Wednesday, 13 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Osteoarthritis: Treatment In herbal and traditional Chinese medicine - The Individual herb

Kyle J. Norton (Scholar, Master of Nutrients, All right reserved)
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 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.

Musculoskeletal disorders (MSDs) are 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 of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).
The characteristics of osteoarthritis are aching pain(5), stiffness(6), or difficulty of moving the joint or joints(7). The pain usually gets worse in change of weather, at night and in the advanced diseases, the pain can occur even at rest(8). Today management of osteoarthritis (OA) focuses on pain relief and improved physical function through pharmacological, non pharmacological, and surgical treatments(4).

                                    The Treatment

B. In herbal  and traditional Chinese medicine perspective
B.2. Herbal and Traditional Chinese medicine 
Many herbal medicine have been found effectively for reduction of symptoms and treatment for patient with osteoarthritis(430), including 
B.2.1. Individual herb
1. Ginger
Ginger has been used internally and externally for over a thousand years in China to manage all types of arthritis symptoms, through its effective in compress therapy(431). According to Dr. Therkleson T., in the study of 20 adults with moderate to severe osteoarthritis(414). On a self-report arthritis Health Assessment Questionnaire, topical ginger  showed to relief osteoarthritic symptoms, in both  body physiological recordings and pain scale(415).
The Edith Cowan University, in the study of a self-treatment using the ginger patch for a further 24 week, showed that ginger treatment relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis(416).
Ginger extract, according to Frederiksberg Hospital, in adouble blind study conducted in accordance with Good Clinical Practice (European Guideline for GCP), exhibited a statistically significant effect on reducing symptoms of OA of the knee(432).

2. Willow bark
A herbal medicine used over thousands of years for treatment as an anti-inflammatory, antipyretic, and analgesic advocate in many culture(433). Its extract, according to studies may be a potential medicine  for treatment of patient with painful  osteoarthritis(434)(436) or used conjunction with NSAIDs and opioids(434).
In the trail of total of 78 patients (39 willow bark extract, 39 placebo),. researcher sat the Universität Tübingen showed that Willow bark extract reduces pain, stiffness and improvesphysical function
after 2 weeks of treatment for patient with OA, through its moderate analgesic effect with tolerate side effects(437).
Unfortunately, the study by the Eberhard Karls-Universität, in the 127 outpatients with hip or knee OA 2 randomized, controlled, double-blind trials with followup for 6 weeks, showed insufficient different of the herbal extract in comparison to the placebo(435).

3. Stinging nettle
Stinging nettle also known as Urtica dioica, a herbal medicine with long history for the effectiveness in treating of getting rid of water in the body and relieve pain, showed  to relive pain and reduce risk of progression of the disease patients with osteoarthritis(438)(439). Application of stinging nettle daily for one week to the painful area in patient with OA, effectively relieves more pain in comparison to placebo(442)
In a randomized double-blind parallel-groups clinical trial, conduced by the University of Bordeaux, Phytalgic (fish-oil, vitamin E, Urtica dioica) improve not only the symptoms of patient with osteoarthritis. but also reduced the need for analgesics and NSAIDs(440).
 Dr. Christensen R, and Dr. Bliddal H. said " Phytalgic... tested in a placebo-controlled trial for 3 months and according to the authors has a very large clinical effect, considerably larger than that of any other known product. Even experts endorsing nutraceuticals for OA symptoms.."(441).

4. Devil’s claw
Devil’s claw is also one most common used in alternative medicine for treatment of patient suffering from osteoarthritis(443), probably through anti inflammatory activity(446) in inhibition of different proinflammatory mediators(447)(448).
 In the review of the data of literature on Devil's Claw and OA from 1966 to 2006, research at the University of Southampton indicated that Devil's Claw exhibits effectively the reduction of the main clinical symptom of pain in OA patient but suggestion of it safety in use is necessary(444).
Dr. Chrubasik S said that preparations of devil's claw extract, should be taken account of the presence of the quantity of harpagoside of which has proven importantly in relived painful lower back or arthrotic pain as an attractive alternative to synthetic analgesics(445).

5. Hot Chilli (Capsaicin)
Topical capsaicin is considered as alternative therapy in patient with osteoarthritis, without any severe adverse effects, according to Dr Rains C, and Bryson HM(449).
Topical Capsaicin cream used for treatment of soft tissue with a pharmaceutical name of Finalgon®(420), may be effective for treatment of osteoarthritis in dependent to its concentration.
In a randomized, single-blind, 28-day study conducted by Research Testing Laboratories, capsaicin cream (0.25%) applied twice daily, showed to relieve severity of osteoartghritic pain with side effect of burning sensation(419).
Civamide cream produced by Winston Pharmaceuticals, approved by FDA, civamide cream is a cis-isomer of capsaicin topical medication used for treatment of osteoarthritis of the knee and other neuropathic pain(417). In the study by Northwestern University Feinberg School of Medicine, in patients with OA of the knee, civamide cream 0.075% or a lower dose of civamide cream, 0.01% effectively in relieve pain and improve physical functions(418).

5. Green Tea
Green tea  has been a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years. 
In mouse model, epigallocatechin 3-gallate (EGCG), a polyphenol present in green tea, exhibited reduced OA palliative effect and progression, through less Safranin O loss and cartilage erosion(450) by attenuating the inflammation induced by calcium pyrophosphate crystals(452)(453).
Sunphenon, a green tea extract has shown to enhance bone mineralization, relieves osteoarthritis, and aids digestion, through its antioxidant effects(451).
According to the Texas Tech University Health Sciences Center, epigallocatechin gallate and green tea extract, suppressed the condition caused in part by injury, loss of cartilage structure and function, through their effects in balanced inflammatory and anti-inflammatory pathways(454),  probably caused by IL-1β, a major cytokine driving the inflammatory processes(455)(456).

6. Turmeric
Turmeric, a cooking spice used in many culture in South East Asian, especially in India, also has been used as herbal medicine over thousands of year as anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations, etc.(457). Curcumin (Cur) and bisdemethoxycurcumin (BDMC), extracted from Curcuma longa slow osteoarthritis progression against bone turn over through the stimulation of interleukin (IL)-1β , downregulate the expression of inflammatory markers on osteoblasts(459).
The joint study St. Louis University School of Medicine and University of Nebraska Medical Center in review of research at the laboratory, translational and clinical levels data found that most the studies and trails supports the use of curcumin for various musculoskeletal disorders, including osteoarthritis, osteoporosis,..(458). In the antioxidant perspective, curcuminoids relieve osteoarthritis symptoms. through reduction of systemic oxidative stress(460)  in patients with knee osteoarthritis(460).
The Belgium study of 820 patients treated with a new Curcuma extract (Flexofytol®, 4-6 capsules per day), suggested that the extract improves patient pain, articular mobility, and quality of life. Within the first 6 weeks, more than half of participants were able to discontinue analgaesic and anti-inflammatory drugs with tolerate adverse effects(461)

7. Cat's claw
Cat's claw (Uncaria tomentosa), the very commonherbal medicine, has been used in traditional medicine over two thousand years as a tonic, contraceptive, anti-inflammatory and infectious agent, and to treat diarrhea, rheumatic disorders, acne, diabetes, cancer and diseases of the urinary tract, etc.(462). The The natural mineral supplement, sierrasil combined with a cat's claw extract, may be protential treatment to improved joint health, according to a a randomized controlled trial (466). Recently, according to the study by Case Western Reserve University, herbal and amino acid mixture containing extract of the Uncaria tomentosa, may be potentially useful as a new adjunct therapeutic/preventive agent for OA or injury recovery effectively, due to its anti inflammatory(464) and chondroprotective activities, in up-regulation of ACAN and COL2A1 expression in IL-1β-stimulated and inhibiting the activation of nuclear factor (NF)-kB in human OA chondrocytes(463) as well as reducing of pro-inflammatory mediators and effectors(464).
The Facultad de Medicina, in the comparison of the species U guianensis and U tomentosa, found that both herbal medicine are effective in treatment of Osteoarthritis, probably through its anti-inflammatory properties in inhibited TNFalpha and PGE2 production(465).

8. Bromelain
Bromelain, a group of protein digesting enzymes  found in pineapples (Ananas comosus) has been used in traditional medicine as inflammatory agent and to treat pains, strains, and muscle aches and pains and ease back pain and chronic joint pain, skin diseases, etc.(467). The herbal medicine may be used as valuable and safe alternative to NSAIDs in patients suffering acute and chronic OA pain from degenerative joint diseases due to its anti-inflammatory and analgesic effects(468).
According to the Rehabilitation Centre for Cardiovascular and Rheumatic Diseases, oral enzyme therapy (Phlogenzym-(PE)), has found effectively in treatment for patient with osteoarthritis with high levels of pain due to signs of inflammation(469). Other oral enzyme-rutosid combination (ERC) containing rutosid and the enzymes bromelain and trypsin, showed to consist the same effectiveness as NSAIDs in the treatment of painful episodes of OA of the knee(471).
Dr. Brien S and the research team in the study of the anti-inflammatory and analgesic properties in patient with osteoarthritis said that more studies and trials are necessary to trials to establish the efficacy and optimum dosage for bromelain as a safer alternative or adjunctive treatment for osteoarthritis(470).

10. Boswellia serrata 
 Boswellia serrata used as incense in religious and cultural ceremonies and in medicine over thousands of year may be the potential source for treatment of osteoarthritis due to its anti inflammatory(472), anti-arthritic and analgesic activity activity(473) in decreased knee pain, increased knee flexion and increased walking distance(473).
FlexiQule, the commercial Boswellia extract, improved pain, stiffness, physical, social/emotional functions and walking distance at 4 weeks of treatment with patient of symptomatic knee osteoarthritis (OA)(474), the Circulation Sciences and the International Irvine Network suggested.
DR. Kizhakkedath said that formula containing Curcuma longa and Boswellia serrata extracts (CB formulation) at 500 mg administered twice a day in a directly compared with the selective COX-2 inhibitor, celecoxib at 100 mg twice a day, induced more successful symptom scoring and clinical examination(475).
The study of Indira Gandhi Medical College also supported of  Boswellia extract effectiveness  by decreasing in knee pain, increasing knee flexion and walking distance of in the study of 30 patient with osteoarthritis of knee(476).

11. Gingko
Gingko is  also known as Ginkgo biloba, one of the oldest herbal medicine in human medical history, used in traditional herbal medicine in treating impotence, memory loss,respiratory diseases, circulatory disorders,,...(477).
Gingko extract, with anti inflammatory(478) and immune modulatory(479) activities may be a potential herbal medicine for treatment of osteoarthritis by inhibiting the interleukin-1 (IL-1)-stimulated human chondrocytes degeneration and MMP(matrix metalloproteinases)-1, MMP-3, and 13.causes of cartilage degradation(481)(482) found in patient of osteoarthritis(480) of which  make the extract the candidate as a potential therapeutic agent, according to the Postgraduate Institute of Medical Education and Research(480).
In Osteoarthritis (OA) rat model, the extract EGb761, a standardized extract of Ginkgo biloba leaves also expressed its anti inflammatory effect on human articular chondrocytes of which inhibited cartilage degradation(482).

12. Dan Shen
Dan Shen with the pharmaceutical name of Radix Salvia miltiorrhizae, is a bitter and slightly cold herb, used mainly in traditional Chinese medicine for tonifying blood(494), such as getting rid of clot blood, invigorate blood, breakup blood stasis,... through its effects on liver and heart meridians.
In the animal model study of rabbits, with severe articular cartilage degeneration and lower proteoglycan (PG), the herbal medicine Dan Shen showed effectively in against oxidative stress causes ofarticular cartilage degeneration in patient with Osteoarthritis OA(491).
According to Veterinary Herbal Medicine By Susan G. Wynn, Barbara Fougère, page 349. Dan Shen induced formation of dense callus and increased activity of osteoblasts of which enhanced the improvement of bone heeling(492). Certain studies found in Dan Shen (Salvia miltiorrhiza) in Medicine: Volume 2. Pharmacology ..., Volume 2 edited by Xijun Yan also supported the use of Dan Shen injection for treatment of osteoarthritis because of its anti inflammatory effect(493).

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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review by Pereira D1, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E.(PubMed)
(4) Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis by Waller B1, Ogonowska-Slodownik A2, Vitor M3, Lambeck J4, Daly D5, Kujala UM6, Heinonen A7.(PubMed)
(5) Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with kneeosteoarthritis: A systematic review and meta-analysis by Zhang C1, Xie Y2, Luo X3, Ji Q3, Lu C3, He C4, Wang P3.(PubMed)
(6) Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis by Farid R1, Rezaieyazdi Z, Mirfeizi Z, Hatef MR, Mirheidari M, Mansouri H, Esmaelli H, Bentley G, Lu Y, Foo Y, Watson RR.(PubMed)
(7) Functional ability, mobility, and pain before and after knee replacement in patients aged 75 and older: a cross-sectional study by Limnell K1, Jämsen E, Huhtala H, Jäntti P, Puolakka T, Jylhä M.(PubMed)
(8) The symptoms of OA and the genesis of pain by David J. Hunter, MBBS PhD,1,2 Jason J. McDougall, BSc PhD,3 and Francis J. Keefe4(PubMed)
(430) Herbal medicines for the treatment of osteoarthritis: a systematic review by L. Long, K. Soeken 1 and E. Ernst(Rheumatology)
(431) Ginger compress therapy for adults with osteoarthritis by Therkleson T1.(PubMed)
(432) Effects of a ginger extract on knee pain in patients with osteoarthritis by Altman RD1, Marcussen KC.(PubMed)
(433) Efficacy and Safety of White Willow Bark (Salix alba) Extracts by Shara M1, Stohs SJ2.(PubMed)
(434) Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritisor back pain by Uehleke B1, Müller J, Stange R, Kelber O, Melzer J.(PubMed)
(435) Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials by Biegert C1, Wagner I, Lüdtke R, Kötter I, Lohmüller C, Günaydin I, Taxis K, Heide L.(PubMed)
(436) Willow bark extract, a useful alternative for the treatment of osteoarthritis: comment on the editorial by Marcus and Suarez-Almazor by Chrubasik S, Pollak S, Black A.(PubMed)
(437) Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial by Schmid B1, Lüdtke R, Selbmann HK, Kötter I, Tschirdewahn B, Schaffner W, Heide L.(PubMed)
(438) STINGING NETTLE CREAM FOR OSTFOARTHRITIS  by Keith Rayburn, MD; Eric Fleischbein, PharmD; Jessica Song, PharmD; Blaine Allen, RN; Mary Kundert, PharmD; Charles Leiter, PharmD; Thomas Bush, MD(Research letter)
(439) Stinging nettle cream for osteoarthritis by Rayburn K1, Fleischbein E, Song J, Allen B, Kundert M, Leiter C, Bush T.(PubMed)
(440) Phytalgic, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial by Jacquet A1, Girodet PO, Pariente A, Forest K, Mallet L, Moore N.(PubMed)
(441) Is Phytalgic(R) a goldmine for osteoarthritis patients or is there something fishy about this nutraceutical? A summary of findings and risk-of-bias assessment by Christensen R, Bliddal H.(PubMed)
(442) Randomized controlled trial of nettle sting for treatment of base-of-thumb pain by Randall C1, Randall H, Dobbs F, Hutton C, Sanders H.(PubMed)
(443) The use of glucosamine, devil's claw (Harpagophytum procumbens), and acupuncture as complementary and alternative treatments for osteoarthritis by Sanders M1, Grundmann O.(PubMed)
(444) Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: a review of efficacy and safety by Brien S1, Lewith GT, McGregor G.(PubMed)
(445) [Devil's claw extract as an example of the effectiveness of herbal analgesics].[Article in German] by Chrubasik S1.(PubMed)
(446) A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain by Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC.(PubMed)
(447) Alteration of anti-inflammatory activity of Harpagophytum procumbens (devil's claw) extract after external metabolic activation with S9 mix by Hostanska K1, Melzer J, Rostock M, Suter A, Saller R.(PubMed)
(448) A review of the efficacy and safety of devil's claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis by Denner SS1.(PubMed)
(449) Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis by Rains C1, Bryson HM.(PubMed)
(450) Green tea polyphenol treatment is chondroprotective, anti-inflammatory and palliative in a mouse post-traumaticosteoarthritis model by Leong DJ, Choudhury M, Hanstein R, Hirsh DM, Kim SJ, Majeska RJ, Schaffler MB, Hardin JA, Spray DC, Goldring MB, Cobelli NJ, Sun HB.(PubMed)
(451) Antioxidant and pro-apoptotic effects of marine-derived, multi-mineral aquamin supplemented with a pine bark extract, Enzogenol, and a green tea extract, Sunphenon. by O'Callaghan YC1, Drummond E, O'Gorman DM, O'Brien NM.(PubMed)
(452) Epigallocatechin-3-gallate reduces inflammation induced by calcium pyrophosphate crystals in vitro by Oliviero F1, Sfriso P, Scanu A, Fiocco U, Spinella P, Punzi L.(PubMed)
(453) Epigallocatechin-3-gallate selectively inhibits interleukin-1beta-induced activation of mitogen activated protein kinase subgroup c-Jun N-terminal kinase in human osteoarthritis chondrocytes. by Singh R1, Ahmed S, Malemud CJ, Goldberg VM, Haqqi TM.(PubMed)
(454) Dietary polyphenols and mechanisms of osteoarthritis by Shen CL1, Smith BJ, Lo DF, Chyu MC, Dunn DM, Chen CH, Kwun IS.(PubMed)
(455) Green tea: a new option for the prevention or control of osteoarthritis by Katiyar SK, Raman C.(PubMed)
(456) Epigallocatechin-3-gallate selectively inhibits interleukin-1beta-induced activation of mitogen activated protein kinase subgroup c-Jun N-terminal kinase in human osteoarthritis chondrocytes by Singh R1, Ahmed S, Malemud CJ, Goldberg VM, Haqqi TM.(PubMed)
(457) Popular #Herbs - Turmeric (Curcuma longa) by Kyle J. Norton
(458) Role of Curcumin in Common Musculoskeletal Disorders: a Review of Current Laboratory, Translational, and Clinical Data by Peddada KV1, Peddada KV2, Shukla SK3, Mishra A3, Verma V4.(PubMed)
(459) Evaluation of the protective effects of curcuminoid (curcumin and bisdemethoxycurcumin)-loaded liposomes against bone turnover in a cell-based model of osteoarthritis by Yeh CC1, Su YH2, Lin YJ2, Chen PJ2, Shi CS3, Chen CN2, Chang HI2.(PubMed)
(460) Mitigation of Systemic Oxidative Stress by Curcuminoids in Osteoarthritis: Results of a Randomized Controlled Trial by Panahi Y1, Alishiri GH, Parvin S, Sahebkar A.(PubMed)
(461) A new curcuma extract (flexofytol®) in osteoarthritis: results from a belgian real-life experience by Appelboom T1, Maes N2, Albert A3.(PubMed)
(462) Cat's claw (Uncaria tomentosa) by Kyle J. Norton
(463) Effect of a Herbal-Leucine mix on the IL-1β-induced cartilage degradation and inflammatory gene expression in human chondrocytes by Akhtar N1, Miller MJ, Haqqi TM.(PubMed)
(464) Cat's claw: an Amazonian vine decreases inflammation in osteoarthritis by Hardin SR1.(PubMed)
(465) Efficacy and safety of freeze-dried cat's claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis by Piscoya J1, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJ, Sandoval M.(PubMed)
(466) Early relief of osteoarthritis symptoms with a natural mineral supplement and a herbomineral combination: a randomized controlled trial [ISRCTN38432711] by Miller MJ1, Mehta K, Kunte S, Raut V, Gala J, Dhumale R, Shukla A, Tupalli H, Parikh H, Bobrowski P, Chaudhary J.(PubMed)
(467) Popular #Herbs - Bromelain by Kyle J. Norton
(468) A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain by Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC.(PubMed)
(469) Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs by Klein G1, Kullich W, Schnitker J, Schwann H.(PubMed)
(470) Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies by Brien S, Lewith G, Walker A, Hicks SM, Middleton D.(PubMed)
(471) Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study by Akhtar NM1, Naseer R, Farooqi AZ, Aziz W, Nazir M.(PubMed)
(472) Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview by M. Z. Siddiqui(PMC)
(473) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial by Kimmatkar N1, Thawani V, Hingorani L, Khiyani R.(PubMed)
(474) FlexiQule (Boswellia extract) in the supplementary management of osteoarthritis: a supplement registry by Belcaro G1, Dugall M, Luzzi R, Ledda A, Pellegrini L, Cesarone MR, Hosoi M, Errichi M, Francis S, Cornelli U.(PubMed)
(475) Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis by Kizhakkedath R1.(PubMed)
(476) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial by Kimmatkar N1, Thawani V, Hingorani L, Khiyani R.(PubMed)
(477) Popular Herbs - Ginkgo biloba by Kyle J. Norton
(478) Ginkgo biloba extract EGb 761 has anti-inflammatory properties and ameliorates colitis in mice by driving effector T cell apoptosis by Venkata S. Kotakadi,† Yu Jin,† Anne B. Hofseth, Lei Ying, Xiangli Cui, Suresh Volate, Alexander Chumanevich, Patricia A. Wood,1 Robert L. Price,2 Anna McNeal,2 Udai P. Singh,2 Narendra P. Singh,2 Mitzi Nagarkatti,2 Prakash S. Nagarkatti,2 Lydia E. Matesic,3 Karine Auclair,4 Michael J. Wargovich,5 and Lorne J. Hofseth(PMC)
(479) Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo by Parsad D1, Pandhi R, Juneja A.(PubMed)
(480) Ginkgo biloba extract individually inhibits JNK activation and induces c-Jun degradation in human chondrocytes: potential therapeutics for osteoarthritis by Ho LJ1, Hung LF2, Liu FC3, Hou TY3, Lin LC4, Huang CY2, Lai JH5.(PubMed)
(481) Inhibitory effects of EGb761 on the expression of matrix metalloproteinases (MMPs) and cartilage matrix destruction by Wang X1, Zhao X, Tang S.(PubMed)
(482) EGb761 inhibits inflammatory responses in human chondrocytes and shows chondroprotection in osteoarthritic rat knee by Chen YJ1, Tsai KS, Chiu CY, Yang TH, Lin TH, Fu WM, Chen CF, Yang RS, Liu SH.(PubMed)
(483) Phytodolor--effects and efficacy of a herbal medicine by Gundermann KJ1, Müller J.(PubMed)
(484) Phytodolor® in musculoskeletal disorders: re-analysis and meta-analysis by Uehleke B1, Brignoli R, Rostock M, Saller R, Melzer J.(PubMed)
(485) Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews.
Soeken KL1.(PubMed)
(487) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study by Mills SY1, Jacoby RK, Chacksfield M, Willoughby M.(PubMed)
(488) [Gitadyl versus ibuprofen in patients with osteoarthrosis. The result of a double-blind, randomized cross-over study].[Article in Danish]by Ryttig K1, Schlamowitz PV, Warnøe O, Wilstrup F.(PubMed)
(489) Gitadyl versus ibuprofen in patients with osteoarthritis: a double-blind, randomized, cross-over study of clinical efficacy and effects on platelets and PMNs by Mieszczak CI1, Kharazmi A, Rein J, Winther K.(PubMed)
(490) [Gitadyl versus ibuprofen].[Article in Danish] by [No authors listed](PubMed)
(491) Danshen prevents articular cartilage degeneration via antioxidation in rabbits with osteoarthritis by Bai B1, Li Y2.(PubMed)
(492) Veterinary Herbal Medicine By Susan G. Wynn, Barbara Fougère, page 349.
(493) Dan Shen (Salvia miltiorrhiza) in Medicine: Volume 2. Pharmacology ..., Volume 2 edited by Xijun Yan 

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