Musculo-Skeletal Disorders - Polymalagia Arthritis

7/30/2019 Musculo-Skeletal Disorders - Polymalagia Arthritis

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Musculo-Skeletal Disorders - Polymalagia Arthritis byKyle J. Norton

Musculoskeletal disorders (MSDs) is medical condition mostly caused by

work related occupations and working environment, affecting patients'muscles, joints, tendons, ligaments and nerves and developing over time. A

community sample of 73 females and 32 males aged 85 and over underwent

a standardised examination at home. Musculoskeletal pain was reported by

57% of those interviewed. A major restriction ofjoint movement range was

frequent in the shoulder but uncommon in other joints. A shoulder

disorder was found in 27% of subjects, rheumatoid arthritis in 1% and

osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of

subjects, respectively. Disability was frequent: a walking distance of < 500

m was found in 60% and ADL dependency in 40% of the group. Factors

related to one or both of these disability measures included female gender,hip and knee OA, impaired vision, cognitive impairment and

neurological disease(1).

IV. Polymalagia Arthritis

Polymalagia Arthritis is defined as a condition a common inflammatory

rheumatic disease which cause pain, stiffness and tenderness in large

muscles, including muscles shoulders and pelvic girdleas a result of the

presence of a synovitis in proximal joints and periarticular structures,causing musculoskeletal symptoms in PMR.

A. Signs and Symptoms

1. In the study in Assessment and management of polymyalgia rheumatica

in older adults, Dr. Kennedy-Malone LM, and Dr. Enevold GL. at the

University of North Carolina School of Nursing in Greensbor, showed that

Polymyalgia rheumatica (PMR) is a periarticular rheumatic condition

characterized by pain and stiffness, primarily in the neck, shoulders,

hips, and pelvic girdle. Temporal arteritis (TA) orgiant cell arteritis, the

most common primary vasculitis in older adults, is found inapproximately 10% to 30% of people who have PMR. Left untreated, TA

can result in sudden, irreversible blindness. Geriatric nurses need to

familiarize themselves with these disorders to accurately assess and manage

people with them(3).

2. Other symptoms include


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polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in the Spanish

population, showed that he HLA-DRB1 alleles associated with susceptibility

for developing PMR and GCA are different. Whether PMR with low ESR

represents a different clinical subset of the disease should be clarified in a

larger sample of patients. HLA-DRB1 genes might predict the presence of

relapses in PMR, but they do not seem to be indicators of severe disease in

GCA patients(7).

2. Environmental contagious factors

In the review personal and published observations of giant cell (temporal)

arteritis (GCA) or polymyal-gia rheumatica (PMR) with familial or conjugal

aggregation and emphasise on epidemiological, clinical and genetic features

of such cases, showed that familial aggregation of GCA and PMR

accumulated data pointing to a genetic predisposition. However,

environmental contagious factors could have trigger synchronous diseaseonset in up to one-fourth of the cases(8).

3. Giant cell arteritis

Giant cell arteritis (GCA) is an inflammatory vasculopathy that involves

large- and medium-sized arteries and can cause vision loss, stroke and

aneurysms. GCA occurs in people aged >50 years and is more common in

women. A higher incidence of the disease is observed in populations from

Northern European countries. Polymyalgia rheumatica (PMR) is a

periarticular inflammatory process manifesting as pain and stiffness in the

neck, shoulders and pelvic girdle. PMR shares the same pattern of age and

sex distribution as GCA. The pathophysiology of PMR and GCA is not

completely understood, but the two conditions may be related and often

occur concurrently(9)

4. Etc.

B.2. Risk factors

1. Aging

If you are over 50 years of age, you are at increased risk of Polymalagia

Arthritis (PMR). Polymyalgia rheumatica is a rheumatic disease whichmainly affects the elderly, and is seldom diagnosed in patients 50 years of age(10).

2. Diet

In the study to investigate the association of red meat and other specific


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dietary components in predicting the development of inflammatory

polyarthritis, DR. Pattison DJ, and the research team at the University of

Manchester, indicated that high level of red meat consumption may

represent a novel risk factor for inflammatory arthritis or may act as a

marker for a group of persons with an increased risk from other lifestyle

causes(11).

3. Smoking

In the study to examined the influence of smoking on disease outcome at 3

years among patients newly presenting with inflammatory polyarthritis (IP),

indicated that Despite smokers being more likely to develop nodules and to

be RF positive, current smokers did not have higher levels of radiologic

damage, and had fewer swollen joints. We hypothesize that this could be due

to either the effect of cigarette smoking on the inflammatory response or

other factors (e.g., reduced physical activity in smokers) which may limitjoint inflammation and damage(12).

4. Gender

If you are women, you are at increased risk to develop Polymalagia Arthritis

5. Race

Rheumatic diseases are common in China. In the study to clarify prevalence

rates of common rheumatic diseases in China, using the World Health

Organization-International League of Associations for Rheumatology

COPCORD (Community Oriented Program for Control of Rheumatic

Diseases) protocol and those that did not employ this protocol but were

published in recognized journals were identified and analyzed. showed that

the prevalence of rheumatic complaints varied with the locality surveyed.

The prevalence of OA is comparable with that in Western countries but

varies in terms of joint involvement. The prevalence of ankylosing

spondylitis is similar to that in Caucasians. Except in Taiwan, the prevalence

of RA in China is lower than that in developed countries. The prevalence of

hyperuricemia and gout increased after the 1980s, but it remains lower thanthat in developed countries(13).

6. Etc.

C. Complications

1. Visual complications


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There is a report of Four case histories are reported in which patients with

polymyalgia rheumatica (polymyalgia arteritic) developed evidence of

cranial arteritis (in one case two years and in one six months) following

withdrawal of steroid therapy after apparent cure(14).

2. Stroke

Polymyalgia rheumatica (PMR) is a relatively common rheumatic disease,

particularly in the elderly. Vasculitis is associated with PMR and

theoretically makes such patients susceptible to vascular events such as

stroke, according to study of researchers at the Taipei Medical

University(15)

3. Low back pain and MRI-abnormalities

Abnormalities in shoulder and hip joints are most common, but signs of

cervical and lumbar interspinous bursitis might also be found in patientswith PMR(16).

4. Cervical interspinous bursitis

Cervical interspinous bursitis is a likely basis for discomfort in the neck of

patients with PMR. The prominent inflammatory involvement of cervical

bursae supports the hypothesis that PMR is a disorder of prominent

involvement of extra-articular synovial structures. MRI evidence of

interspinous cervical bursitis was found in all patients with PMR, and in

three patients with fibromyalgia, in two with psoriatic spondylitis and one

with cervical osteoarthritis(17).

5. Renal failure

Renal involvement in PMR is extremely rare and very few cases of AA

amyloidosis secondary to PMR have been described in literature. Dr. Javaid

MM, and research team at the King's College Hospital NHS Foundation

Trust, rpeort a case of a case of a patient with history PMR who developed

nephrotic range proteinuria and rapidly deteriorating renal function

secondary to AA amyloidosis within 18 months of the onset of symptoms of

PMR. This case reinforces the association of PMR with secondary AAamyloidosis and highlights the importance of monitoring renal function in

patients with PMR(18).

6. Perforated colonic diverticular disease

Patients with polymyalgia may have perforated colonic diverticular disease

which mimics their rheumatic pathology. In such cases steroid therapy,


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which is the mainstay of polymyalgia therapy, can be detrimental. Primary

and hospital practitioners are encouraged to be vigilant regarding non-

specific gastrointestinal symptoms and consider alternative diagnoses in

those patients whose symptoms do not resolve with standard therapy, as this

can lead to an overall better outcome(19)

7. Metastatic lymphoma

There is a report of A 48-year-old HIV-positive woman presented with

progressive pain and stiffness of both shoulders and hips. She was given the

diagnosis of polymyalgia rheumatica (PMR) due to high erythrocyte

sedimentation rate. However, a 1-week course of prednisolone failed to

improve her symptoms. She later discovered a breast lump of which

histopathological tissue was consistent with a diffuse large B-cell

lymphoma. Whole body bone scan revealed multiple bony metastases(20).

8. Cancer

Patients hospitalized for PMR and GCA had a marginally increased risk of

cancer, with the highest risk noted for the first year after hospitalization.

However, for specific cancers, such as skin cancer and leukaemia, the

increases were still significant for patients diagnosed later than 1 year after

hospitalization(21)

9. Etc.

D. Diagnosis

There is no specific test to diagnose polymyalgia rheumatica. The practice

guideline for general practitioners (GPs) on polymyalgia rheumatica and

temporal arteritis was published in February 2010 by the Dutch College of

General Practitioners. This guideline provides GPs with recommendations

for the diagnosis and treatment of polymyalgia rheumatica. After other

disorders have been excluded, the diagnosis of 'polymyalgia rheumatica' is

made in patients over the age of 50 who have bilateral pain in the neck and

shoulder girdle and/or hip girdle that has lasted for longer than 4 weeks,

morning stiffness that lasts longer than 60 minutes and an ESR > 40 mm inthe first hour(22). Other researchers suggested that Diagnosis of

rheumatologic disorders in the elderly is often complicated by the primary

care clinician's inability to differentiate among similar manifestations of

rheumatologic disorders, the presence of comorbid conditions, and

symptoms attributed simply to aging. A major consequence of the aches and

pains associated with rheumatologic disorders, including polymyalgia


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rheumatica (PMR), is the impedance of activities of daily living, potentially

leading to a loss of independence. PMR is common in the elderly. Often

coexisting with PMR, temporal arteritis can lead to complications, including

blindness, stroke, or cardiac sequelae. Timely detection and appropriate

treatment of PMR in the elderly may improve quality of life, as well as deter

irreversible problems. Patient education also has an important role(23).

If you are suspected to develop Polymalagia Arthritis, after a general

physical exam, including the examination of shoulder motion, or swelling of

the joints in the wrists, hands, etc., certain tests may be necessary

1. Blood test(24)

a. Erythrocyte sedimentation rate (ESR) is the blood test to exam the red

blood cells in a test tube. he higher the ESR value is an indication of

inflammation.

b. C-reactive protein (CRP)

Blood test measures the levels of C-reactive protein (CRP) produced by theliver in response to an injury or infection and people with polymyalgia

rheumatic.

c. Blod test for thrombocytes

Patient with polymyalgia rheumatica have an unusually high number of

thrombocytosis. On the other hand, People with anemic polymyalgia

rheumatica have a lower number of red blood cells than normal.

d. Rheumatoid factor (RF)

RF is an antibody, a protein made by the immune system presented in the

blood of people with rheumatoid arthritis, but not in the blood of people with

polymyalgia rheumatica.

2. Biopsy

Polymyalgia rheumatica is often associated with giant cell arteritis with

biopsy by taking a small sample from the scalp artery in the emporal artery

and examined under a microscope in a laboratory. Patients suspected of

giant cell arteritis or polymyalgia rheumatica are often referred to the

otolaryngologist for temporal artery biopsy. These patients may initially

present to the otolaryngologist with symptoms referable to the head and

neck(25).

3. Etc.

E. Preventions

In conventional medicine, there is no known way to prevent Polymalagia

Arthritis, although progression of the disease usually can be stopped or


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slowed by early, aggressive treatment. Since Polymalagia Arthritis is caused

by inflammation pain, stiffness and tenderness in large muscles, including

muscles shoulders and pelvic girdleas a result of the presence of a synovitis

in proximal joints and periarticular structures. Diet with high in anti

inflammatory and immunity enhancing foods, antioxidants and

phytochemicals may provide protection and reduced risk of the disease.

E.1. The do's and do not's list

1. Reduce intake of saturated and trans fat and increase intake of

omega 3 fatty acids

Although Limited studies have shown that certain dietary fatty acids (ie,

oleic acid and alpha-linolenic acid) reduce biomarkers of inflammation.

Most of the studies with fish oil supplementation have shown null effects,

and conflicting results have been reported with saturated and trans fatty

acids(26). Intake of high amount of saturated fat and trans fay can increase

the production of inflammatory cytokines. Also There is reasonably strongevidence that omega-3 fatty acids may help people with rheumatoid arthritis.

The results of over 13 double-blind, placebo-controlled studies involving a

total of more than 500 people suggest that omega-3 fatty acids may improve

symptoms of rheumatoid arthritis. One of the ways it appears to work is by

decreasing the production of inflammatory chemicals(27).

2. Increase intake of increasing the ratio of (n-3) : (n-6) PUFACoinciding with this increase in the ratio of (n-6) : (n-3) PUFA are increases

in chronic inflammatory diseases such as nonalcoholic fatty liver disease

(NAFLD), cardiovascular disease, obesity, inflammatory bowel disease

(IBD), rheumatoid arthritis, and Alzheimer's disease (AD). By increasing the

ratio of (n-3) : (n-6) PUFA in the Western diet, reductions may be achieved

in the incidence of these chronic inflammatory diseases(28).

2. Increase intake of fruit and vegetable

In a cross-sectional study of 1200 Puerto Rican adults aged 45-75 y, we

assessed FV intake with a food-frequency questionnaire, Dr. Bhupathiraju

SN, and Dr.Tucker KL. at the Tufts University, showed that FV variety, but

not quantity, appears to be important in reducing inflammation. Although

the results are suggestive, larger studies are needed to confirm a possibleassociation with CHD risk score(29).

3. Avoid high glycemic index diets

Other studies suggested that the consumption of high glycemic index diets,

which have low fiber content and are rich in trans fat cause the activation

of the immune system, leading to excessive production ofpro-


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inflammatory mediators and the reduction of the anti-inflammatory ones.

Although the results are controversial, healthy dietary intakes with the

reduction in fat intake (especially trans and saturated fat) and the increase in

fruits, vegetables, and whole grain consumption seem to be associated with

the improvement in subclinical inflammatory condition(30).

4. Reduced intake of pro inflammatory foods, such as sugar, dairy

products, red meat and processed, meat, alcohol, artificial ingredients,

refined products, etc.

5. Increase in take of anti inflammatory foods, such as fresh vegetables

and fruits, seeds and sprouts whole grain, fish, turkey, chicken, legumes, etc.

6. Stop smoking

As smoking are associated with increased of Polymalagia Arthritis.

7. Moderate exercise

Moderate exercise enhances immune function in fighting against

inflammation and increase the blood circulation to provide nutrients to the

body's organs need

8. Etc.

E.2.Foods to prevent Polymalagia Arthritis(PMR)1. Soy

In the study to examine the role of TK activity on the expression of the

inducible nitric oxide (NO) synthase (iNOS), found that TK inhibition by

genistein had no effect on the expression or nuclear translocation of the

transcription factors interferon regulatory factor-1 and nuclear factor-KB,

respectively, both of which have been implicated in transcriptional

regulation of the human iNOS gene. Nuclear run-on analysis demonstrated

that the effect of genistein on iNOS messenger RNA expression was not at

the level of transcription, suggesting that posttranscriptional regulation of

iNOS messenger RNA might be TK dependent. Isoflavones, such asgenistein, are useful tools to dissect regulatory pathways in vitro and in vivo

and may have potential use as novel antiinflammatory therapeutic

agents(31).

2. Green tea

Green tea contains more amount of antioxidants than any drinks or food with


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the same volume, and is the leaves of Camellia sinensis, undergone minimal

oxidation during processing, originated from China. Green tea has been a

precious drink in traditional Chinese culture and used exceptional in

socialization for more than 4000 thousand years. Because of their health

benefits, they have been cultivated for commercial purposes all over the

world.

a. Immune system

a. 1. In the investigation of the immunomodulatory effects of decaffeinated

green tea extract in rain bow of the study of "Immunomodulatory effects of

decaffeinated green tea (Camellia sinensis) on the immune system of

rainbow trout (Oncorhynchus mykiss)" bySheikhzadeh N, Nofouzi K,

Delazar A, Oushani AK.(32), researchers found that showed that

decaffeinated green tea in lower doses of administration could be optimum

to enhance the immunity of rainbow trout(32).

a.2. In the investigation of Green tea and Arthritis of the study of "Green tea

polyphenol epigallocatechin 3-gallate in arthritis" by Ahmed S.,

researcher indicated that although these findings provide scientific evidence

of the anti-rheumatic activity of EGCG, further preclinical studies are

warranted before phase clinical trials could be initiated with confidence for

patients with joint diseases(33).

3. Olive oil

Olive is belongs to the the family Oleaceae, native to the coastal areas of the

eastern Mediterranean Basin and south end of the Caspian Sea. Its fruit, is

also called the olive and the source of olive oil.

a. Olive oil phenolics

In the evaluation of the olive oil phenolics of the Mediterranean diet and its

lower incidence of atherosclerosis, cardiovascular disease, and certain types

of cancer, found that olive oil phenolics have positive effects on certain

physiological parameters, such as plasma lipoproteins, oxidative damage,

inflammatory markers, platelet and cellular function, and antimicrobial

activity, according to "Chemistry and health of olive oil phenolics" by

Cicerale S, Conlan XA, Sinclair AJ, Keast RS.(34)

b. Antioxidants and weight loss

In the analyzing the influence of a Mediterranean dietary pattern on plasma

total antioxidant capacity (TAC) found that Mediterranean diet, especially

rich in virgin olive oil, is associated with higher levels of plasma antioxidant

capacity. Plasma TAC is related to a reduction in body weight after 3 years


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of intervention in a high cardiovascular risk population with a

Mediterranean-style diet rich in virgin olive oil, according to "A 3 years

follow-up of a Mediterranean diet rich in virgin olive oil is associated

with high plasma antioxidant capacity and reduced body weight gain"

by Razquin C, Martinez JA, Martinez-Gonzalez MA, Mitjavila MT, Estruch

R, Marti A.(35)

4. Salmon

a. Antioxidants

In the research of the antioxidant effect of vitamin E after ingestion of

salmon found that that megadoses of vitamin E, far from having pro-

oxidative activity, actually increase the anti-oxidative capacity of the liver,

especially after ingestion of salmon oil, according to "Effects of megadoses

of dietary vitamin E on the antioxidant status of rats fed lard or salmon

oil" by Flader D, Brandsch C, Hirche F, Eder K.(36)

b. Selenium

Salmon contains trace minerals selenium which is essential for the healthy

function of the thyroid and immune system as it increases the antioxidant

defense system by fighting against the forming of free radicals and reduce

the risk of irregular cells growth causes of tumor and cancer, according to

the study of "Selenium in the immune system" by Arthur JR, McKenzie RC,

Beckett GJ.,(37)

c. Omega 3 fatty acids

Omega 3 fatty acids is necessary to maintain the ratio of good and bad

cholesterol, thus reducing the risk of cholesterol inflammation according to

the study of "In vitro fatty acid enrichment of macrophages alters

inflammatory response and net cholesterol accumulation" by Wang S,

Wu D, Lamon-Fava S, Matthan NR, Honda KL, Lichtenstein AH., posted in

PubMed (IV) and forming of free radical in the heart cells, leading to heart

diseases. It also reduces the risk of plaque forming in the arterial wall, thus

also decreasing the risk of stoke, according to the study of "N-3 vs.

saturated fatty acids: effects on the arterial wall" by Sudheendran S,Chang CC, Deckelbaum RJ., posted in PubMed (38).

5. Circuit fruits

Circuit fruit contain high amount of Quercetin which can reduce the risk of

Rheumatoid Arthritis as a result of anti inflammatory and antioxidant effects

a. Anti-Inflammatory


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According to the study of `Antioxidant and Anti-Inflammatory Activities of

Quercetin 7-O--D-Glucopyranoside from the Leaves of Brasenia

schreberi.`by Legault J, Perron T, Mshvildadze V, Girard-Lalancette K,

Perron S, Laprise C, Sirois P, Pichette A. (Source from Laboratory for

Analysis and Separation of Plant Species (LASEVE), Universit du Qubec

Chicoutimi , Chicoutimi, Qubec, Canada.), posted in PubMed,

researchers found that some flavonoids have been reported to possess

beneficial effects in cardiovascular and chronic inflammatory diseases

associated with overproduction of nitric oxide. Quercetin-7-O--D-

glucopyranoside possesses anti-inflammatory activity, inhibiting expression

of inducible nitric oxide synthase and release of nitric oxide by

lipopolysaccharide-stimulated RAW 264.7 macrophages in a dose-

dependent manner. Quercetin-7-O--D-glucopyranoside also inhibited

overexpression of cyclooxygenase-2 and granulocyte macrophage-colony-

stimulating factor.

b. Free radical scavenger

In a study of `Dietary chromones as antioxidant agents-the structural

variable.`by Dias MM, Machado NF, Marques MP. (Source from Research

Unit "Molecular Physical Chemistry", University of Coimbra, Portugal.),

posted in PubMed, researchers found that from the eighteen tested

compounds, three-fisetin, luteolin and quercetin-are shown to act as effective

antiradicals. Consistent structure-activity relationships (SARs) were

established regarding the antioxidant role of this type of chromone-based

system.

6. Turmeric

Turmeric,principal curcuminoid of the popular Indian spice, a rhizomatous

herbaceous perennial plant of the ginger family, Zingiberaceae, native to

tropical South Asia.

a. Anti inflammatory effects

In a systematic review of the literature was to summarize the literature on

the safety and anti-inflammatory activity of curcumin, found that curcumin

has been demonstrated to be safe in six human trials and has demonstratedanti-inflammatory activity. It may exert its anti-inflammatory activity by

inhibition of a number of different molecules that play a role in

inflammation, according to "Safety and anti-inflammatory activity of

curcumin: a component of tumeric (Curcuma longa)" by Chainani-Wu N

(39)

b. Antioxidants


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In the research of a literature search (PubMed) of almost 1500 papers

dealing with curcumin, most from recent years, with ll available abstracts

were read and pproximately 300 full papers were reviewed, found that

curcumin, a component of turmeric, has been shown to be non-toxic, to have

antioxidant activity, and to inhibit such mediators of inflammation as

NFkappaB, cyclooxygenase-2 (COX-2), lipooxygenase (LOX), and

inducible nitric oxide synthase (iNOS). Significant preventive and/or

curative effects have been observed in experimental animal models of a

number of diseases, including arteriosclerosis, cancer, diabetes, respiratory,

hepatic, pancreatic, intestinal and gastric diseases, neurodegenerative and

eye diseases, "Curcumin, an atoxic antioxidant and natural NFkappaB,

cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase

inhibitor: a shield against acute and chronic diseases" by Bengmark S.

(40)

7. Etc.

E.3. Phytochemicals to prevent Polymalagia Arthritis (PMR)

1. Green tea Polyphenols

(-)-epigallocatechin-3-gallate (EGCG), the predominant green tea

polyphenol which mimic its effects, inhibits enzyme activities and signal

transduction pathways that play important roles in inflammation and joint

destruction in arthritis. The use of EGCG as a possible chemopreventive

agent with a potential to inhibit the development of arthritis. Here we review

the biological effects of EGCG in an attempt to understand its pivotal

molecular targets that directly affect the inflammation and joint destruction

process for prevention and/or for the development of new therapeutics for

arthritis in humans(41).

2. Curcumin

In the study to to investigate the anti-inflammatory properties of BDMC33

and elucidate its underlying mechanism action in macrophage cells. showed

that the inflammatory action of BDMC33 on activated macrophage-like

cellular systems, which could be used as a future therapeutic agent in themanagement of chronic inflammatory diseases(42)

3. Resveratrol

Resveratrol (RES), a well-known antioxidant and anti-inflammatory

compound, is abundant in red wine and exerts numerous pharmacological

effects, including hepatoprotection and cadioprotection(43)


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4. Boswellic acid

Gum-resin extracts of Boswellia serrata have been traditionally used in folk

medicine for centuries to treat various chronic inflammatory diseases. The

resinous part of Boswellia serrata possesses monoterpenes, diterpenes,

triterpenes, tetracyclic triterpenic acids and four major pentacyclic

triterpenic acids i.e. -boswellic acid, acetyl--boswellic acid, 11-keto--

boswellic acid and acetyl-11-keto--boswellic acid, responsible for

inhibition of pro-inflammatory enzymes(44).

5. Cucurbitacins

In the observations on the analgesic effects of WEDC by investigating its

actions using the hot plate test and zymosan-induced writhing test in mice,

as well as zymosan-induced arthritis in rats evaluating articular

inflammatory pain, cell migration and determination of NO release into thejoint exudate, showed that The oral treatment of the animals with WEDC (1-

10 mg/kg) produced a significant, dose-dependent reduction of articular

incapacitation and abdominal contortions in the writhing test. The same

effect was not observed in the hot plate and rota-rod tests. WEDC also

reduced nitrite release into the zymosan-inflamed joints. In the evaluation of

COX activity, we observed that WEDC was able to selectively inhibit COX-

2 but not COX-1 activity in COS-7 cells. Moreover, WEDC treatment did

not show gastrointestinal toxicity(45).

6. Etc.

F. Treatments

F.1. In conventional medicine perspective

1. Non Medication

The aim of non medical treatment is to control painful myalgia, improve

muscle stiffness, and relieve the symptoms of constitutional features of the

disease.

a. Fasting as part of a naturopathic treatment

Fasting may be formed part of polymyalgia rheumatica (PMR) treat.According to the report of a 67-year-old woman with proven diagnosis of

giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) was admitted

to stationary treatment twice to receive a complex therapy with methods of

natural medicine comprising fasting as its main treatment element(56)

b. Diet therapy


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Leucine-rich milk and whey proteins may be a potential treatment of age

related loss of muscle mass and strength, according to the study of Dr,

Bjrkman MP, and the rerearch team at Helsinki University Central

Hospital(57). Other suggested that exercise and amino acid supplementation

(AAS) together may be effective in enhancing not only muscle strength, but

also combined variables of muscle mass and walking speed and of muscle

mass and strength in sarcopenic women(58).

c. Etc.

2. Medical treatment

2.1. Tocilizumab (TCZ)

Tocilizumab (TCZ) is the first humanized interleukin-6 receptor-inhibiting

monoclonal antibody developed to treat rheumatoid arthritis.

a. In the study to assess the outcomes of 10 patients with relapsing/refractoryGCA, TAK, or PMR treated with tocilizumab (TCZ), found that TCZ led to

clinical and serological improvement in patients with refractory/relapsing

GCA, TAK, or PMR. The demonstration of persistent large-vessel vasculitis

at autopsy of one patient who had shown substantial response requires close

scrutiny in larger studies(59).

Other researchers in the study of ffficacy and safety of tocilizumab (TCZ) in

patients with systemic juvenile idiopathic arthritis (SJIA): tender 52-week

data indicated that TENDER 1-year results demonstrate that TCZ is highly

effective and generally well tolerated in pts with sJIA(60).

b. Side Effects are not limit to

b.1. Dizziness

b.2. Headache

b.3. Allergic effects, such as rash; hives; itching; difficulty breathing, etc.

b.4. Skin changes

b.5. Tiredness or weakness

b.6. Etc.

2.2. Corticosteroids [CS] and nonsteroidal antiinflammatory drugs

[NSAIDs])

2.2.1.. Corticosteroids, a drug, a common presentation in primary care, and

non-selective non-steroidal anti-inflammatory drugs (sometimes also

referred to as traditional NSAIDs or tNSAIDs) and selective cyclo-


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pain and swollen, treat circulation issues, reduce cholesterol, etc.

In the investigation of the effect of a daily application of 6g Kytta-Salbe f (3

x 2 g) over a 3 week period with patients suffering from painful

osteoarthritis of the knee with the complaints relating to osteoarthritis of the

knee had persisted for 6.5 years found that the comfrey root extract ointment

is well suited for the treatment of osteoarthritis of the knee. Pain is reduced,

mobility of the knee improved and quality of life increased, according to

"Efficacy of a comfrey root (Symphyti offic. radix) extract ointment in

the treatment of patients with painful osteoarthritis of the knee: results

of a double-blind, randomised, bicenter, placebo-controlled trial" by

Grube B, Grnwald J, Krug L, Staiger C.(46)

2. Devil's claw

Devil's claw also known as wood spider, is a plant of genus Harpagophytum

in the family of Pedaliaceae, native to South Africa.The plant has been usedas herb in traditional and herbal medicine to treat fever, rheumatoid arthritis,

skin, gallbladder, pancreas, stomach and kidneys conditions, etc.

1. Antiinflammatory effects

In the investigation of Harpagophytum procumbens (Hp) and it effect on

inflammatory and degenerative disease, found that standardized ethanol Hp

extract from Harpagophytum procumbensinhibits induction of pro-

inflammatory gene expression, possibly by blocking the AP-1 pathway. This

is novel evidence of a possible mechanism of action of this antiinflammatory

drug, according to "Molecular Targets of the AntiinflammatoryHarpagophytum procumbens (Devil's claw): Inhibition of TNF and

COX-2 Gene Expression by Preventing Activation of AP-1." by Fiebich

BL, Muoz E, Rose T, Weiss G, McGregor GP.(47)

2. Osteoarthritis

a. In the observation of Harpagophytum procumbens and it effects on

chronic inflammatory conditions such as Osteoarthritis found that Devil's

Claw appeared effective in the reduction of the main clinical symptom of

pain. The assessment of safety is limited by the small populations generally

evaluated in the clinical studies. From the current data, Devil's Claw appearsto be associated with minor risk (relative to NSAIDs), but further long-term

assessment is required, according to the study of "Devil's Claw

(Harpagophytum procumbens) as a treatment for osteoarthritis: a

review of efficacy and safety" by Brien S, Lewith GT, McGregor G.(48)

b. In the study of Devil's Claw (Harpagophytum procumbens) and it effects

on osteoarthritis found that fourteen studies were identified: eight


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observational studies; 2 comparator trials (1 open, the other randomized to

assess clinical effectiveness); and 4 double-blinded, placebo-controlled,

randomized controlled trials to assess efficacy. Many of the published trials

lacked certain important methodological quality criteria. However, the data

from the higher quality studies suggest that Devil's Claw appeared effective

in the reduction of the main clinical symptom of pain, according to the study

of "Devil's Claw (Harpagophytum procumbens) as a treatment for

osteoarthritis: a review of efficacy and safety" by Brien S, Lewith GT,

McGregor G.(49)

4. Degenerative diseases of the musculoskeletal system

Extracts of the secondary tubers of Devil's Claw (Harpagophytum

procumbens) and it degenerative painful rheumatism effects found that

Pharmacological experiments have shown analgesic, antiphlogistic and

antiinflammatory actions. Most important constituents are iridoidglycosides, which are supposed to contribute mainly to the observed effects.

However, the entire extract has to be considered as active ingredient,

according to"[Therapy of degenerative diseases of the musculoskeletal

system with South African devil's claw (Harpagophytum procumbens

DC)].[Article in German]" by Wegener T.(50)

5. Arthrosis of hip or knee

In observation of Preparations made from the secondary tubers of Devil's

claw (Harpagophytum procumbens) and it effects on rheumatic diseases

(arthrosis and low back pain) found that a continuous improvement in

typical clinical findings such as 45.5% for pain on palpation, 35% for

limitation of mobility and 25.4% for joint crepitus. Only two cases of

possible adverse drug reactions were reported (dyspeptic complaints and a

sensation of fullness), according to "Treatment of patients with arthrosis

of hip or knee with an aqueous extract of devil's claw (Harpagophytum

procumbens DC.)" by Wegener T, Lpke NP.(51)

6. Low back pain

In the analyzing Harpagophytum procumbens and it osteoarthritis and lowback pain effects found that the use of an aqueous extract of Harpagophytum

procumbens at 60 mg harpagoside being non-inferior to 12.5 mg rofecoxib

per day for chronic non-specific low-back pain (NSLBP) in the short term.

Strong evidence exists for the use of an aqueous Harpagophytum extract at a

daily dose equivalent of 50 mg harpagoside in the treatment of acute

exacerbations of chronic NSLBP., according to the study of


19/22

"Harpgophytum procumbens for osteoarthritis and low back pain: a

systematic review" by Gagnier JJ, Chrubasik S, Manheimer E.(52)

3. Valerian

Valerian is a perennial flowering plant, in the genus Valeriana, belonging to

the family Valerianaceae, native to Europe and parts of Asia. The herb has

been used as a sedative and relaxing agent and to treat the liver, the urinary

tract, the digestive tract problem, nerve conditions, etc.

In the classification of V. officinalis extracts and its antioxidant properties

against iron in hippocampal neurons in vitro, found that The effect of V.

officinalis in deoxyribose degradation and reactive oxygen species (ROS)

production was also investigated. In brain homogenates, V. officinalis

inhibited thiobarbituric acid reactive substances induced by all pro-oxidants

tested in a concentration dependent manner. Similarly, V. officinalis caused

a significant decrease on the LPO in cerebral cortex and in deoxyribosedegradation. QA-induced ROS production in cortical slices was also

significantly reduced by V. officinalis, according to "In vitro antioxidant

activity of Valeriana officinalis against different neurotoxic agents" by

Sudati JH, Fachinetto R, Pereira RP, Boligon AA, Athayde ML, Soares FA,

de Vargas Barbosa NB, Rocha JB.(53). The herb valerian may be useful as a

mild sleep aid in clinical populations, such as persons with rheumatoid

arthritis, according to the research team at the University of Virginia, School

of Nursing(54)

E.2. In traditional Chinese medicine perspective

The aims of the Chinese herbal medicine formula is to enhance the immune

system and promote kidney's Qi.

Du huo Ji Sheng Tang (DHJST)

a. In the study of Action Mechanisms of Du-Huo-Ji-Sheng-Tang on

Cartilage Degradation in a Rabbit Model of Osteoarthritis, Dr. Chao-Wei

Chen and the research team at the Shanghai Municipal Hospital of

Traditional Chinese Medicine, showed that at the end of the sixth week after

surgery, there was a significantly histological degeneration in the controlgroup compared with the normal group. In the control group, the mean score

for histological degeneration were further increases at 10th week, and there

was a significantly lower mean score for histological degeneration in the

DHJST group compared with the control group. To research the potential

mechanism, the expression level of VEGF and HIF-1 were detected. The

expression of VEGF mRNA and HIF-1 mRNA are low in normal group,


20/22

while the activities increase gradually in the control group. However,

compared to that of the same time point model group, activity of VEGF and

HIF-1 decreased significantly in DHJST group. In conclusion, DHJST

exerts significant therapeutic effect on osteoarthritis rabbits, and

mechanisms are associated with inhibition of VEGF and HIF-1

expression(57).

b. Ingredients

1. Du Huo (Radix Angelicae Pubescentis)

2. Chuan Xiong (Rhizoma Chuanxiong)

3. Sang Ji Sheng (Herba Taxilli)

4. Ren Shen (Radix et Rhizoma Ginseng)

5. Du Zhong (Cortex Eucommiae)

6. Gan Cao (Rx et Rz Glycyrrhizae)

7. Niu Xi (Radix Cyathulae)8. Dang Gui (Radix Angelicae Sinensis)

9. Xi Xin (Radix et Rhizoma Asari)

10. Bai Shao (Radix Paeoniae Alba)

11. Qin Jiao (Radix Gentianae Macrophyllae)

12. Sheng Di Huang (Radix Rehmanniae)

13. Fu Ling (Poriae)

14. Gui Xin (Cortex Rasus Cinnamomi)

15. Fang Feng (Radix Saposhnikoviae)(56)

Natural Remedy For Arthritis, Gout, And Rheumatism

Discover An Amazing, All-natural System That

Literally Stops Arthritis, Gout, And Rheumatism In As Little As 7 Days.

For common types of diseases of Ages of 50+, please visit

http://medicaladvisorjournals.blogspot.ca/p/better-of-living-health-50-

over.html

Sources(1) http://www.ncbi.nlm.nih.gov/pubmed/14528524

(2) http://health.yahoo.net/channel/musculoskeletal-disorders.html

(3) http://www.ncbi.nlm.nih.gov/pubmed/11410767



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Musculo-Skeletal Disorders - Polymalagia Arthritis

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