Arthritis is a common physiological condition among people across the world. It is rare among youths but there has been a steady increase over the last decade. Arthritis, especially in the knees, is a problem that a majority of elders in the US, UK, Europe as well as Australia and Asia suffer from. Arthritis is a chronic condition and there is no cure but surgery. Even all surgeries are not always successful in alleviating the entire problem.

In the US there are a few hundred thousand knee surgeries every year and the UK observes some 70,000 or more. More than half of these knee replacement surgeries are primarily for arthritis. Arthritic pain can be unbearable for any and sundry. Although there are many alternative treatments popularly practiced around the world, tai chi has been proved to be one of the most effective of all in treating arthritis pain.

Tai chi is a form of martial art that was developed in China. It is said that during the medieval times, Chinese monks were growing weak and suffered from physical problems and pain in the joints due to excessive meditation and very little physical movement. Tai chi was developed in this era to treat the pain at the joints, to improve muscle simulation and for better physical and mental health of the monks.

Several years later, tai chi is a popular martial art today not just as a sport but as an effective way to alleviate arthritis pain. Researchers from various universities have conducted case studies by observing people practicing tai chi and the improvement in their movements, agility and physical resistance have been recorded. How much arthritic pain they felt after having participated in tai chi classes for a few weeks had also been taken into account to establish a holistic and factual report!

In all such reports, tai chi has been regarded as an effective remedy which is natural and free of any medications or drugs to reduce arthritis pain. Moreover, tai chi has mental benefits as well. Elderly people practicing tai chi have reported feeling less depressed, more energetic and have also completely walked out of pain relief medications.

According to studies published by the Tufts University in Massachusetts, The George Institute as well as the Arthritis Foundation, the slow, methodic and controlled movements of tai chi can help in simulating muscles throughout the body, enhance balance, agility of the body and also enables energy circulation to all parts of the body.

It was recently reported in ScienceDaily that “In the largest study to date of the Arthritis Foundation’s Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study’s lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC’s Thurston Arthritis  Research Center.

“Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis,” Callahan said. “We found this in both rural and urban settings across a southeastern state and a northeastern state.”

The following are the 25 recommendations with updates and links to further reading by Arthritis Today.

1. Drug and non-drug treatments. The optimal osteoarthritis (OA) treatment program should consist of both medications and non-drug treatments.
Non-drug treatments
2. Education and self-management. The initial focus of treatment should be on what patients can do for themselves, rather than on passive therapies delivered by a health professional.  Learn about the Arthritis Foundation Self-Help Program.
3. Regular telephone contact.  The best evidence for the benefit of phone contact came from a study of 439 OA patients in which monthly phone calls from lay personnel promoting self-care were associated with improvements in joint pain and physical function for up to a year.
4. Physical therapy. Studies consistently support the usefulness of an evaluation by a physical therapist and instruction in appropriate exercise to reduce painand improve function. Physical therapists can also provide assistive devices to make daily tasks easier.
5. Aerobic, muscle-strengthening and water-based exercises.A rounded exercise program can promote muscle strength, improve range of motion, increase mobility and ease pain. Read this Arthritis Today articles on fitness and exercise.
6. Weight loss. Maintaining your recommended weight or losing weight if you are overweight can lessen your pain by reducing stress on your affected joints. Weight loss specifically helps ease pressure on weight-bearing joints such as the hips and knees. Arthritis Today’s special weight-loss guide.
7. Walking aids. Canes and crutches can reduce pain in hip and knee or OA. If both hips and/or knees are affected wheeled walkers may be preferable.
8. Footwear and insoles. If osteoarthritis affects the knee, special footwear and insoles can reduce pain and improve walking.
9. Knee braces. For osteoarthritis with associated knee instability, a knee brace can reduce pain, improve stability and reduce the risk of falling.
10. Heat and cold. Many people find the heat of a warm bath, heat pack or paraffin bath eases OA pain. Others find relief in cold packs. Still others prefer alternating the two.  Learn more about using heat and cold.
11. Transcutaneous electrical nerve stimulation (TENS).  A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It has been shown to help with short-term pain control in some patients with knee or hip arthritis.
12. Acupuncture. A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been touted as a treatment for osteoarthritis pain. A recent trial of 352 patients with knee osteoarthritis showed small but statistically significant improvement in pain intensity two and four weeks after a course of acupuncture. Read more about acupuncture.
Drug treatments
13. Acetaminophen. At a dosage of up to 4 grams per day, acetaminophen (Tylenol), can be an effective initial treatment osteoarthritis pain. The American College of Rheumatology (ACR) recommends acetaminophen as the initial treatment for osteoarthritis of the hip and knee. Read more about acetaminophen and other oral analgesics.
14. Nonsteroidal anti-inflammatory drugs. Despite cardiovascular and gastrointestinal concerns about this class of drugs, the committee concludes NSAIDs can be useful for OA pain, but advises using at the lowest effective dosages and avoiding long-term use if possible.  In people at high risk of gastrointestinal side effects, the committee recommends a COX-2 inhibitor or a traditional NSAID along with proton pump inhibitor or other stomach-protective drug. Read more about NSAIDs. Learn how to avoid NSAID-related stomach problems.
15. Topical analgesics (NSAIDs and Capsaicin).Topical NSAIDs and capsaicin, an analgesic derived from chili peppers, can be used along with or instead of oral analgesics or NSAIDs for OA pain.One of them, Voltaren Gel, is a topical formulation of the NSAID diclofenac, and is available only by prescription. Learn more about topical analgesics.
Read the latest FDA warnings on topical analgesics.
16. Corticosteroid injections. Injecting corticosteroid compounds directly into affected joints can be useful when there is localized inflammation and/or moderate to severe pain that doesn’t respond to oral pain relievers. The ACR recommends corticosteroid injections as an alternate initial therapy to acetaminophen for patients who have moderate to severe knee pain and signs of inflammation and who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.
17. Hyalruonic acid injections. A series of injections of hyaluronic acid, meant to supplement a natural substance that gives joint fluid its viscosity, may be useful in treating the pain of hip and knee arthritis, according to the experts. However, a recent study published in Arthritis & Rheumatismfound a single intraarticular injection of hyaluronic acid for the treatment of hip osteoarthritis was ineffective in achieving significant pain relief in comparison to placebo.
18. Glucosamine and/or chondroitin for symptom relief. Treatment with one or both of these supplements may provide symptomatic benefit for some people with knee osteoarthritis. However, the experts advise discontinuing them if you don’t notice any relief within six months. Learn about the use of these and other supplements in Arthritis Today’s Supplement Guide.
19. Glucosamine sulfate, chondroitin and/or diacerein for possible structure-modifying effects. There is some evidence that glucosamine or chondroitin may not only ease symptoms but may slow or halt cartilage breakdown in osteoarthritis. Similar effects have been seen with the osteoarthritis medication diacerein. (Diacerein is not approved in the U.S.)
20. Opioid and narcotic analgesics. The use of weak opioids and narcotic analgesics can be considered for patients who cannot tolerate other medications or for whom other medications are not effective, according to recommendations. Stronger opioids should be used only for the management of severe pain in “exceptional circumstances.” For information on narcotic analgesics, read Arthritis Today’s Drug Guide.
Surgery
21. Joint replacement surgery. When symptoms of knee or hip OA are not controlled with drug and non-drug treatments, replacing the joint with a prosthesis is often effective. Learn more about the benefits of joint replacement surgery for older people with osteoarthritis.
22. Unicompartmental knee replacement. Approximately 30 percent of people with knee osteoarthritis have disease that is largely restricted to one area of the joint. In these cases, unicompartmental knee replacement (also called partial knee replacement) may offer the same improvement and function as total knee replacement but with less trauma and better range of motion. Learn how to prepare for joint surgery.
23. Osteotomy and joint-preserving surgery. For young, active people with hip or knee osteoarthritis, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement by years.
24. Joint lavage and arthroscopic debridement. The roles of joint lavage (flushing the joint with a sterile saline solution) and arthroscopic debridement (the surgical removal of tissue fragments from the joint) are controversial. Some studies have shown short-term relief; however, a 2008 Cochrane Review by the Cochrane Collaboration – an international not-for-profit organization, providing up-to-date information about the effects of health care – shows that in people with osteoarthritis arthroscopic debridement probably does not improve pain or ability to function compared to placebo (sham surgery).
25. Joint fusion when replacement has failed. When knee replacement fails, joint fusion (a procedure in which the bones that form the joint are surgically prepared and then held in place with screws, pins or plates until they fuse into a single rigid unit) can be considered a salvage procedure.

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