Giving pain a push

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Giving pain a push

Knees slightly bent, arms moving slowly and gracefully, a group of about 20 people studiously follows an instructor in a tai chi session at the Hospital for Rheumatic Diseases, Hanyang University Medical Center in Seoul. The tai chi students are seeking relief from the pain of arthritis, one of the most common chronic ailments and a leading cause of disability.

Although the 12 movements of sun-style tai chi, one of the four most popular types of tai chi in China and selected for arthritis sufferers, looks deceptively easy -- there is no vigorous stretching or bending involved, just a sustained fluid movement from one position to another -- several patients at the session drop out for a rest after the first 10 minutes.

Jang Young-je, 64, whose fingers and toes are deformed from years of arthritis, says, "It is not too strenuous, but it is more difficult than quick movements." Although she has tried dancing and swimming to keep her body moving, as advised by her doctor, Ms. Jang says she finds this routine the most convenient one to do at home.

Jun Sun-ok, 53, diagnosed with osteoarthritis four years ago, has been attending the monthly sessions at the hospital since May and does the routine twice a week at home.

"There is a definite improvement in the pain. For the next three to four days I feel no or very little pain in the fingers and knees."

A random study done by the Hospital for Rheumatic Diseases in Seoul examined the changes in pain, balance, muscle strength and physical function in older osteoarthritis patients after a 12-week tai chi program. The research found that the group that exercised showed significant improvement in physical functioning, while the control group, which did not exercise, reported no change and in some instances a decline in physical states.



"The exercise group reported significantly less pain and stiffness in their joints," says Bae Sang-cheol of the Hospital for Rheumatic Diseases. Dr. Bae conducted a seminar on the study at a recent American College of Rheumatology Conference in New Orleans, Louisiana.

One of the advantages of this gentle form of tai chi over aquatics, another commonly prescribed exercise for arthritis patients, is that it can be done even in the cold winter months when going to the pool may become inconvenient, just as the arthritis symptoms seem to worsen.

The drop of the mercury is felt in the bones by people suffering from arthritis who complain of achy and stiff joints: The number of arthritis outpatients shoots up by about 40 percent in November over the previous month, according to a survey last year by a local hospital that tracked the number of outpatients over a three-year period.

Although people generally talk about arthritis as one disease, there are numerous forms of arthritis, the two most common of which are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, also called degenerative arthritis, is associated with general wear and tear. It can affect any joint in the body and although it initially tends to strike only one joint, multiple hand joints may eventually become arthritic if the fingers are involved.

Rheumatoid arthritis is one of the most debilitating of the more than 100 forms of arthritis, causing joint aches and eventually joint deformations. Unlike osteoarthritis, which is associated with ageing, rheumatoid arthritis is an inflammatory condition which can strike young children as well as the elderly.

Although both osteoarthritis and rheumatoid arthritis affect the joints, there are differences in symptoms. In osteoarthritis, the joint pains are noticeable during or after use, and a change of weather can also bring about discomfort. There may also be swelling and stiffness in a joint, especially after using it, and a loss of joint flexibility. Bony lumps on the middle or end joints of the fingers or the base of the thumb may also be a sign of osteoarthritis.

The symptoms of rheumatoid arthritis may come and go over time. Unlike degenerative arthritis in which joints become painful after use, rheumatoid arthritis sufferers feel achy and stiff after sleep or after periods of rest. Rheumatoid arthritis generally causes problems in multiple joints simultaneously, affecting both sides of the body at the same time. When the smaller joints of the hands and feet are affected, they may become deformed over time. Another key difference between the two common forms of arthritis is that whereas the former affects only the bones and the joints, the latter can cause inflammation in other organs.

There are currently no cures for either forms of arthritis, and treatments focus on reducing pain and maintaining joint movement. Common medications used to treat the pain and mild inflammations of osteoarthritis include topical pain relievers, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs) that relieve pain and fight inflammation. More recently, COX-2 inhibitors which do not appear to have the stomach-damaging side effects of the NSAIDs have been introduced. For more severely damaged joints, a joint replacement surgery is performed.

Medications for rheumatoid arthritis can relieve the symptoms and slow or halt their progression. NSAIDs, COX-2 inhibitors, corticosteroids that reduce inflammation and slow joint damage and other disease-modifying anti-rheumatic drugs are used to treat rheumatic arthritis. Although it is still difficult to completely cure rheumatic arthritis, better medications in the form of biologic agents are being developed, according to Dr. Bae. "For example, monoclonal antibodies manufactured using molecular bioengineering that can block specific inflammatory pathogens are looking very promising," he said.

by Kim Hoo-ran

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