Physiotherapy is a primary management strategy for OA that has been shown to produce moderate benefits on pain and function. Tai Chi is a traditional Chinese martial art used in China for centuries, which combines meditation with movement and breathing, with benefits for the mind and body. In one study, 204 patients were randomized to twice weekly Tai Chi for 12 wks vs physio as per conventional guidelines for 6 wks followed by home exercise for 6 wks. The primary outcome was WOMAC pain score at 12, 24 and 48 wks. Results showed no statistical difference between groups in terms of pain and physical function. Tai Chi showed a trend toward improved depression and quality of life compared with physio. This study provides good evidence that Tai Chi is a reasonable alternative to physiotherapy for patients who have not done well with physio or who may prefer the mind-body benefits of Tai Chi.
Next was an RCT of knee joint distraction vs high tibial osteotomy. Given increasing rates of knee OA among younger people, there is a need for joint saving treatments to delay TKR and reduce the likelihood of revision surgeries. Knee joint distraction is a minimally invasive surgical procedure with a distraction frame providing 6 to 8 weeks of absence of mechanical stress on the cartilage and bone turnover. A previous open trial showed a beneficial effect. This was a multicentre trial from the Netherlands, with roughly 100 patients randomized 2 to 1 to high tibial osteotomy vs joint distraction. Patients all had medial compartment OA, were less than 65 years old, and had BMI less than 35. They found comparable clinical results in both groups in the first year. Radiographic outcomes were improved with distraction as measured by the increase in cartilage and joint space width. These results suggest that knee joint distraction may be an option to postpone the need for a knee prosthesis and potentially for revision surgery.
It is an interesting new procedure with a few more posters to be presented here at EULAR. Stay tuned for more research!
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.View Full Bio