent).

RA is not only a significant health risk for millions of Americans, it is costly. The most recent data provided by the CDC reports that in 2003 the total economic burden of arthritis and other rheumatic conditions in the U.S. was 128 billion dollars, up from 86.2 billion dollars in 1997. In the same year, medical expenditures were 80.8 billion dollars, up from 51.1 billion in 1997. In addition, as RA has a strong association with depression, it is a main contributor to the 83 billion dollar burden depression has on the U.S. economy

Clearly, RA is big business, yet it does not have to be. If “alternative” therapies like massage therapy, chiropractic adjustments and, Tai Chi Chuan (TCC) were utilized, these numbers would dramatically decrease.

Medical Research and Management

Bias against research designs that are not randomized control trials continues to limit treatment options for RA patients. Take, for instance, TCC. According to the highly respected Cochrane Library – the “gold standard” of peer-reviewed literature – “[TCC] is an ancient Chinese health-promoting martial art form that has been recognized in China as an effective arthritis therapy for centuries” (emphasis mine). Paradoxically, Tai Chi is still not recognized in the U.S. as a viable treatment option for arthritis patients. The answer to this conundrum, and more, can be seen through the eyes of medical research and management.

For example, in 2007 the world-renown journal Rheumatology published a systematic review of relevant data evaluating Tai Chi’s efficacy in managing RA. Although, positive benefits were reported on balance and strength, cardiovascular/respiratory function, flexibility, immune system, arthritis symptoms, muscular strength and psychological effects the researchers concluded the follow contradictory findings:

“There are few trials testing the effectiveness of Tai Chi in the management of RA. The studies that are available are of low methodological quality. Collectively this evidence is not convincing enough to suggest that tai chi is an effective treatment for RA. The value of Tai Chi for this indication therefore remains unproven. [Emphasis mine]”

Because many alternative therapies fail to produce random control trials in great numbers, the medical community has all but bastardized them. Consequently, instead of offering more natural approaches, physicians continue to treat RA patients with harmful and aggressive synthetic therapies such as are seen below.

The following list of common RA treatments comes from a 2012 U.S. Department of Health & Human Services report:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil, Motrin and Aleve.
Corticosteroid injections or oral versions.
Oral disease-modifying antirheumatic drugs (DMARDs).
Biologic (a new injectable category of DMARDs).

In addition, according to researchers, “Combination therapies serve an important role because treatment with a single DMARD often does not adequately control symptoms.” However, what is not being taken into account is that each person responds quite differently to a drug therapy cocktail. It is impossible, therefore, to predict how patients will respond and they oftentimes experience a wide variety of side effects. Take the following, for example:

NSAIDs have been linked to: Cardiovascular issues like hypertension, congestive heart failure; gastrointestinal issues like heartburn, vomiting, heartburn, constipation and diarrhea; central nervous system problems such as dizziness, tinnitus and headaches; liver damage; and various types of cancer.
Steroids cause ligament laxity, adrenal/skin atrophy, cataracts, diabetes, and a slew of other diseases.
DMARDs create toxic build-up in body and can cause blindness, low white blood cell counts (thus, contributing to infection), nausea, skin rashes, proteinuria, liver damage, abdominal pain, hair loss and a weakened immune system (thus, contributing more to the auto-immune nature of RA).
Biologicals – by inhibiting natural inflammatory cytokines like tumor necrosis factor – can cause cancer, tuberculosis, congestive heart failure, multiple sclerosis, and contributes to systemic infection.

Sadly, many of these drug therapies are experimental. Subsequently, scientists are not even aware of how they work and they have no idea of the long-term effects on the body. For instance, it has been reported that DMARDs “affect the immune system, although doctors do not know precisely how it works to improve rheumatoid conditions.” Needless to say – even though these therapies may temporarily relive some pain and discomfort associated with RA – they do not address the root cause, only address symptoms and come at a very high cost.

Tai Chi’s Efficacy

WebMD reports that, “Although there isn’t a cure for rheumatoid arthritis early, aggressive treatment has been shown to help prevent disability.” The medical community is correct: RA is completely incurable under typical medical management. What most do not know, however, is that it is very manageable and potentially curable using natural treatments utilizing nutrition, meditation, exercise, and other “alternative” therapies to our advantage. One very well documented approach to RA is Tai Chi.

Below is a sample of published studies highlighting TCC’s efficacy in the management and prevention of RA.

The American Journal of Physical Medicine & Rehabilitation published a study in which researchers concluded that, “Tai-Chi Chuan exercise appears to be safe for RA patients and may serve as an alternative for their exercise therapy and part of their rehabilitation program. Weight-bearing exercises have the potential advantages of stimulating bone growth and strengthening connective tissue.”

The British Journal of Sports Medicine published a study reviewing controlled experimental studies and clinical trials involving 2216 men and women and found that the “evidence provided by cross sectional and longitudinal studies suggests that TCC exercise has beneficial effects on cardiorespiratory and musculoskeletal function, posture control capacity, and the reduction of falls experienced by the elderly.” Thus, positively affecting RA.

The Cochrane Library conducted a review to accurately access the safety of TCC as a treatment modality for RA patients. Four trials including 206 participants were analyzed and researchers concluded, “The results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA.”

The Oxford journal Rheumatology published a random control trial suggesting “that group Tai Chi is a safe and potentially promising complementary therapy for adults with RA.” According to researchers, the “results demonstrate that Tai Chi seems to be associated with trends to improvement in disease activity that relates to both symptoms of pain and the cognitive coping process, which in turn is related to physical and psychological disability.” They claimed that their results were “consistent with two non-randomized studies of Tai Chi for RA that reported that there was no significant exacerbation of joint symptoms for 10 weeks of Tai Chi. It is also consistent with other Tai Chi studies in which Tai Chi had beneficial effects on tension, anxiety and depression.”

Journal of Korean Academy of Nursing published a report that studied the manner in which TCC can help prevent and manage RA-related symptoms like pain, fatigue, sense of balance and activities of daily living (ADLs) researchers took 32 people and carried out a 50 minute TCC regimen for 12 weeks and compared them to a group of 29 who did not do the exercise. The results from this study were that, “pain and fatigue significantly decreased in the experimental group [and] sense of balance was enhanced significantly.” Thus, researchers concluded that, “Tai Chi exercise is an effective nursing intervention that can be used for rheumatoid arthritis patients.”

BMC Musculoskeletal Disorders published a study showing that, “Tai Chi practice lead to improved lower-limb muscle function at the end of intervention and at 12 weeks follow-up. Qualitative analyses showed that patients experienced improved physical condition, confidence in moving, balance and less pain during exercise and in daily life. Other experience included stress reduction, increased body awareness, confidence in moving and indicated that Tai Chi was a feasible exercise modality in RA.”

In response to the variety of benefits rheumatoid patients have received from Tai Chi, the National Rheumatoid Arthritis Society has implemented a special Tai Chi for Arthritis program based on Sun forms Tai Chi. The program includes warm-up, wind-down, Qigong, and 12 Sun styles Tai Chi movements. The positive results RA patients have experienced thus far has been outstanding and the program has already spread to several arthritis foundations globally.

In summary, scientific research has validated TCC’s efficacy in helping people manage the pain of RA. Furthermore, it has been proven that it can actually help reverse the disease by restoring proper range of motion in the joints, thereby creating the environment where the body’s innate healing capability can restore joint health. Its effect on stabilizing joints and maximizing the healing power of Qi needs to be investigated more, yet in the meantime it is safe to recommend Tai Chi for anyone suffering from RA.

Conclusion

By labeling TCC as “alternative,” the medical community has successfully place a stigma on it to be less effective, inferior, or even experimental. Subsequently, the U.S. has been very reluctant to utilize Tai Chi in its approach to rheumatoid arthritis. It would behove rheumatologists and RA patients alike to review the literature and consider implementing TCC in their RA treatment protocol.