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Looking to the East: Arthritis Studies and Possible Prevention In the United States alone, an estimated 20.7 million people are affected by osteoarthritis (OA), the most common form of arthritis. Furthermore, nearly all people over 75 years of age have OA in at least one joint. The joints most commonly affected are the hips, knees, fingers, feet and spine. Chinese Hips Less Susceptible to Osteoarthritis A recent study led by Dr. Michael Nevitt of the University of California, San Francisco, indicates that rates of hip osteoarthritis are significantly lower in elderly Chinese people than in their American counterparts. In fact, the presence of the condition is eighty to ninety percent lower in China than in America, something that has researchers discussing genetics, lifestyle and obesity rates in search of possible reasons for the difference. The study examined 1,506 residents of Beijing, all over age sixty. As part of the study, participants answered questions about hip pain and underwent hip x-rays. The data gathered from this group were then compared to rates of hip osteoarthritis in white Americans. The results were reported in the July 2002 issue of Arthritis and Rheumatism. Rates of hip osteoarthritis were remarkably lower amongst the Chinese participants, although the incidence of knee osteoarthritis was close to American rates. Genetics and lifestyle Genetics and lifestyle would seem to be the most likely causes of the enormous difference in hip osteoarthritis rates. One theory speculates that how the two groups use their hips explains the research results. The Chinese traditionally squat more than they sit when relaxing or at work. Regular squatting demands a range of motion from the hip that is much greater than sitting. These mobility demands may stimulate cartilage regeneration. As an example of the importance of squatting in China, researchers pointed to traditional Chinese toilets where, unlike Western toilets, individuals must squat, rather than sit, to relieve themselves. While lifestyle may indeed play a role, it should be noted that Chinese-Americans also display lower rates of hip osteoarthritis. Squatting, as a relaxing or work position, is not as common among Chinese Americans, who tend to sit. This suggests that genetics may influence the numbers more than lifestyle. Another possible explanation is obesity. The Chinese population does not have the high obesity rates associated with the American diet and lifestyle. Extra weight places stress on the weight-bearing joints, especially the hips and knees, increasing the risk of osteoarthritis. Why obesity should dramatically increase American rates of osteoarthritis in the hips when compared to Chinese rates, while rates of knee osteoarthritis remain the same, remains a mystery. Hip anatomy differences may also explain why the Chinese develop hip osteoarthritis so infrequently. Levels of physical activity, diet and many other considerations must be taken into account. A combination of several factors may explain the lower Chinese rate for hip OA. Further research should uncover how these factors interact. Tai Chi: Can It Prevent OA? Tai chi is a form of Chinese exercise developed over 600 years ago. It consists of a series of gentle, graceful movements performed slowly and with great concentration. The Chinese believe tai chi strengthens the body, mind and spirit, and that it allows the body's qi or chi (pronounced chee) to flow freely. Qi is the body's vital energy: according to traditional Chinese medicine, free-flowing qi is essential to good health. Western medical science has never confirmed the existence of qi to its own satisfaction, but many doctors recommend tai chi as an alternative to high-impact, strenuous exercise. Tai chi developed out of the Chinese martial arts tradition and while some forms of tai chi have retained this heritage, most who practice it do so purely for exercise. The slowness of tai chi movements reduces the chances of injury, and makes it easy to learn. The Chinese hold that tai chi is preventive medicine, and there seems to be no reason to doubt this. After all, any form of exercise is preventive medicine, and maintaining a healthy body reduces the risk of a number of ailments. Tai chi proponents claim that the exercises slow the progression of osteoarthritis. Studies of the benefits of tai chi have proven somewhat inconclusive. Most tests have been unable to prove or disprove this claim. Most results indicate that, if nothing else, tai chi does not aggravate osteoarthritis. Light exercise that does not put undue strain on the joints has long been recommended for people with arthritic joints, so tai chi is a viable counterpart to swimming, aquacise and other low-impact activities. Tai chi improves flexibility, balance and muscle tone, all of which are important aspects of an effective osteoarthritis treatment program. In 1996, a fifteen-week-long study revealed that regular tai chi practice improved balance tremendously and reduced the chance of falls by the elderly by 47.5 percent. This may be enough reason for people with osteoarthritis to consider tai chi: a fall can further damage joints already weakened by osteoarthritis. (As a side benefit not related to OA, participants in the same study also had a reduction in blood pressure.) If you're considering tai chi, numerous classes are available throughout the country. Don't fall into the trap of trying to teach yourself from a book or video: seek out a qualified instructor. Explain any joint problems you may have to the instructor before starting the program. Tai chi movements can usually be altered to suit your individual needs. Be aware that five different styles of tai chi are taught: Chen, Hao, Sun, Wu and Yang. Those with arthritis should avoid Chen tai chi because of its high level of motion. Sun tai chi is probably the best for those with knee osteoarthritis, as it does not employ the deep knee bends of the other forms. Resources Arthritis Today. (nd). Tai chi. Retrieved August 16, 2002, from www.arthritis.org/resources/arthritistoday/2000_archives/2000_07_08_taichi.asp. Reuters Health. (2002). Arthritic hips rare among Chinese elderly-study. Retrieved August 16, 2002, from www.healthy.net/asp/templates/news.asp?Id=5363.

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