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Thursday, 29 January 2015

(Preview) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Rheumatoid Arthritis(RA)

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Rheumatoid Arthritis(RA)

Rheumatoid Arthritis is a chronic disorder as a result of inflammation, affecting mostly the flexible (synovial) joints and tissues and organs in the body. The disease affects more women than in men and generally occurs after the ages of 40, causing diminished quality of life of many elders.


A. Signs and Symptoms
1. The feet 

Pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle(2).

2. The Joints
In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function(3).


3. The Muscle strength
According toJyväskylä Central Hospital, in RA,
women reported greater disability than men both in the  Decreased activity and pain, muscle strength has a major impact on disability especially in female rheumatoid patients(4).

4. Rheumatoid nodules 
Rheumatoid nodules affect the joints of patients and commonly found under the skin as a result of microchimerism(5).


5. Conjunctival nodule
Although is rare in patients with rheumatoid arthritis. There is a 49-year-old woman with seropositive rheumatoid arthritis, who was being treated only with oral steroids and hydroxychloroquine, developed diffuse anterior scleritis in the right eye(6).


6. Morning stiffness
Morning stiffness,
appeared to reflect functional disability and pain more than traditional markers of inflammation such as joint counts and ESR in patients with early RA. is a very common symptoms of patients in early rheumatoid arthritis(7).

7. Quality of life
7.1. Physical disability

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that causes deformity of the joints and physical disability(7a). Disease activity scores (DASs)  showed significant correlations with physical HRQoL(8).

7.2. Psychiatric disorder 
According to Tuen Mun Hospital,  In patients with rheumatoid arthritis (RA), 
 23.5% patients diagnosed with a psychiatric disorder, including depressive disorders and anxiety disorders(9).
8. Etc.


B. Causes and Risk Factors
B.1. CausesT

he probable causes of  Rheumatoid Arthritis may include the following
1. Abnormal autoimmune response
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by the progresses ofdestruction of cartilage and bone. According to
Osaka University, Abnormal networks of immune response-related molecules in bone marrow cells from patients with rheumatoid arthritis  is correlated to pathologically involved in RA(10).

2. Abnormal lipid profile
 
Rheumatoid arthritis (RA) has shown to associate between inflammation status/autoimmune antibodies and plasma lipid. According to People's Hospital of Peking University, patients with increased inflammation markers and autoimmune antibodies are susceptible to elevation of abnormal lipid profile(11).

3. Genetic susceptibility

Mutatution of gene TAGAP(12) and CCR5(both involved immune defense)((13) have showed to associate with several diseases, including RA.


4. Inflammatory and infectious connections
Chronic inflammation of the joint can result of thickens the synovium, affecting the cartilage and bone within the joint.

Rheumatoid arthritis (RA) is a associated with the T helper 17 cells (Th17)  in several chronic inflammatory states(14). Periodontal infection (P. gingivalis) may also carries a unique risk for development of autoimmune antibodies in patients withRA(15).
5. Etc.

Risk factors
1. Age

The risk of rheumatoid Arthritis increases with age, especially  in the elderly aged 65 and over(16). 


2. Gender, body mass index

If  you are women and overweight, you are at increased risk to develop Rheumatoid Arthritis. According to the
study of Korean RA population(16)(17).

3. Race
Several genes/loci are consistently associated with rheumatoid arthritis (RA) in European and Asian populations(18).


4. Smoking

Smoking is considered a risk facor in contribution to early RAand  a more active disease,
according to a large cohort of patients with early rheumatoid arthritis (RA)(19).

5. Family history

Mothers confer susceptibility to RA on their offspring more often than fathers, the risk of rheumatoid arthritis (RA) in the first degree relatives study found(20).

6. Vaccines
Certain vaccines may causes Rheumatoid Arthritis. According to approximately 1 million Kaiser Permanente Northern California members ages 15-59 years from 1997 through 1999, there is a possible association between RA and influenza vaccine(21).


7. Other risk factors

Other risk factors may include
a. Changes in the female hormone such as in pregnancy, breastfeeding and 

b. Use of the oral contraceptive (OC) pill appear to have a role. Of the 
c. Traditional lifestyle exposures
d. Occupation probably has a minor influence
e. Diets high in caffeine, low in antioxidants 
f. Infection due to exposure to environment toxins, 
Epstein-Barr virus (EBV)(22).
8. Etc.

C. Complications
1. Osteoporosis

Medication taken such as Glucocorticoid of patients with RA can induce, osteopprosis, a condition that weakens your bones and makes them more prone to fracture. According to the Pusan National University School of Medicine, the prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects(23). 

2. Carpal tunnel syndrome
Carpal tunnel syndrome is a condition of pressure on the nerve in the wrist that supplies feeling and movement to parts of the hand. There is a report of a case of carpal tunnel syndrome caused by volar dislocation of the lunate in a patient with rheumatoid arthritis(24).


3. Heart involvement
According to the University of Palermo, RA is shown a significant involvement of certain heart diseases, including  pericardial effusion, 
valvular nodules, tricuspidal valve insufficiency, aortic valve stenosis, mitral valve insufficiency, aortic valve insufficiency, combined valvular alterations, mitral valve thickening and/or calcification, aortic valve thickening and/or calcification, valvular thickening and/or calcification, and mitral valve prolapse (25).

4.  Interstitial lung disease (ILD)
People with rheumatoid arthritis have an increased risk of interstitial lung disease (ILD). According to study,
High doses of corticosteroids and disease modifying antirheumatic drugs showed to improve patients of RA and interstitial lung disease (ILD)(26).

5. Dry eye syndrome and Sjogren’s syndrome 

 Proper management are necessary for the development of dry eye syndrome and secondary Sjogren’s syndrome in patients with rheumatoid arthritis(27).

6. Cerebral vasculitis

Eventhough, it is rare, but there is a report of case of the developed systemic vasculit in a 64-year-old woman was suffering from rheumatoid arthritis since the age of 57(28).

7. Etc.

D.The do’s and  do not’s list
1. Reduce intake of saturated and trans fat and increase intake of omega 3 fatty acids

Limited studies have shown that certain dietary fatty acids (ie, oleic acid and alpha-linolenic acid) reduce biomarkers of inflammation.

a. Fish oil supplementation have shown null effects(29). 
b. Intake of high amount of saturated and trans fat can increase the production of inflammatory cytokines. but conflicting results have been reported(29)
c. Omega-3 fatty acids may help people with rheumatoid arthritis(29a). 

2. Increase intake of fruit and vegetable 
According to Tufts University, showed that
fruit and vegetable variety, but not quantity, may reduce  inflammation(30).

3. Avoid high glycemic index diets 

Consumption of high glycemic index diets, which have low fiber content and rich in trans fat may contribute to excessive production of pro-inflammatory mediators and the reduction of the anti-inflammatory ones. Although the results are controversial, healthy dietary intakes with the reduction in fat intake(31).

4. Lost weight
If you are overweight or obsisty, reduced weight is associated to reduced risk of  rheumatoid Arthritis (RA). If you are women and overweight or obesity, you are at highest risk to develop rheumatoid Arthritis (RA).


5. Reduced intake of pro inflammatory foods, such as sugar, dairy products, red meat and processed, meat, alcohol, artificial ingredients, refined products, etc.


6. Increase in take of anti inflammatory foods, such as fresh vegetables and fruits, seeds and sprouts whole grain, fish, turkey, chicken, legumes, etc.


7. Stop smoking
As smoking are associated with increased of Rheumatoid Arthritis.


8.  If you are in occupation of increased risk of development of Rheumatoid Arthritis(RA), you should take all precaution if necessary.


9. Moderate exercise
Moderate exercise enhances immune function in fighting against inflammation and increase the blood circulation to provide nutrients to the body’s organs needed
10. Etc.

E. The Diet
1. Organic Soy 

Intake of soy protein can enhance the protective effect against Rheumatoid Arthritis. According to study administration of soy protein significantly suppressed the progression of collagen II-induced arthritis and inhibited the production of tumor necrosis factor-alpha, interleukin6, leptin, and adiponectin in rats(32). 


2.  Green tea
EGCG in experimental animals, showed to exhibit anti-rheumatic activity in patient of RA(33).


3. Olive oil
According to study of a case control study of Rheumatoid Arthritis (RA) 168 cases and 137 controls, an increase in olive oil consumption by two times per week, resulted in a reduced Relative Risk (RR) for development of RA(34).


4. Salmon 
Salmon contains high amount Omega 3 fatty acid of the can decrease the risk of RA(35).


5.  Circuit fruits
Circuit fruits containing high amount of Quercetin may reduce the risk of Rheumatoid Arthritis as a result of anti inflammatory and antioxidant effects.
5.1. Anti-Inflammatory
a. According to study  some flavonoids hmay possess beneficial effects in cardiovascular and chronic inflammatory diseases associated with overproduction of nitric oxide. 

b. Quercetin-7-O-β-D-glucopyranoside possesses anti-inflammatory activity, inhibiting expression of inducible nitric oxide.

5.2. 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.), quercetin are shown to act as effective antiradicals.


6. Red wine and skin and of grape
Resveratrol found abundantly in red wine and the skin and seed of grape showed to exhibit its inflammatory effects in significantly decreased cartilage destruction(36).


7. Turmeric
Turmeric (Curcuma longa L., Zingiberaceae) rhizomes contain curcuminoids and the less well-studied essential oils. According to University of Arizona, Crude or refined TEO extracts dramatically inhibited joint swelling  in female rats. However, this anti-arthritic effect was accompanied by significant morbidity and mortality(37).


8. Ginger 
Ginger (Zingiber officinale) supplements are being promoted for arthritis treatment in western societies on the basis of ginger’s traditional use as an anti-inflammatory in Chinese and Ayurvedic medicine. According to University of Arizona, crude dichloromethane extract, containning essential oils and more polar compounds, was more efficacious (when normalized to gingerol content) in preventing both joint inflammation and destruction(38).
9. Etc.

F. The Phytochemicals 

1. Curcumin, a phytochemical found abundant in Curcumin is a phytochemical found abundantly in turmeric, its principal curcuminoid is a popular Indian spice,
a. Anti-inflammatory agent
According to the study by Satoskar RR, Shah SJ, Shenoy SG., poated in US National Library of Medicine National Institutes of Health,
curcumin (diferuloyl methane) researchers in model of postoperative inflammation, showed a better anti-inflammatory activity in comparison with phenylbutazone and placebo.

b. Antioxidants
In a study by Mahmoud El-sherbiny, Azza Araffa, Mona Mantawy and Hany M. Hassan (Therapeutic Chemistry Department, National Research Centre – Dokki, Giza, Egypt. Immunology Department, Animal Reproduction Research Institute (ARRI), Giza, Egypt), posted in World Applied Sciences Journal 12 (10): 1832-1838, 2011, researchers, curcumin showed a protective role against cytotoxic, immunosuppressive, oxidative and immunosuppressive profile due to lead acetate exposure.


2. Gingerol
Gingerole, is also known as gingerol, a phytochemical of Flavonoids (polyphenols) found in fresh ginger.
a. Antioxidant and anti-inflammatory effects

[6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol found in Zingiber officinale Rosc. showed a Comparative antioxidant and anti-inflammatory effects(39).

b. Rheumatoid arthritis
The crude dichloromethane extract, contained essential oils and more polar compounds, was more efficacious in protection of joint rheumatoid arthritis(40).


3.  Quercetin
Quercetin, a member of flavonoids, found in fruits, vegetables, leaves and grains inhibits synovial fibroblasts proliferation and pro inflammatory activities involved joint destruction in rheumatoid arthritis (RA)(41).


4. Omega 3 fatty acid
a. Antioxidants
Hexane extract from different parts in several Hypericum species possess considerable antioxidant activity with  highest radical scavenging activity in seed(42).


b. Relieving inflammation
Omega-3PUFA showed to exhibit some protective effect in relieving inflammation, according to study(43).


c. Suppression of inflammatory
 
n-3 LCPUFAs found abundantly in salmon, showed to suppress the inflammatory processes in pregnant women(44).

d. Neonatal immune responses
  Increased intakeily fish showed to intervene pregnancy modifies neonatal immune responses but may not affect markers of infant atopy assessed at 6 mo of age(45).


5. Epigallocatechin-3-gallate (EGCG) and theaflavin-3,3′-digallate (TFDG)
  Epigallocatechin-3-gallate (EGCG), a
polyphenols in green tea, and theaflavin-3,3′-digallate (TFDG), a black tea polyphenol inhibit osteoclasts through pro infammtory expression and activity(46).

6. Resveratrol

Resveratrol is a phytochemical in the class of Stilbenoids, found abundantly in skins and seed of grape wine, nuts, peanuts, etc.
Resveratrol exhited its
inflammatory effects through inhibited adhesion- and proliferation-stimulating effects(47). The combination of  resveratrol and quercetin, in vitro showed significant antioxidant effect on frozen ram sperm(48).
7. Etc.


G. Antioxidants and  Rheumatoid Arthritis(RA)(49) 

Antioxidants found abundantly in fruits and vegetables can enhance the immune system fighting against forming of free radicals causes of irregular cell growth and foreign invasion of inflammation and infection.
1. Vitamin C
Vitamin C beside is vital in restoring the antioxidants vitamin E in scavenging the free radicals before they can become harmful to the body, it also protects the capillaries from breaking off in triggering an inflammatory reaction. Other study found that vitamin C also reduces the risk of cartilage loss and developing knee pain. 


2. Vitamin E 

Accoring to genetically altered mice study, diet included fish oil plus vitamin E significantly reduce the levels of inflammation by analyzing the pro and anti-inflammatory cytokines in the blood serum.

3. Glucosamine
Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, is a precursor for glycosaminoglycans formed a major component of joint cartilage. According to study, supplemental glucosamine may help to prevent cartilage degeneration and treat arthritis.


d. DLPA (dl- phenylalanine)
DLPA, a mixture of D-Phenylalanine and L-Phenylalanine and a nutritional supplement amino acid effectively reduce arthritis pain and joint inflammation in many patients.


e. Glucosamine and Methylsulfonylmethane
According to a double-blind, placebo-controlled study,  administration of combined
MSM and glucosamine after 12 weeks, improves arthritis symptoms in comparison to placebo.
f. Etc.


H. Treatments
H.1.In conventional medicine perspective

The aim of treatment is to stop the progression and relieve the symptoms of the disease.
1.  Non Medication 
a. Physical therapy 
Physical therapy (PT) delivered by specially trained therapists for 6 week home based of moderate to severe rheumatoid arthritis (RA), improved short and long term outcomes following treatment(50). 

b. Hydrotherapy 
Hydrotherapy combined warm water immersion and exercise treatment on RA, according to University Health Network, improved symptoms physically and emotionally, including alleviated pain , improved joint tenderness and in knee range of movement (women only)(51).


c. Relaxation therapy and biofeedback training
Relaxation and temperature biofeedback training as an adjunctive therapy, revealed significant and positive changes following treatment in
physical functioning such as pain, tension, and sleep patterns for patients with RA(52).

d. Low level laser therapy
Low level laser therapy (LLLT) has shown a beneficary short term relief of pain and morning stiffness in RA  patients with a few side effects(54).


e. Occupational therapy

Review of literature occupational therapy in stdies data base in 6 controlled studies had a high methodological quality, showed a porsitie effect on joint protection but limit effect on improving functional ability(55).

f. Prosorba column apheresis therapy (PCT)
Approval of Prosorba column apheresis therapy (PCT) for rheumatoid arthritis (RA) in 1999 to use only in some medical centers and generally is used only for very severe rheumatoid arthritis.  PCT is a relatively underutilized choice for the management of active, aggressive RA, according to some researchers(56).
g. Etc.


2. Medication, surgery and others
Medication or combined medication are used to stop the progression and relieve the symptoms of the disease
In the study of  2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis, Dr. da Mota LM, and scientists at the Universidade de Brasília suggested that (57)
1) The therapeutic decision should be shared with the patient;
2) Immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission;
3) Treatment should be conducted by a rheumatologist;
4) The initial treatment includes synthetic DMARDs;
5) Methotrexate is the drug of choice;
6) Patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs;
7) Exceptionally, biologic DMARDs can be considered earlier;
8) Anti-TNF agents are preferentially recommended as the initial biologic therapy; 

9) after therapeutic failure of a first biologic DMARD, other biologics can be used;
10) Cyclophosphamide and azathioprine can be used in severe extra-articular manifestations;
11) Oral corticoid is recommended at low doses and for short periods of time;
12) Non-steroidal anti-inflammatory drugs should always be prescribed in association with a DMARD; 

13) Clinical assessments should be performed on a monthly basis at the beginning of treatment;
14) Physical therapy, rehabilitation, and occupational therapy are indicated;
15) Surgical treatment is recommended to correct sequelae;
16) Alternative therapy does not replace traditional therapy;
17) Family planning is recommended;
18) The active search and management of comorbidities are recommended;
19) The patient’s vaccination status should be recorded and updated;
20) Endemic-epidemic transmissible diseases should be investigated and treated.

E.2. In herbal medicine perspective
1. Organic Soy 

Intake of soy protein can enhance the protective effect against Rheumatoid Arthritis. In the study to evaluate preventive and therapeutic effects of Soy protein has shown to significantly suppress the progression of collagen II-induced arthritis, through its immunomodulatory inhibitor effect(32). 


2.  Green tea
Scientific evidence of the anti-rheumatic activity of EGCG 
 in experimental animals, through its anti vascular inflammation in rheumatoid arthritis(33a) and enhanced immune effects(33).

3. Turmeric
According to the University of Arizona,
administered via intraperitoneal injection of crude or refined TEO extracts inhibited joint swelling (90-100% inhibition) in female rats with streptococcal cell wall (SCW)-induced arthritis(37).

4. Ginger 
Ginger (Zingiber officinale) supplements are being promoted for arthritis treatment in western societies due its effectsagainst  anti-inflammatory activity found in Chinese and Ayurvedic medicine. According to University of Arizona, crude dichloromethane extract, containing essential oils and more polar compounds, was efficacious for prevention both joint inflammation and destruction(38).


5. Alfalfa
Alfalfa,
cultivated all over the world as hay for cattle feeding and used in traditional medicine over thousands of year to treat high cholesterol, asthma, osteoarthritis, rheumatoid arthritis, diabetes, enhance digestive system, bleeding disorder, kidney and urinary tract infection, etc. , is a flowering plant in the genus Medicago, belonging to the family Fabaceae. The leaves, sprouts, and seeds to make medicine has been North Americal aboriginal has used Alfalfa seed as food, such as making bread and mush.
a. Antioxidants
  Dietary protein-xanthophylls (PX) concentrate of alfalfa to turkey diets by University of Life Sciences in Lublin, Skromna 8, 20-704 Lublin, Poland.enhanced TBARS and oxidation-reduction as an antioxidant in the raw meat.


b. Disease of autoimmune

Alhalfa decreased the disease severity, increased survival and life span of the autoimmune-prone MRL-lpr/lpr mice, according to five groups of 12-week-old female mice.

 c. Anti-inflammatory activity
  Alfalfa sprout ethyl acetate extract (ASEA) in mice conducted by College of Life Science, National Taiwan University, Taipei, Taiwan, Republic of China. showed to induce suppression of the production of pro-inflammatory cytokines and alleviate acute inflammatory hazards in mice with inflammatory diseases.


6. Grape Seed Extract
Grape Seed Extract, containing
contains many concentrations, including vitamin E, flavonoids, linoleic acid, oligomeric proanthocyanidins(OPCs), etc. and used in traditional medicine as antioxidant, anti-inflammatory agents and to treat skin wounds with less scarring, allergies, macular degeneration, arthritis, enhance circulation of blood vessels, lower cholesterol, etc., is the commercial extracts from whole grape seeds.
a.  Antioxidant Activity 
Grape seed extract increased antioxidant activity dose-dependently, according to “Total Phenolic Content, Antioxidant Activity and Cross-Cultural Consumer Rejection Threshold in White and Red Wines Functionally Enhanced with Catechin-Rich” by Yoo YJ, Saliba A, Prenzler PD, Ryan DM.(60).

b. Arthritis (CIA)
GSPE dose-dependently suppressed osteoclastogenesis in vitro and significantly reduced hydrogen peroxide production, according to “Grape seed proanthocyanidin extract (GSPE) attenuates collagen-induced arthritis” by Cho ML, Heo YJ, Park MK, Oh HJ, Park JS, Woo YJ, Ju JH, Park SH, Kim HY, Min JK.(61).


7. Ginseng Asia
a. Antioxidant activity
Polysaccharides from the rhizomes of Panax japonicus C.A. Meyer showed the efficacy in
scavenging activity of hydrogen peroxide, 2,2-diphenyl-1-picryl-hydrazyl (DPPH) and free radicals of superoxide anion in vitro(62).

b. Immunological activities
Water-soluble ginseng oligosaccharides (designated as WGOS) promoted  B and T-cell stimulators and enhanced highest immunostimulating effect.(63).


8. Etc.


E.3. In traditional Chinese medicine perspective
According to the article of TCM Differentiation & Treatment for Rheumatic Arthritis & Rheumatoid Arthritis by Sam Shien-Chien Liang, C.A. PH.D, RA is characterized as a type of “bi” syndrome ( Bi-syndrome is a disease characterized by pain, numbness, and dyskinesia(
movement disorders) of the muscle and joints of the limbs), wind “bi”, heat “bi”, cold “bi”, damp “bi”.
E.3.1. Heat “Bi”
1. Symptoms include pain, redness, inflammation, and localized heat sensation in the joints, fever, aversion to wind, thirst, and irritability.
2. Treatment: strengthen spleen, drain dampness, clear heat, detoxify, open channels.
3. Formulas:
a. For redness, swelling, and pain,
fomula includes Cinnamon & Anemarrhena Combination
a.1.(Gui Zhi Shao Yao Zhi Mu Tang) + Stephania & Astragalus Combinationa,2,(Fang Ji Huang Qi Tang) + Cinnamon & Angelica Formula
a.3.(Shang Zhong Xia Tong Yong Tong Feng Tang)
b. For redness, swelling, pain, and dampness
Cinnamon & Anemarrhena Combination (Gui Zhi Shao Yao Zhi Mu Tang) + Ma Huang & Coix
Combination (Ma Xing Yi Gan Tang)
c. For redness ,swelling, pain, aversion to wind, thirst, and irritability
Cinnamon & Anemarrhena Combination (Gui Zhi Shao Yao Zhi Mu Tang) + Ma Huang & Gypsum Combination (Yue Bi Tang) + Stephania & Astragalus Combination
d. For heat, pain, and subdermal red spots
Cinnamon & Anemarrhena Combination (Gui Zhi Shao Yao Zhi Mu Tang) Stephania & Astragalus Combination (Fang Ji Huang Qi Tang) + Tang Kuei & Anemarrhena Combination (Dang Gui Nian Tong Tang)


E.3.2. Wind “Bi”
a. Symptoms include soreness and pain in the joints throughout the body, often bigger joints such as the elbow, knee, and ankle joints, thin white coat, floating rapid or floating slow pulse.
b. Treatment: expel wind, disperse evil, dry dampness, activate blood.
c. Formulas
Cinnamon & Angelica Formula (Shang Zhong Xia Tong Yong Tong Feng Tang) + Stephania & Carthamus Combination (ShuFeng Huo Xue Tang) + Stephania & Astragalus Combination (Fang Ji Huang Qi Tang).


E.3.3. Cold (painful) “Bi”
a. Symptoms include excruciating pain in the joints, immobility, foot swelling, localized pain, no redness and local heat sensation, pain is aggravated by cold and alleviated by warmth, white tongue coat, wiry and tight pulse.
b. Treatment: warm yang, disperse cold, activate blood, dispel wind, dry damp, stop pain, and open channels.
c. Formulas
Wu Tou & Cinnamon Combination (Wu Tou Gui Zhi Tang) + Dang Gui & Astragalus Combination
(Dang Gui Bu Xue Tang) + Clematis & Stephania Combination (Shu Jing Huo Xue Tang).


E.3.4. Damp (stagnant) “Bi”
a. Symptoms include numbness, heavy sensation, and pain in the joints, localized pain and swelling, slow exacerbation, flabby tongue with teethmarks, white greasy tongue coat, soggy or slow pulse.
b. Treatment: tonify mspleen, dry dampness, warm yang, dispel wind, disperse cold, open channel.
c. Formulas
c.1. Ma Huang & Asarum Combination (Ma Huang Fu Zi Xi Xin Tang) + Cinnamon, Hoelen & Atractylodes Combination (Gui Zhi Jia Ling Fu Zhu Tang)
c.2. Coix Combination (Yi Yi Ren Tang) or Chiang-huo & Tu-huo Combination (Qiang Huo Sheng Shi Tang).


E.3.5. Qi & Blood Stagnation “Bi”
a. Symptoms include swollen, painful joints, dull skin, color, dry lips, chest congestion, palpitation,
dark tongue, and choppy pulse.
b. Treatment: activate blood, relieve stagnation, mstop pain, open channels.
c. Formulas
Clematis & Stephania Combination (Shu Jing Huo Xue Tang) or Drive Out Blood Stasis from a Painful Body Decoction (Sheng Tong Zhu Yu Tang) + Stephania & Astragalus Combination (Fang
Ji Huang Qi Tang) + Dang Gui & Anemarrhena Combination (Dang Gui Nian Tong Tang).


E.3.6. Liver & Kidney Deficiency type Wind Cold Damp “Bi”
a. Symptoms include painful joints in the extremities, coldness and sore pain in the low back, numbness and immobility of the lower extremities, pain is aggravated by rainy weathers, thin white and slightly greasy tongue coat, soggy and slow, or deep and thin pulse.
b. Treatment: tonify and nourish liver and kidneys, benefit the blood and qi, dispel wind, disperse cold, dry dampness.
c. Formulas: For lower extremities
Du-huo & Loranthus Combination (Du Huo Ji Sheng Tang) or Three Painful Obstruction Decoction (San Bi Tang) + Cinnamon & Anemarrhena Combination (Gui Zhi Shao Yao Zhi Mu Tang) + Major Siler Combination (Da Fang Feng Tang).


E.3.7. Qi & Blood Deficiency type Wind Cold Damp “Bi”
a. Symptoms include sore pain in the low back and legs, numbness and trembling of the lower extremities, fatigue, shortness of breath, pale face and lips, dull pain in the joints, pale tongue, thin white tongue coat, deep and weak, or deep and thin pulse.
b. Treatment: benefit qi, nourish blood, warm and open channels.
c. Formulas
Astragalus & Cinnamon Twig Five Substance Decoction (Huang Qi Gui Zhi Wu Wu Tang) or Major Siler Combination (Da Fang Feng Tang) + Dang Gui & Anemarrhena Combination (Dang Gui Nian Tong Tang) + Coix Combination (Yi Yi Ren Tang).


E.3.8. Yin Cold Stagnation “Bi”
a. Symptoms include aversion to cold, swelling and dull pain throughout the body, swelling in the joints, no redness and local heat, numbness, clear and long stream urination, white tongue coat, slow and thin, or deep and thin pulse.
b. Treatment: warm and tonify yang, disperse cold, clear stagnation.
c. Formulas

  Ma Huang & Asarum Combination (Ma Huang Fu Zi Xi Xin Tang) + Cinnamon, Hoelen & Atractylodes Combination (Gui Zhi Jia Ling Fu Zhu Tang) + Stephania & Astragalus Combination (Fang
Ji Huang Qi Tang) or Coix Combination (Yi Yi Ren Tang)
For more information of Acute Rheumatoid Arthritis, Chronic Rheumatoid Arthritis and acupuncture treatment in TCM perspective accotding to above doctor, please visit (64).


Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Musculoskeletal disorders (MSDs)  by Kyle J. Norton


 

References
(2) http://www.ncbi.nlm.nih.gov/pubmed/21614474
(3) http://www.ncbi.nlm.nih.gov/pubmed/15130901
(4) http://www.ncbi.nlm.nih.gov/pubmed/15901635
(5) http://www.ncbi.nlm.nih.gov/pubmed/21953057
(6) http://www.ncbi.nlm.nih.gov/pubmed/22271069
(7) http://www.ncbi.nlm.nih.gov/pubmed/15338490

(7a) http://www.ncbi.nlm.nih.gov/pubmed/25374443
(8) http://www.ncbi.nlm.nih.gov/pubmed/22279457
(9) http://www.ncbi.nlm.nih.gov/pubmed/22657161 
(10) http://www.ncbi.nlm.nih.gov/pubmed/21679443
(11) http://www.ncbi.nlm.nih.gov/pubmed/22321280
(12) http://www.ncbi.nlm.nih.gov/pubmed/20854658
(13) http://www.ncbi.nlm.nih.gov/pubmed/22665517
(14) http://www.ncbi.nlm.nih.gov/pubmed/21616040
(15) http://www.ncbi.nlm.nih.gov/pubmed/22347541

(16) http://www.ncbi.nlm.nih.gov/pubmed/22693083
(17) http://www.ncbi.nlm.nih.gov/pubmed/20810033
(18) http://www.ncbi.nlm.nih.gov/pubmed/22355377
(19) http://www.ncbi.nlm.nih.gov/pubmed/21338325
(20) http://www.ncbi.nlm.nih.gov/pubmed/9263145
(21) http://www.ncbi.nlm.nih.gov/pubmed/21763385
(22) http://www.ncbi.nlm.nih.gov/pubmed/16766362

(23) http://www.ncbi.nlm.nih.gov/pubmed/22709491
(24) http://www.ncbi.nlm.nih.gov/pubmed/17165005
(25) http://www.ncbi.nlm.nih.gov/pubmed/22703938
(26) http://www.ncbi.nlm.nih.gov/pubmed/22341526
(27) http://www.ncbi.nlm.nih.gov/pubmed/22696854
(28) http://www.ncbi.nlm.nih.gov/pubmed/9805988 

(29) http://www.ncbi.nlm.nih.gov/pubmed/17045074
(29a) http://altmedicine.about.com/od/arthritis/a/rheumatoid.htm
(30) http://www.ncbi.nlm.nih.gov/pubmed/21068354 
(31) http://www.ncbi.nlm.nih.gov/pubmed/18820806 

(32) http://www.ncbi.nlm.nih.gov/pubmed/21681567
(33) http://www.ncbi.nlm.nih.gov/pubmed/20447316

(33a) http://www.ncbi.nlm.nih.gov/pubmed/23871988
(34) http://www.ncbi.nlm.nih.gov/pubmed/1771399
(35) http://www.ncbi.nlm.nih.gov/pubmed/20877766
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(39) http://www.ncbi.nlm.nih.gov/pubmed/19833188
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(44) http://www.ncbi.nlm.nih.gov/pubmed/22011457
(45) http://www.ncbi.nlm.nih.gov/pubmed/22218160
(46) http://www.ncbi.nlm.nih.gov/pubmed/22186621
(47) http://www.ncbi.nlm.nih.gov/pubmed/21569399
(48) http://www.ncbi.nlm.nih.gov/pubmed/22289215

(49) http://the-anti-aging-guide.blogspot.ca/2011/04/viii-arthritis.html
(50) http://www.ncbi.nlm.nih.gov/pubmed/11196519
(51) http://www.ncbi.nlm.nih.gov/pubmed/8971230
(52) http://www.ncbi.nlm.nih.gov/pubmed/7020777
(54) http://www.ncbi.nlm.nih.gov/pubmed/10955339
(55) http://www.ncbi.nlm.nih.gov/pubmed/14974005
(56) http://www.ncbi.nlm.nih.gov/pubmed/15517623

(58) “Effect of protein-xanthophylls (PX) concentrate of alfalfa supplementation on physico-chemical properties of turkey breast and thigh muscles during ageing” by Karwowska M, Stadnik J, Dolatowski ZJ, Grela ER., posted in PubMed
(59) ” The ethyl acetate extract of alfalfa sprout ameliorates disease severity of autoimmune-prone MRL-lpr/lpr mice” by Hong YH, Huang CJ, Wang SC, Lin BF., posted in PubMed
(60) “Ethyl acetate extracts of alfalfa (Medicago sativa L.) sprouts inhibit lipopolysaccharide-induced inflammation in vitro and in vivo” by Hong YH, Chao WW, Chen ML, Lin BF., posted in PubMed
(60) http://www.ncbi.nlm.nih.gov/pubmed/22133028
(61) http://www.ncbi.nlm.nih.gov/pubmed/19446580
(62) http://www.ncbi.nlm.nih.gov/pubmed/22214823
(63) http://www.ncbi.nlm.nih.gov/pubmed/22183124

(64) http://www.suntenglobal.com/news/img/2008%20summer.pdf