Wednesday, 27 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The Phytochemicals

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.,.
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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 Phytochemicals

1. Curcumin
Curcumin is a phytochemical found abundantly in Turmeric, principal curcuminoid of the popular Indian spice
1.1. Anti-inflammatory agent
Curcumin (diferuloyl methane) may be used as nonsteroidal anti-inflammatory drugs (NSAIDs for treatment of rheumatoid arthritis(143). Dr. Sarker MR and the research team at the University of North Texas Health Science Center in the study of animal model, suggested that dietary curcumin amy have a positive effects on improved anti-inflammatory or antioxidant actions(144).

1.1. Antioxidants
Curcumin, one of most powerful antioxidant found in foods was found epidemiologically as a proven antioxidant for its anti-inflammatory, anti-amyloidogenic, neuroprotective, and cognition-enhancing effects(145).  The antioxidant is also considered as a novel promising therapeutics against chronic neuroinflammation and neurodegeneration in Alzheimer's disease by the Western Sydney University(146).
In rheumatoid arthritis patients, oral administration of curcumin sginificantly improved the American College of Rheumatology (ACR) DAS scores in reduction in tenderness and swelling of joint and and other arthritic conditions(147) such as dramatic amelioration of arthritis symptoms(148).

2. Gingerol
Gingerole, is also known as gingerol, a phytochemical of Flavonoids (polyphenols) found in fresh ginger.
2.1. Antioxidants and Anti-inflammatory effects
Crude ginger and rosemary extracts showed to inhibit the production of pro-inflammatory cytokines due ot its function as an inflammatory mediators with high antioxidant activity(149). The comparison of different ginger constituents, such as [6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol, 6-Shogaol has found to be most potent antioxidant and anti-inflammatory phytochemical due the presence of alpha,beta-unsaturated ketone moiety(150).
Dr. Masuda Y. and the research team at the Osaka City University said" antioxidants isolated from the rhizomes of ginger,....the antioxidant activity might be due to not only radical scavenging activity of antioxidants but also their affinity of the antioxidants to the substrates"(151).

2.2. Rheumatoid arthritis
In rheumatoid arthritis, ginger-turmeric rhizomes mixture on animal model, may be effective against rheumatoid arthritis (RA) severity and complications, through the mediation of decreasing the systemic inflammation that occur at the appearance of polyarthritis, oxidative stress and dyslipidemia(152). According to DR. Ramadan G1 and the research team at the King Faisal University, the anti-inflammatory/anti-oxidant activity of ginger is less potent than turmeric but constitute to some beneficial effects against rheumatoid arthritis onset/progression(153).

3. Quercetin
Quercetin is a member of flavonoids, found in fruits, vegetables, leaves and grains with anti inflammatory and antioxidant property(154)(155). which have been found effectively in reduce the early onset and stop the progression of rheumatoid arthritis.
In rat adjuvant arthritis, an oral daily dose of 150 mg/kg b.w. of quercetin for 28 days,quercetin lowered levels of pro inflammatory cytokines, interleukin-1β, C-reactive protein, and monocyte chemotactic protein-1 and restored plasma antioxidant capacity(156), . Dr.Ji JJ and the research team at the Dalian Medical University, suggested that quecetin may be a potent agent for treatment of symptoms of RA such as disabling joint disease involved hands, wrists, feet and other small joints, through its anti inflammatory and antioxidant effects(157).
4. Epigallocatechin-3-gallate (EGCG) 
Epigallocatechin-3-gallate (EGCG) found in green tea has been found to process antitumor,anti-Alzheimer, and anti-aging properties throguh epidemiological studies(158). According to the joint study lead by the Zhejiang University, Epigallocatechin-3-gallate (EGCG) improved anti-oxidant defense enzyme, reduced mitochondrial oxidative stress, through its antioxidants and inflammatory effects which may contribute to the treatment of rheumatoid arthritis(159).
In rheumatoid arthritis, Epigallocatechin-3-gallate (EGCG) may have a beneficiary effects for treatment of RA due to its suppressed autoimmune arthritis activity(160), also through vary antioxidant and anti inflammatory pathways.

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(143) Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation by Satoskar RR, Shah SJ, Shenoy SG.(PubMed)
(144) Curcumin Mimics the Neurocognitive and Anti-Inflammatory Effects of Caloric Restriction in a Mouse Model of Midlife Obesity by Sarker MR1, Franks S2, Sumien N1, Thangthaeng N1, Filipetto F2, Forster M1.(PubMed)
(145) Curcumin and Apigenin - novel and promising therapeutics against chronic neuroinflammation in Alzheimer's disease by Venigalla M1, Gyengesi E2, Münch G3(PubMed)
(146) Novel promising therapeutics against chronic neuroinflammation and neurodegeneration in Alzheimer's disease by Venigalla M1, Gyengesi E2, Sharman MJ3, Münch G4(PubMed)
(147) A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis by Chandran B1, Goel A.(PubMed)
(148) Oral curcumin has anti-arthritic efficacy through somatostatin generation via cAMP/PKA and Ca(2+)/CaMKII signaling pathways in the small intestine by Yang Y1, Wu X2, Wei Z2, Dou Y2, Zhao D3, Wang T2, Bian D2, Tong B2, Xia Y2, Xia Y4, Dai Y5(PubMed)
(149) Evaluation of in vitro anti-inflammatory effects of crude ginger and rosemary extracts obtained through supercritical CO2 extraction on macrophage and tumor cell line: the influence of vehicle type by Justo OR1, Simioni PU2, Gabriel DL2, Tamashiro WM2, Rosa Pde T3, Moraes ÂM4.(PubMed)
(150) Comparative antioxidant and anti-inflammatory effects of [6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol by Dugasani S1, Pichika MR, Nadarajah VD, Balijepalli MK, Tandra S, Korlakunta JN.(PubMed)
(151) Antioxidant properties of gingerol related compounds from ginger by Masuda Y1, Kikuzaki H, Hisamoto M, Nakatani N.(PubMed)
(152) Protective effects of ginger-turmeric rhizomes mixture on joint inflammation, atherogenesis, kidney dysfunction and other complications in a rat model of human rheumatoid arthritis by Ramadan G1, El-Menshawy O.(PubMed)
(153) Anti-inflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis by Ramadan G1, Al-Kahtani MA, El-Sayed WM.(PubMed)
(154) Antioxidant and Anti-Inflammatory Activity Determination of One Hundred Kinds of Pure Chemical Compounds Using Offline and Online Screening HPLC Assay by Lee KJ1, Oh YC1, Cho WK1, Ma JY1.(PubMed)
(155) Radical-scavenging and Anti-inflammatory Activity of Quercetin and Related Compounds and Their Combinations Against RAW264.7 Cells Stimulated with Porphyromonas gingivalis Fimbriae. Relationships between Anti-inflammatory Activity and Quantum Chemical Parameters by Murakami Y1, Kawata A2, Ito S3, Katayama T2, Fujisawa S2(PubMed)
(156) Quercetin reduced inflammation and increased antioxidant defense in rat adjuvant arthritis by Gardi C1, Bauerova K2, Stringa B3, Kuncirova V4, Slovak L4, Ponist S4, Drafi F4, Bezakova L5, Tedesco I6, Acquaviva A3, Bilotto S6, Russo GL7.(PubMed)
(157) Quercetin: a potential natural drug for adjuvant treatment of rheumatoid arthritis by Ji JJ1, Lin Y, Huang SS, Zhang HL, Diao YP, Li K.(PubMed)
(158) Green tea polyphenols and their potential role in health and disease by Afzal M1, Safer AM, Menon M.(PubMed)
(159) Mitochondrial modulation by Epigallocatechin 3-Gallate ameliorates cisplatin induced renal injury through decreasing oxidative/nitrative stress, inflammation and NF-kB in micebyPan H1, Chen J2, Shen K3, Wang X1, Wang P1, Fu G1, Meng H1, Wang Y1, Jin B1.(PubMed)
(160) Green Tea Epigallocatechin-3-Gallate Suppresses Autoimmune Arthritis Through Indoleamine-2,3-Dioxygenase Expressing Dendritic Cells and the Nuclear Factor, Erythroid 2-Like 2 Antioxidant Pathway by Min SY1, Yan M1, Kim SB2, Ravikumar S3, Kwon SR4, Vanarsa K3, Kim HY5, Davis LS1, Mohan C3.(PubMed)
(161) Effect of green tea extract and vitamin C on oxidant or antioxidant status of rheumatoid arthritis rat model by Meki AR1, Hamed EA, Ezam KA(PubMed)

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