A Randomized Pilot rTMS Trial for Knee Arthritis Pain and Depression

Inclusion Criteria: * • Age 50 or years older. * Chronic pain as indicated by complaints of pain in one or more body regions for 6 months or more. Participants who meet at least one of the following criteria for Osteoarthritis (OA) * Fulfills the American College of Rheumatology (ACR) criteria for symptomatic knee OA and had radiographic evidence of tibiofemoral or patellofemoral OA (defined as the presence of a definite osteophyte in the tibiofemoral compartment and/or the patellofemoral compartment. * Knee pain for \>- 3 months and on most days of the past month * Patient PROMIS Pain Interference score \>=40 (100 mm VAS); * Access to computer or device for telehealth delivery; * Able to walk without cane or assistance. * Psychological distress expressed as depression: Persistent depressive symptomatology (Beck Depression Inventory)\>20 in two consecutive screenings within 2-3 weeks. * Willingness to complete the 3-month study, including twice-a-week Tai Chi sessions and rTMS, with additional 6 and 12 month follow up * Approval to participate in program by patient's primary care provider or another member of their medical team (e.g. cardiologist). * Ability to pass the Physical Activity Readiness Questionnaire (PAR-Q) administered in the telephone screening. * Internet access \>No contraindications to rTMS Exclusion Criteria: * • Change in psychotropic or pain medication during the past four months. This will minimize the amount of symptom change due to medication alterations. * A current diagnosis of mania, hypomania, unstable bipolar disorder, psychotic disorder or a history of psychosis, as noted in electronic medical record. * Dementia, neurological disease, cancer, cardiovascular disease, metabolic disease, renal disease, liver disease, or other serious medical conditions limiting ability to participate in the Tai Chi or Exercise programs, as determined by primary care physicians. * No current medical conditions that limit ability to participate safely in moderate exercise. * Meets criteria for alcohol or drug dependence within the past three months. * Currently practicing Tai Chi