Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Tai Chi for Knee OA Pain Management: a Mechanistic Study

Eligibility criteria:
Inclusion Criteria:

          1. Postmenopausal women.

          2. WOMAC pain score ≥ 50 on at least 1 of the 5 questions in pain subscale (range of 0 to
             100, with higher scores indicating greater pain.

          3. English literacy.

          4. Able to undergo an MRI scan

          5. Diagnosed Have the following symptoms associated with knee OA based on American
             College of Rheumatology clinical classification criteria for osteoarthritis (Peat
             2006). Pain in the knee. Need to at least 3 of the following: over 50 years of age,
             less than 30 minutes of morning stiffness, crepitus on active motion, bony tenderness,
             bony enlargement, or no palpable warmth of synovium.

        Exclusion Criteria:

          1. Prior experience with mind-body practice (e.g. TC, Qi Gong, yoga, or acupuncture) or
             physical therapy programs for knee OA within the past 3 months.

          2. Severe medical limitations (i.e., dementia, symptomatic heart or vascular disease, or
             recent stroke) precluding full participation.

          3. Medical/neurologic or other systemic diseases affecting the musculoskeletal systems
             (i.e. polio/Parkinson's/multiple sclerosis, etc. in addition to cerebral vascular
             accident or stroke) and diabetes with peripheral neuropathy affecting their
             sensory/balance.

          4. Intra-articular steroid injection or reconstructive surgery on most severely affected
             knee in the past three months.

          5. Intra-articular hyaluronic acid injections on most severely affected knee in the past
             six months.

          6. Inability to walk without an assistive device.
Female
No healthy subjects accepted to join the trial.



Eligibility (NLI label): Entailment