Tai chi improves pain and functional status in adults withRheumatoid arthritis

Background: Tai Chi (TC) is a traditional Chinese martial art that has been practiced in China for centuries. Practice of TC has been associated with improved balance in the elderly and strength and flexibility in frail elderly subjects and reduced pain, stress and anxiety. The effects of TC in patients with rheumatoid arthritis (RA), has not been studied, but TC may improve muscle strength and influence well being ('mind-body' interactions). We conducted a pilot randomized controlled trial to collect preliminary data on the safety and effect of TC in RA.

Methods: 20 patients with Functional Class I or II RA were randomly assigned to either TC or education and stretching exercise (attention control) and both provided in group format twice-weekly for 12 weeks, each session lasting 60 minutes. Arthritis status and functional capacities were examined at baseline and on completion of the 12-week program by an investigator blinded to treatment assignment. The primary endpoint was ACR 20 response at 12 weeks.

Results: 75% of subjects were female, 75% were white, 20% took steroids on a daily basis and 75% took disease modifying drugs. Mean age was 50 years and median disease duration was 14 years. Mean baseline disease characteristics included tender joint count of 14, swollen joint count of 10, ESR of 31 mm/h, CRP of 0.93 mg/dl, and HAQ Disability index of 0.7. The change between baseline and 12 weeks is shown below and mean change between groups was compared using a two-group t-test. There were no adverse events associated with TC or education and stretching.

Baseline vs. 12 weeks TC (n=10) Attention control (n=10)

Primary End-Point
ACR20 (% responders at 12 weeks) 50% 0%*

Secondary End Points (mean change)
Tender joints (number) -5.40 0.50*
Swollen joints (number) -1.50 1.70
Ritchie Articular Index -0.14 0.05*
HAQ Disability Scale -0.49 0.06**
Pain (VAS)(1-10) -0.96 1.56*
Patient Global (1-10) -0.45 0.74
Fatigue (VAS) (1-10) -1.54 -0.51
50 foot walk (sec) -1.10 -1.40
ESR, mm/h -0.10 1.78
CRP,mg/L -0.08 0.14
Grip strength (kg) 1.00 -0.96
SF-36 Physical Component Summary score 5.83 1.63
SF-36 Mental Component Summary score 7.26 -0.37
EQ-5D Thermometer Rating Scale (0-100) 6.40 -9.90

*p <.0.05 **P <0.01 (significant improvement of TC vs. attention control). Increase = improvement, all other results, decrease = improvement

Conclusion: Patients with Functional Class I or II RA receiving 12 weeks of group TC had significant improvement in their ACR20 and HAQ disability index compared with those receiving education and stretching exercises. These promising results warrant further investigation into the potential complementary role of TC for treatment of RA.

Disclosure: This study was partially supported by the General Clinical Research Center, (Grant M01-RR0054) and a grant from Tufts-New England Medical Center.