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Sunday, 24 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The do’s and do not’s list

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 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.

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

Rheumatoid Arthritis

Rheumatoid Arthritis is defined 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 men and generally occurs after the ages of 40, causing diminished quality of life of many elders(1). According to CDC, Musculoskeletal disorders (MSDs)  affects over 52 millions of adults in the US alone, including 294,000 children under age 18 with some form of arthritis or rheumatic conditions(2). Rheumatoid Arthritis can induced bone loss through elevating bone resorption without increasing bone formation(4). A cross-sectional population-based study of 1042 patients with rheumatoid arthritis showed that RA patients had an increased risk of death from various causes(4a).

                              The Prevention and Management


The do’s and do not’s list
The aim of the do and do not list is to find the common strategy with the use of natural remedies to prevent the early onset of RA and protect against the progression and pregressive symptoms of rheumatoid arthritis. Dr. Combe B said in the study of early rheumatoid arthritis: strategies for prevention and management"... A very early use of effective disease-modifying anti-rheumatic drugs (DMARDs) is a key point in patients at risk of developing persistent and erosive arthritis" and " Information and education for patients, as well as some non-pharmacological interventions, can be proposed as treatment adjuncts. Finally, the reduction or stopping of smoking, which could prevent the development and progression of early RA, is the only prevention tool currently available"
In herbal medicine, disease-modifying anti-rheumatic drugs (DMARDs) may be replaced with the intake of anti inflammatory foods.

1. Reduce intake of saturated and trans fat and increase intake of omega 3 fatty acids
Omega-3 FAs imay protect against the development of RA-related autoimmunity in pre-clinical RA, according to a nested case-control study (109). But according to Dr. Devaraj S. and the research team at the UC Davis Medical Center, oonly limit study showed the effects of dietary fatty acids (ie, oleic acid and alpha-linolenic acid) reduce biomarkers of inflammation, null effects in fish oil(110).
According to  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.
Intake of high amount of saturated fat and trans fay can increase the production of inflammatory cytokines(111).
 
2. Increase intake of fruit and vegetable 
Vegetables and fruit formed a important part of human nutrition with good sources of nutrients, dietary fibre, and phytochemicals have been found to reduce risk of chronic diseases, including rheimatoid arthritis RA(112)
In a cross-sectional study of  1200 Puerto Rican adults aged 45-75 y, intake variety of fruits and vegetable but not quantity appears to be important in reducing inflammation(113). The healthy  Mediterranean-type diet rich in fish, fruit and vegetables and low in saturated fats showed to contribute to over all health including complications of RA and RA itself(114).

3. Avoid high glycemic index diets
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 of pro-inflammatory mediators(116). Dr. Kremer JM and Dr. Bigaouette J. of American diet in patients with RA said" Patients with RA ingest too much total fat and too little PUFA and fiber. Their diets are deficient in pyridoxine, zinc and magnesium vs the RDA and copper and folate vs the TAD"(115). Increase intake of  fruits, vegetables, and whole grain consumption seem to be associated with the improvement in subclinical inflammatory condition(116).

4. Maintaining body weight
According to the joint study lead by the Philadelphia VA Medical Center and University of Pennsylvania, a low body mass index (BMI) has been associated with accelerated mortality in patients with rheumatoid arthritis (RA) and obesity showed no support a biologically protective role in RA patients(117). Patients with high BMI have lower mortality than thinner patients(118).


5. Reduced intake of pro inflammatory foods
Foods sugar, dairy products, red meat and processed, meat, alcohol, artificial ingredients, refined products, etc. induced the production of pro inflammatory cytokine is associated to the expression and progression of  Rheumatoid Arthritis(120) as Dr. Seaman DR. said" Nearly all degenerative diseases have the same underlying biochemical etiology, that is, a diet-induced proinflammatory state" and "treatment program must also include nutritional protocols to reduce the proinflammatory state"(119).

6. Increase in take of anti inflammatory foods
such as fresh vegetables and fruits, seeds and sprouts whole grain, fish, turkey, chicken, legumes, etc.
A high vegetable diet and fish oil are found to associate to reduce inflammation and progression of RA. Dr. Adam O and the research team at the Medizinische Klinik Innenstadt der LMU suggested that auch diet improved tender and swollen joints decreased caused by expression of pro inflammatory cytokines(121). Others in the study of 49 patients with active rheumatoid arthritis completed a 24-week, showed the intake of fish oil with olive oil is also associated with certain changes in immune function, probably through the health benefits from the presence of omega-3 fatty acids in olive(122).

7. Stop smoking
Smoking are associated with increased of Rheumatoid Arthritis as it is considered as the most important extrinsic risk factors for the development and severity of Rheumatoid Arthritis, causing over expression of oxidative stress, inflammation, autoantibody formation and epigenetic changes(124).
According to the data of 2,800 adult patients included in the BARFOT early RA between 1992 and 2005study in Sweden. stop smoking after onset of RA did not change the poor prognosis of smokers with RA but reduced risk cardiovascular mortality and morbidity and the association of smoking with vasculitis and noduli in RA(123).

8. Occupations
 If you are in occupation of increased risk of Rheumatoid Arthritis(RA), such as farmers, upholsterers, lacquerers, concrete workers, and hair-dressers, you should take all precaution if necessary(124).
According to the Department of Occupational Health, Karolinska Hospital, in a register based cohort study of a total of 375,035 men and 140,139 women concluded "there were rather small differences in the relative risk of RA in different exposure groups and different occupations"(125).

9. Moderate exercise
Moderate exercise such as yoga(127)(128), taichi(128), qi kong(128),.....enhances immune function in fighting against inflammatory and infectious disease outcomes(128).
In the study of habitual physical activity levels of 29 female patients with RA, researchers at the joint study lead by University of the Witwatersrand showed that the exercise improved bone density and induced protective effects on bone health(126).
In animal model,

Arthritis Is Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

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Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca

References

(1) 8 Areas of Age-Related Change(NIH)
(2) Arthritis-Related Statistics(CDC)
(3) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(4) Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity ,Bone Mineral Density and Radiological Grading by Mehaney DA, Eissa M, Anwar S, El-Din SF(PubMed)
(110) The effect of weight loss and dietary fatty acids on inflammation by Devaraj S1, Kasim-Karakas S, Jialal I.(PubMed)
(111) 4 Natural Remedies for Rheumatoid Arthritis(About health)
(112) Critical review: vegetables and fruit in the prevention of chronic diseases by Boeing H1, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller MJ, Oberritter H, Schulze M, Stehle P, Watzl B.(PubMed)
(113) Greater variety in fruit and vegetable intake is associated with lower inflammation in Puerto Rican adults by Bhupathiraju SN1, Tucker KL.(PubMed)
(114) A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow by McKellar G1, Morrison E, McEntegart A, Hampson R, Tierney A, Mackle G, Scoular J, Scott JA, Capell HA.(PubMed)
(115) Nutrient intake of patients with rheumatoid arthritis is deficient in pyridoxine, zinc, copper, and magnesium by Kremer JM1, Bigaouette J.(PubMed)
(116) [Role of diet on chronic inflammation prevention and control - current evidences].[Article in Portuguese] by Geraldo JM1, Alfenas Rde C.(PubMed)
(117) Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis by Baker JF1, Billig E2, Michaud K3, Ibrahim S1, Caplan L4, Cannon GW5, Stokes A6, Majithia V7, Mikuls TR8.(PubMed)
(118) Paradoxical effect of body mass index on survival in rheumatoid arthritis: role of comorbidity and systemic inflammation by Escalante A1, Haas RW, del Rincón I.(PubMed)
(119) The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? by Seaman DR.(PubMed)
(120) Osteoarthritis and rheumatoid arthritis pannus have similar qualitative metabolic characteristics and pro-inflammatory cytokine response by Furuzawa-Carballeda J1, Macip-Rodríguez PM, Cabral AR.(PubMed)
(121) Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis by Adam O1, Beringer C, Kless T, Lemmen C, Adam A, Wiseman M, Adam P, Klimmek R, Forth W.(PubMed)
(122) Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects by Kremer JM1, Lawrence DA, Jubiz W, DiGiacomo R, Rynes R, Bartholomew LE, Sherman M.(PubMed)
(123) The Effect of Stopping Smoking on Disease Activity in Rheumatoid Arthritis (RA). Data from BARFOT, a Multicenter Study of Early RA by Andersson ML1, Bergman S, Söderlin MK.(PubMed)
(124) Rheumatoid arthritis and occupation by SNORRASON E.(PubMed)
(125) Occupation, occupational exposure to chemicals and rheumatological disease. A register based cohort study by Lundberg I1, Alfredsson L, Plato N, Sverdrup B, Klareskog L, Kleinau S.(PubMed)
(126) Habitual Physical Activity, Sedentary Behaviour and Bone Health in Rheumatoid Arthritis by Prioreschi A1, Makda MA2, Tikly M2, McVeigh JA1.(PubMed)
(4a) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study by Sihvonen S1, Korpela M, Laippala P, Mustonen J, Pasternack A(PubMed)