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Friday, 15 January 2016

Most Common diseases of elder: The Clinical Trials and Studies of Osteoarthritis Back by Respectable Institutions

Kyle J. Norton (Scholar)

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(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



                                                Content



The symptoms
The causes and risk factors
Diseases associated with osteoarthritis
The Complications
The Diagnosis
The Misdiagnosis and delay diagnosis

The Prevention and Management
The Do and do not’s list
The Diet
The Antioxidants
The Phytochemicals



Treatment
In conventional medicine perspective
Physical Activity
Weight management
Medication
Non medication therapy
Surgery

In herbal and traditional Chinese medicine perspective
Life style modification according herbal and TCM medicine specialists
Diet modification according herbal and TCM medicine specialists
The Preventive Minerals and Vitamins
The Supplements for osteoarthritis
Natural therapy

Herbal therapy in Herbal and Traditional Chinese medicine
Individual herb
Herbal prescriptions or formulas


                                   Osteoarthritis 

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 Symptoms 

Some researchers classified the severity symptoms of osteoarthritis as follow
1. Pain in joints of the hand
Most commonly affected joints of the hand in osteoarthritis include the carpometacarpal joint of the thumb (CMC 1) and the distal (DIP) andproximal (PIP) interphalangeal joints. may be resulted of
associated of High Bone Mass in Women and Small Bone Size and Low Lean Mass in Men(9), especially for patient with knee osteoarthritis(10).Ageing(11), female gender(12), genotype(13)(14), heavy work(15)(16) have shown to associate to the pain and pressure on the hands, and injuries predispose to osteoarthritis in the hand(17). The pain may be also due to permeability change in the synovial tissue caused by molecules released from the joint cartilage(18)(19).

2. Knee and Hip
Osteoarthritis (OA) of the knee and hip is among the most frequent arthritic conditions(19). Some researcher suggested that the pathological joint changes in OA include: cartilage destruction by pro-inflammatory cytokines(20), matrix metalloproteinases(21)(22) and prostaglandins(23) in promotion of  a catabolic environment(19).

3. Spine
Vertebral deformity, in particular wedging, of the thoracic spine is not exclusively characteristic for osteoporosis(24), but in Europe, it is a marker of vertebral osteoporosis, in different regions and populations(25) and certain vertebral deformities develop by mechanisms other than fracture(26). Osteoporotic fracture of the thoracic spine can induce severe pain in your back, legs, and arms and weakness or numbness in these areas if the fracture injures the nerves of the spine(27)
 Osteoarthritis is found to affect the low back can lead to chronic low back pain (lumbago)(28)(29) and degenerative disc disease (spondylosis)(30)(31). Other researchers indicated that postmenopausal women with lumbar spine disc degeneration are as the result of  by increased CII degradation(32)(33).

               
                      The Causes and Risk Factors

A. Causes
1. Process of wear and repair
Osteoarthritis (OA), a widespread degenerative disease of skeletal joints(34) and is often associated with senescence in vertebrates. arising from long term wear and tear, heavy long-term use or specific injuries(35). Improper repair process of injure of joints can also result of symptoms of Osteoarthritis (OA)(36) in old age(37), according to TCM.

2. Nutrient deficiency and overload
Poor nutritional conditions experienced early in life are linked to greater prevalence of osteoarthritis (OA)(35)(38), such as vitamin D. On the other hand, nutrient overload and metabolic surplus, such as obesity may contribute to early onset of osteoarthritis (OA)(38).

3. Cartilage
Cartilage is a flexible connective tissue cushioned the ends of bones in your joints and allowed the joints to move smoothly. Rough or wears down cartilage due to aging or damage can causes pain due to bone in the joint rubbing against another bone(39)(40).
The above causes of Osteoarthritis (OA) may also be the result of injure(35), overuse(15)(16), Rheumatoid Arthritis(41), etc.

4. Etc.

B. Risk factors
Aging changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors(39)(40)
1. Abnormal biomechanics
The biomechanics of the foot and ankle is important to the normal function of the lower extremity(42). Abnormal biomechanics can cause abnormal stress and eventual breakdown of connective tissue and muscle(42) of that can lead to early onset of  Osteoarthritis (OA)(43).

2. Joint injury and obesity 
According to the University of Calgary, joint injury and obesity were associated with an increased risk of OA of the knee and hip(44). Dr. Rogers LQ and the research team at the Southern Illinois University School of Medicine indicated that the high and low joint stress from physical activity (PA)
ate associated to reduce risk of the disease(45). In obesity, according to Duke University Medical Center, it is one of the most significant, and potentially most preventable, risk factors for the development of osteoarthritis due to a strong association between body mass index and osteoarthritis of the hip, knee, foot and hand(46)(47).

3. Age-related sarcopenia(48)(49) and increased bone turnover(49) have found to be associated to the development of OA(49). Other suggested that Osteoarthritis development in the injured joints is caused by pathways of joint-related mechanisms and deconditioning of the musculoskeletal system(50). As well as intra-articular pathogenic processes initiated at the time of injury(51).

4. Normal Aging 
Normal aging in humans is associated with declines in skeletal muscle mass and strength and increased muscle fatigability (sarcopenia)(52).

5. Muscle strength
Reduced muscle strength due to ageing, injure or other conditions is regarded as a risk factor for pain and disability in osteoarthritis (OA)(53)(54).

6. Gender
Women are susceptible to the greater risk for the development of  osteoarthritis (OA), but research in sex and gender differences in osteoarthritis to date, may not be appreciated by the orthopedic community, according to Mayo Clinic(56)(57)

7. Genetic 
 Asian are at higher risk to develop osteoarthritis, according to research of  Praxisklinik für Unfallchirurgie und Orthopädie(57)(58), due to  genetic polymorphisms associated with osteoarthritis and related end-points(58).

8. Deformation of bone
People who were born with defective joints or cartilage are at increased risk of developing osteoarthritis(59)(60).

9. Physical activity
People who involve in activity such as sport are at higher risk to develop osteoarthritis, if injure(61).

10. Occupations
Certain occupations are associated to the increased risk of osteoarthritis, especially to workers involving repetitive movements that stress on a particular joint(61)(62).

11. Deficiency in DNA repair
Progeroid human DNA repair syndrome trichothiodystrophy may be associated to the to the development of osteoarthritis(63).

12. Other diseases and conditions may have a higher risk of developing the condition.
a. Gout
Gout is a type of arthritis as a result of uric acid builds up in blood causes of joint inflammation(64). According to a total of 4249 completed questionnaires returned (32%) from 359 attendees, 164 cases of gout were clinically confirmed, there is highly significant association existed between the site of acute attacks of gout and the presence of OA(65).

b. Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease, causing the attack of flexible (synovial) joints, inflammation of the surrounding tissues and many tissues and organs. Patients with heumatoid arthritis (RA) are associated to increase risk of OA due to progression of aging(66).

c. Paget’s disease of the bone
Paget’s disease of bone is a condition a chronic disorder of excessive and abnormal bone remodeling result in excessive breakdown and formation of bone tissue causing pain, misshapen bones, fractures, and arthritis in the joints near the affected bones(67) with prevalence trends of doubling each decade from the age of 50 onwards, causing bone pain, depending on skeletal sites involved and range from secondary osteoarthritis to malignant degeneration(68).

d. Septic arthritis
Septic arthritis is a condition of inflammation of a joint as a result of bacterial or fungal infection causes of osteoarthritis(69).

9. Etc.

         Diseases associated with osteoarthritis

Researchers suggested that OA is not simply a disease related to aging or mechanical stress of joints but rather a “metabolic disorder(70)(71)” interrelated to lipid, metabolic, and humoral mediators(70). Indeed, OA has been linked not only to obesity(46)(47) but also to other cardiovascular risk factors(72)(73), namely, diabetes(74), dyslipidemia, hypertension, and insulin resistance(75).
Most people with osteoarthritis also suffer from one or more of below
1. Hypertension
According to the University Health Network Research Institute, the economic burden incurred by RA significantly exceeds that related to OA and HBP(76)(77).

2. Cardiovascular disease
According to Erasmus University Medical Centre, there is an associations of atherosclerosis with osteoarthritis of the knee and hand joints in women(72)(73)(78).

3. Peripheral vascular disease
According to Himchan Hospital, patient with due to osteoarthritis are associated to risk of asymptomatic peripheral vascular disease(80). The average vessel wall thickness of the popliteal artery was 1.09 mm in patients with generalized OA, and 0.96 mm in the matched normal reference population(79).

4. Congestive heart failure
Hypertension, diabetes, and older age have shown to increased risk of Congestive heart failure modestly(81). Etoricoxib, an annti-inflammatory painkillers showed a statistically significant inhibition at 90 mg in patients with osteoarthritis and rheumatoid arthritis(82).

5. Renal function impairment 
According to the Southampton University Hospitals NHS Trust, pain pharmacotherapies osuch as osteoarthritis (OA) or mixed OA and rheumatoid arthritis may increase the risk of adverse events in patients with concurrent cardiovascular (CV) or renal disease(83). Median excretion of pyridinoline and deoxypyridinoline in the OA patients as a whole was raised above values found in a healthy control population(84).

6. Diabetes
Several epidemiological and experimental data support the hypothesis that diabetes could be an independent risk factor for osteoarthritis (OA)(76)(85).

7. Respiratory disease
People with Respiratory disease is also at a higher risk to develop osteoarthritis (OA), such as chronic cough and bilateral infiltrates on chest roentgenogram(86).

8. High serum of Cholesterol
There is an association between high serum cholesterol level and both knee and generalized OA, according to the study of 113 females and 133 males with average ages 46 14.2 and 51.54 16.0 years by King Khalid University Hospital(87).

                   The Complications

The Most common complications for people with
1. Gout
The forming of sodium urate crystals forming in and around your joints, due to high levels of urate can result of inflammatory arthritis or gout(88)(89).
2. Chondrocalcinosis
The forming of calcium pyrophosphate crystals to form in the cartilage, due to  osteoarthritis (OA) can cause calcification(90)(91).

Other may also experience complications of 
1. Rapid, complete breakdown of cartilage due to  upregulating of syndecan-4  is found to associated to patient with osteoarthritis(92)(93). Inhibition of syndecan-4 may be used for the treatment of cartilage damage in osteoarthritis(93).

2. Osteonecrosis
Osteonecrosis, the result of bone death due to collapse of the architecture of bone, as the result of a number of conditions ultimately leading to an impairment of blood supply to the bone tissue(94), According to the study by Akita University Graduate School of Medicine, there is a relationship of subchondral bone collapse caused by osteoporosis, but not osteonecrosis, initiated the osteoarthritic change of the affected knee(96).
Probable bone formation was clear in the patients with osteonecrosis, and cartilage regeneration in the patients with osteoarthritis after injecting autologous adipose-tissue-derived stem cells, hyaluronic acid, platelet rich plasma and calcium chloride(95)

3. Stress fractures
The common complication found in 0.3%-0.8% of patients suffering from rheumatic diseases as a result of multifactorial overuse injuries(97), but Stress fractures of the tibia secondary to tibial deformities are rare from patient with osteoarthritis((98)(99).

4.  Bleeding inside the joint(100). 
5. Infection in the joint(101)(102) 
6. Osteoarthritis can cause deterioration or rupture of the tendons and ligaments around the joint of which can induce risk of instability(103).



                            The Diagnosis 

The aim of the diagnosis is to differentiate the diseases against other types of arthritis to avoid misdiagnosis and to rule out the other (secondary osteoarthritis)causes of osteoarthritis (OA)(104).
After taking the complex physical examination and careful exam the physical symptoms such as, joint swelling, Joint tenderness, decreased range of motion in joints, Visible joint damage, etc. some of the below tests may be necessary.
1. Blood Test
Although blood test is not necessary in many cases of osteoarthritis (OA), it can be helpful tool to rule other causes of the disease, including rheumatoid arthritis as it will indicate an inflammatory process(erythrocyte sedimentation rate (ESR, or sed rate) such as the presence of anti-cyclic citrullinate d peptide (anti-CCP) antibodies(105).

2. Synovial fluid analysis
Synovial fluid analysis is the test to exam the joint synovial fluid for conditions involving joint inflammation, pain, swelling, and fluid accumulation(106). Abnormal joint fluid may comprise abnormal amounts of detrimental bioactive proteins, temporary clearance, dilution or suppression/modulation as an indication of inflammation or osteoarthritis(107).
3. X-rays
X rays beside is one of the common used to diagnosed for findings of osteoarthritis (OA) such as abnormal joints, bone, joint space between adjacent bone, loss of joint cartilage, etc., Accordning to the Framingham study, according to radio graphics, the prevalence of meniscus damage in the knee of subjects with no, one to two, and three or more finger joints with OA was 24.9%, 31.7%, and 47.2%, respectively. X-rays can show damage, other changes associated to osteoarthritis and to confirm the diagnosis(108)

4. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is a more sensitive imaging method, it is used less often than x-rays due to cost and availability. In conjunction of X ray for Osteoarthritis (OA), MRI has been used increasingly in recent years through a meta-analysis of published studies, according to Tufts University, School of Medicine(109) MRI scans show cartilage loss, damage and defects, bone size, bone marrow lesions, bone expansion and damage to ligaments(110).

5. Etc.

The Misdiagnosis and delay diagnosis

Although musculoskeletal disorders is very common with irreversible damage due to osteoarthritis in elder found in evidences of all X ray, misdiagnosis is rare but it can happen. According to the Mount Sinai Medical Center, potentially reversible causes of  osteoarthritis for the problem are too often ignored, and a misdiagnosis of osteoarthritis prevents or delays effective treatment of the actual underlying problem(174).
According to Dr. O'Duffy JD., there was a diagnostic problems of rheumatic disease in patients over 60 years of age, including patient with osteoarthritis, and these problems can be prevent if the doctors have taken accounted the history and physical examination alone, with the laboratory and x-ray findings providing supportive evidence(175).

      The Prevention and management The Do and do not’s list

1. Prevention recurrent injure to damage menisci
The meniscus is an important tissue because if its function in shock absorption and load distribution in the healthy knee joint(111). A meniscal tear can lead to knee osteoarthritis (OA), but knee OA can also lead to a spontaneous breakdown of meniscal tear and damage to meniscal structure(112). Meniscus damage or recurrent injure might be considered as a signifying feature of incipient OA in middle-aged and elderly people(113).

2. Take precaution if your occupation is at increased risk of osteoarthritis
Osteoarthritis (OA) is one of the most important diseases as it frequently affects the active age group of the population contributed to loss of working hours and of disability(114)(115)(117). Compressive, torsional, pulling and angular movements common in certain occupations or sports may result in injuries of soft tissue, thus increasing the development of OA(116).

3. Muscle strengthening and aerobic exercises
Enhanced muscle strengthening with neuromuscular electrical stimulation(118), aerobic exercises(119) and exercice(220)  are effective in reducing pain and improving physical function in patients with mild to moderate OA of the knee(220).

4. Maintain a healthy weight(117)
Increased BMI and obesity are associated with more severe cartilage degeneration(121)(123) as assessed by both morphological and quantitative MRI measurements(122).

5. Avoid dehydration
Dehydration has shown to reduce the mobility of collagen amino acid residues and carbon sugar ring structures in glycosaminoglycans, according to University of Michigan(124) of that may effect the functions of cartilage and induce the risk of OA(125), but dehydration effects are reversible, through the restoration of molecular structure and mobility(124).

6. Avoid intake of inflammatory foods
Loading up on junk foods and fast foods contains high amount of trans fat of that increases the risk of inflammation(126) exhibit pro inflammatory effects(127)  causes of osteoarthritis (OA)(128). Red meat, eggs, and wheat products all contain high amount of arachidonic acid, too much arachidonic acid may be worsen the inflammation process(129), etc.

7. Eat your fruits and vegetables
Fruits and vegetables containning high amount of nutrients and antioxidant(130), can enhance immune defense system(131)within the joint through direct infleuences of transferrin performance for reduction of inflammation(131)(132) as well as suppressing free radicals and the chain of free radicals reaction cause of elevating the swelling and promoting degeneration(133)(134).

8. Replace regular beverage with green tea
Epigallocatechin-3-gallate, a green tea polyphenol(135)(136), was found to be effective in reducing inflammatory cytokines induced inflammatory diseases(137)(138).

9. Etc.


              The Prevention and Management Diet

The aims of the diet is to provide protection to avoid elevation of the inflammatory effects(139) in induced-degeneration causes of osteoarthritis(133)(134)
1. Green tea
Epigallocatechin 3-gallate (EGCG), according to the College of Pharmacy, found abundantly in green tea showed to exhibit its anti anti-rheumatic activity in patients with joint diseases(140) through its antioxidant property(141).

2. Salmon
Salmon is the common name for Salmonidae, born in fresh water, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within five years returning to the exacted location where they were born to reproduce and die.
a. Weight loss
Intake of salmon oil has shown to induce body weight loss in mice, according to the study by University of Washington(142). N3 long-chain polyunsaturated fatty acids (n3-LCPUFA) enhanced body weight loss, at the end of the 1-month period in 16 children through deduction of insulin resistance(143).

b. Antioxidants
Megadoses of vitamin E, found in salmon oil exhibited pro-oxidative activity, through increased the anti-oxidative capacity of the liver(144).

c. Omega 3 fatty acids
Omega 3 fatty acids is necessary to maintain the ratio of good and bad cholesterol(145), thus reducing the risk of cholesterol inflammation(146)(148) cause of heart diseases (147) and osteoarthritis(133)(134).

d. Anti inflammation
Omega 3 fatty acids not only reduces the risk of inflammatory effects on our joints and improved blood flow(149), by regulating the migration of inflammatory cells(139), but also reduce the elevation of the proinflammatory leukotriene LTB(4) causes of autoimmune diseases(150).

3. Walnut tree
Walnut tree, cultivated for its nut and kernel and for commercial purpose all over the world, is one of the Genus plant belong to the family Juglandaceae about 30–130 ft).
a. Antioxidant effects(151)(152)
Even-though walnuts consumption did not only significantly change the plasma antioxidant capacity of healthy, well-nourished older adults through its polyphenols in inhibitiobn plasma and LDL oxidation(151) but chronic consumption, it improved postprandial serum antioxidants and biomarkers of oxidative status(152) through its antioxidant linoleic acid and pyridoxal phosphate in enhancing total plasma thiols(151).

b. Inflammation defense(153)
Intake of walnuts is shown to promote manganese superoxide dismutase (MnSOD), an enzyme located in mitochondria(154), is the key enzyme in protection of the energy-generating mitochondria from oxidative damage caused by free radicals(155).

c. Diabetes risk
Adiponectin found abundantly in walnut-enriched meal plays an important causal role in insulin resistance and metabolic syndrome(156). Diabetes in older adult is shown to associate increased risk of osteoarthritis(157).

4. Dulse
Dulse, commonly used in Ireland and Atlantic Canada both as foods and medicines, is a red seaweed of genus Palmaria, belong to Family Palmariaceae grown attached to rocks by a “holdfast” in the North Atlantic and Northwest Pacific. Dulse is found in many health food stores or fish markets or can be ordered directly from local distributors.
a. Health benefits
Seaweeds, including dulse, showed to consist a important functional activities, such as antioxidant(158)(160)(161), antimutagenic(159)(162) and anticoagulant effect(160), antitumor activity(160), and modification of lipid metabolism(161).
b. Antioxidants
Dulse extracts showed to inhibit certain lipid peroxidations(162).
c. Weigh loss
As a rich source of fiber, dulse enhances the process of digestion, for making the stomach feeling fullness, thus reducing the risk of insulin cause of food craving(163).

5. Lime (Lemon)
Lime, a around shape with green to yellow in color and 3–6 cm in diameter, is a species of Citrus Aurantifolia, belongs to the family Rutaceae, native to Southeast Asia.
a. Antioxidant
Lime flower extract may contain high levels of antioxidant(164)(165) but lesser than the ethanol extract of cinnamon(166).
b. Vitamin C
Besides preventing the breaking off small vein cause of hardening of the vessel wall(167), vitamin C also improves the digestive system in maximum absorption of vital nutrients and plays an important role in enhancing immune system fighting against the forming of free radicals that cause muscle damage(168). According to the University of Limerick, prior supplementation with dietary antioxidants, such as vitamin C and E may ameliorate muscle functional decrements subsequent to eccentric muscle contraction(169).

6. Dairy Products
Dairy products contain high amount of nutrients, it also has measure amount of vitamin D of which is necessary for the body in calcium absorption(170). Intake of dairy products per day, according to joint study including Université Libre de Bruxelles appears to be safe and may confer a favourable benefit with regard to bone health, such as osteoarthritis(172), rheumatoid arthritis(170).
In elderly Fracture risk, according to the Geneva University Hospitals and Faculty of Medicine, improved bone growth is influenced by dietary intake, particularly of calcium and protein such as Dairy products, yogurts are essential to achieve optimal peak bone mass during skeletal growth and to prevent bone loss(171).  Recommendation of consuming 3 servings of dairy products per day during childhood and adolescence, has shown to improve bone health and reduce the risk of fractures in later life(171).
In the observation of  a significant dose-response relationship between baseline milk intake and adjusted mean decrease of JSW in women, researcher at the Brigham and Women's Hospital and Harvard Medical School, Boston, showed that frequent milk consumption may be associated with reduced OA progression in women and delay in knee OA progression(173).



       The Prevention and Management Antioxidants

1. Immune system and functioning (Free radical scavengers)
Free Radicals play an important role in the function of the Immune System. The immune system produces free radicals to kill foreign microbes(176)(177), but the production of free radical sometime can be excessive, leading to formation of a large number of free radicals(178)(179). The domino effects have shown to induce many chronic illness, such as cancers(179)
a. Vitamin A
vitamin A plays an essential roles in enhancing a broad range of immune processes, including white blood cells activation and proliferation(180)(181)of T-helper-cell differentiation, the production of specific antibody in regulation of the immune response(182).
b. Vitamin C
Researchers found that vitamin C raised the concentration in the blood of total immunoglobulin(183) in promotion of the ability of antibodies and phagocytic cells to clear pathogens(184).
c. Vitamin E
Vitamin E not only increased both cell-dividing and IL-producing capacities of naive T cells(185) but also enhanced the immune functions(186) in association with significant improvement in resistance to influenza infection(187).
d. Zinc
Zinc, having a regulatory role in the immune system,(189) as a antioxidant is essential mineral improved immune system by enhancing the proper function of T and B cells(188) which belong to a group of white blood cells known as lymphocytes, in fighting against damaging free radicals(190).

2. Antioxidants and osteoarthritis
Diet included  vitamin E significantly reduce the levels of inflammation by analyzing the pro and anti-inflammatory cytokines in the blood serum(193). According to the study of "Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis", vitamins A, C, and in combination; ginger; turmeric; or Zyflamend (New Chapter, Brattleboro, Vermont) have found to be effective for the treatment of OA(191). According to Dr. Christensen R, and DR.  Bliddal H. food supplement containing fish oils, urtica dioica, zinc, and vitamin E (Phytalgic) may also have a very large clinical effect, for treatment of OA(192)

b. Glucosamine
Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, is a precursor for glycosaminoglycans(194), a major component of joint cartilage(195). Treatment of glucosamine sulfate, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, or nutrients, such as antioxidants and omega-3 fatty acids showed to prevent cartilage degeneration and treat arthritis, according to study(195).

c. DLPA (dl- phenylalanine)
DLPA, a mixture of D-Phenylalanine and L-Phenylalanine, is a nutritional supplement amino acid(196). showed effectively in treatment for OA (197) as well as  reducing arthritis pain(198) and joint inflammation(198) in many patients.

d.  Methylsulfonylmethane, also known  DMSO2 is an organosulfur compound with the formula (CH3)2SO2
In a randomized, double-blind, placebo-controlled trial of Fifty men and women, 40-76 years of age with knee OA pain enrolled in an outpatient medical center. MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events, after 12 weeks(199)(200)

3. Etc.


     The Prevention and Management Phytochemicals 
  
1. Epigallocatechin including catechins, found abundantly in green tea, St John wort, black Tea, carob flour, Fuji apples, etc. is a phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols)
EGCG has shown to slow the progression of OA and relieve OA-associated pain in a mouse model study of research team lead by Dr. Daniel J Leong(201).
a. Inflammatory effects
Catechins might be useful therapeutically as an anti-inflammatory modulator of dental pulpal inflammation(203), through up-regulated expressions of IL-8 in fighting against infection or PGE(2) in response to infection or inflammation(202).

b. Antiviral activities
(-)-epigallocatechin (EGC) and green tea extract (GTE) inhibited the cytopathic effect of coxsackie B3 virus, but did not inhibit the cytopathic effects of HSV-1, HSV-2, influenza A or influenza B viruses(203(204).

c. Antioxidants
Polyphenolic components extracted from green tea leaves, exhibit antioxidative effects against free radical initiated and peroxidation of human low density lipoprotein(205)(206).

2. Catechin is phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in white tea, green tea, black tea, grapes, wine, apple juice, cocoa, lentils, etc.
a. Body-weight regulation
Green tea-caffeine showed to exert its hypolipidemic and antiobesogenic effects through  regulate peroxisome proliferator-activated receptors (PPARs) in the effect on lipid metabolism and obesity(207). The Ewha Womans University study also support the above result in weight reduction but through genes expression(208)It mixture improves weight maintenance, through thermogenesis, fat oxidation, and sparing fat free mass(209).

b. Antioxidant activity(210)(211)
Polyphenolic compounds (included catechins) in the berries of edible honeysuckle, including proanthocyanidins, catechinsexhibit the beneficial anti-adherence and chemo-protective activities in against a number of chronic conditions, e.g., cancer, diabetes mellitus, tumour growth or cardiovascular and neurodegenerative diseases, according to the study by Constantine the Philosopher University in Nitra(212).

c. Anti-inflammatory effect
Polymeric tannins and monomeric flavonoids, such as catechin and epicatechin found in green tea showed to exhibit anti inflammatory effects(213) through interfere with immunobiochemical pathways that are highly relevant for immunosurveillance and competing virus infections(213).

3. Theaflavin is phytochemicals of Flavan-3-ols, in the group of Flavonoids (polyphenols) found abundantly in black tea.
a. Antioxidant capacities
Theaflavin-3′-gallate (TF(2)B), a derivative of theaflavin exhibits positive antioxidant capacities on singlet oxygen(214), hydrogen peroxide(215), hydroxyl radical(216), and the hydroxyl radical induced DNA damage in vitro(214).
b. Antimicrobial activities
Plant polyphenols, including Theaflavins have exhibited anti microbial activity against several food-borne pathogenic bacteria(217) and growed in Mueller-Hinton medium(218).In the evaluation of the antimicrobial activities of seven green tea catechins and four black tea theaflavins, including (-)-gallocatechin-3-gallate, (-)-epigallocatechin-3-gallate, (-)-catechin-3-gallate, (-)-epicatechin-3-gallate, theaflavin-3, 3′-digallate, theaflavin-3′-gallate, and theaflavin-3-gallate exhibit antimicrobial activities, better than medicinal antibiotics, such as tetracycline or vancomycin, at comparable concentrations(218).
c. Anti inflammation
The major polyphenolic compounds in black tea leaves are theaflavins strongly inhibited TPA-induced edema of mouse ears, through its anti inflammatory activity(219).

4. Myricetin is a flavonol, belong to the flavonoid in Flavonoids (polyphenols), found in many grapes, berries, fruits, vegetables, herbs, as well as other plants. It has been used as antioxidant to lower cholesterol, treat certain types of cancer, etc.
a. Antioxidant and cytotoxic activity
Extracted from plants containing phenolic compound, including flavonoid-galloyl glycoside [myricetin 3-O-(2',3'4'-tri-O-galloyl)-α-l-rhamnopyranoside] exhibited high antioxidant activity(220)(221) and cytotoxic activity(222) against Hep G2 and hepatocellular carcinoma(220).
b. Antitumour and anti-inflammatory activities
On mammary tumour cells LM2, myricetin may be a promising agent in the treatment of murine breast cancer by immunomodulatory and antiproliferative activities due to its inhibitory activity to the release of NO(223). According to the study by  East China Normal University, the phytochemical Myricetin also consist anti obesity and anti anti inflammatory activity(224)

5. Cyanidin is an anthocyanins (flavonals), in the group of Flavonoids (polyphenols), found abundantly in red apple and pear, bilberry, blackberry, blueberry, cherry, cranberry, peach, plum, hawthorn, etc.
a. Antioxidants
In menopausal women, intake antioxidants has shown to reduce the level of OS. Blackberries (BBs) containing mainly cyanidin 3-O-β-d-glucoside (C3G) exhibit its antioxidant effect in preventing bone loss in  rat model(225). According to the joint study by Wonkwang University, Cyanidin-3-glucoside (C3G) is one of the major components of anthocyanin, a water-soluble phytochemical, may be a potential antioxidant for prevention of bone-related diseases, such as osteoporosis, rheumatoid arthritis, and periodontitis(226)

b. Anti-inflammatory Effects
According to Kyung Hee University, cyanidin-3-O-beta-D-glycoside express potent anti-inflammatory effects by regulating NF-kappaB pathway(228). Its polyphenolic-enriched red raspberry extract, containing Cyanidin-3-glucoside (C3G) one of the major component of  anthocyanin decreases in the rate of degradation of both proteoglycan and type II collagen as well as inhibition of inflammation, pannus formation, cartilage damage, and bone resorption(227).

c. Obesity
Cyanidin-3-O-β-glucoside (Cy-3-g)-rich foods inhibited the onset of obesity, partly related to the activation of skeletal muscle lipoprotein lipase(LPL), and inhibition of LPL in adipose tissue(229)(230).
6. Etc.


                                             Treatment

A. In conventional medicine perspective
A.1. Physical Activity
According to the center for diseases control and prevention recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week, including daily flexibility exercises to maintain proper joint range of motion and do balance exercises in patient with osteoarthritis(231). According to the study by University of Manitoba, 12 week lower body positive pressure-support low-load treadmill walking program in patients aged between 55 and 75 years, improved  knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA) and consider as a safe user-friendly mode of exercise used in management of day-to-day joint symptoms associated with knee OA(232)(233). Other studies insisted that the same program showed a significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee(234). Stretching gently on joints may improve flexibility, lessen stiffness and reduced pain. In a study of Low-level laser therapy (LLLT) and stretching exercises, researchers found that LLLT can be used as resource to increase the effects of physical therapy(237).

A.2. Weight management
Over weight and obesity are found to be associated to increased risk of osteoarthritis to elder. According to studies, Over weight and obesity  can lead to more severe cartilage degeneration(121)(123) as assessed by both morphological and quantitative MRI measurements(122).
According to the study by University of California San Francisco, in the study of 127 individuals with risk factors for knee OA, 62 subjects with a body mass index (BMI) decrease≥10% found to associate to a slower progression of T2 values in individuals with risk factors for OA,(235).

A.3. Medication
The aim of the treatment is to relieve symptoms of the disease
1. Acetaminophen
a. Acetaminophen such as Tylenol can help to relive the pain of Osteoarthritis. In the study to Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. Both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state(238)(239).
b. According to RX(241) list side effects are not limit to
b.1. Nausea(239) and vomiting(240)
b.2. Appetite loss(241)
b.3. Itching(241)
b.4. Diarrhea
b.5. Dark urine(241)
b.6. Abdominal pain(241)
b.7. Constipation(239)
b.8. Others may include sedation, urinary retention, pruritus and/or respiratory depression(240).

2. Nonsteroidal anti-inflammatory drugs (NSAIDs).
a. The use of the medicine should be taken into account of in cost effectiveness, adverse event data and individual cardiovascular and gastrointestinal risks(242).
b. Side effects are not limit to
According to King’s College School of Medicine and Dentistry, nonsteroidal anti-inflammatory drugs may cause(243)
b.1. A nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs.
b.2. Large intestinal ulcers, bleeding, and perforation
b.3. Relapse of classic inflammatory bowel disease
b.4. Serious complications of diverticular disease (fistula and perforation)
b.5. Small intestinal perforation, ulcers, and strictures requiring surgery
b.6. Specific biochemical and subcellular organelle damage(243).
The University of Sydney insisted that the drug may also cause enteropathy(244).


3. Narcotics
Narcotics are natural opioid drugs derived from the Asian poppy may provide relief from more severe osteoarthritis pain(245), with additive effect(246).
b. According to NIH, the side effects(247) are not limit to
b.1. Risk of dependence
b.2. Dizziness and drowsiness
b.3. Nausea and vomiting
b.4. Headache and fatigue
b.5. Others include
Yawning, insomnia, restlessness, mood swings, diarrhea(247)


A.4.. Non medication therapy
Non medication therapies such as
1. Physical therapy or physiotherapy
Physical therapy is the form of medical rehabilitation for develop, maintain and restore maximum movement and functional ability for patients caused by injure, aging and other external factors such as diseases(250). In knee osteoarthritis, according to The University of Melbourne, more research may be needed to support the claim, physiotherapy interventions has shown to reduce pain and improve function in those with knee OA(249). But according to the joint study by the University of Melbourne, University of Otago and Monash University, physical therapy dose not result in greater improvement in pain or function than other treatment such as sham treatment in patients with hip osteoarthritis(248).

2. Occupational Therapy 
According to the Canadian Association of Occupation Therapists, Occupational therapy is the form of treatment involved evaluating and improving a persons functional abilities of a specific age group or disability such as arthritis, developmental coordination disorder, mental illness, or spinal cord injury, etc...(251). But some research suggested that patient should be encouraged to change of lifestyle to achieve a optimal self-managing the effects and symptoms of OA(252).
Unfortunately, according to the University of Alberta, the implication for Rehabilitation Pain gasp has not been focused in training programs in occupational therapy education even it is a prevalent condition in all age groups(253). Some research in regarded to occupation therapy in treatment of hand exercise in osteoarthritis, insisted that high-quality studies are necessary to establish a strong and sound of evidences in concerning functional assessment and the effect of hand exercises in hand osteoarthritis(254).

In need, depending to the individual needs, including patients education and self-management programs. Weight loss may be necessary if the osteoarthritic patient is overweight(255); physical therapy may also be needed for muscle strengthening with aerobic conditioning(256)(257) and tai chi exercise(258) with improving pain and function in people with OA, depending to the disease severities(258), etc.

Exercise therapy may be beneficiary for treatment of pain in patients with OA(259), but when it is used in conjunctions with other forms of therapies such as strength training and exercise with additional passive manual mobilisation, the combination has found to achieve better pain relief in patients with knee osteoarthritis(260), according to the study by Maastricht University

Manual therapy on the other hand, is more effective than exercise for those with hip OA in the short and long-term(261). Unfortunately, in the  investigate the addition of manual therapy to exercise therapy for the reduction of pain and increase of physical function in people with knee osteoarthritis (OA), researchers at the showed that combined strategy of exercise therapy plus manual therapy with booster sessions was not superior to exercise therapy alone in patients with knee osteoarthritis(262).

A.5. Surgery
Surgery only necessary if symptoms persist, depending on several factors, including the location and severity of OA damage, patient characteristics and risk factors.(265).
1. Arthrocentesis plus corticosteroid
Arthrocentesis is a medical procedure to remove joint fluid with a sterile needle for analysis through injection of corticosteroids into the joints to relieve pain, swelling, and inflammation. According to Regions Hospital, there is a reluctance of surgeon to perform such operation in patient who are receiving anticoagulation at therapeutic levels(263).
According to the Mayo clinic, cortisone shots overdoses can cause joint damage(264).

2. Arthroscopy
Arthroscopy is a minimally invasive surgical procedure to examine and treat the abnormalities of and damage to the cartilage and ligaments through the arthroscope. It is considered as one of the standard interventions with low potential for complications for patient with knee osteoarthritis(265) and ankles, shoulders, elbows, wrists and hips osteoarthritis(266).

3. Lubrication injections
Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) are recommended only to patients who have not found adequate pain relief in conservative treatment(268).
Platelet-rich plasma (PRP) contains high concentrations of autologous growth factors that originate from platelets influences the production of SZP from human joint-derived cells, has shown effectively in treatment of osteoarthritis or damage in the knee joint. or damage in the knee joint, according to the study by University of California(267).

4. Realigning bones
Osteotomy is a surgical procedure used to realign bones, cartilage and reposition the joint to reduce knee pain by shifting your body weight away from the damaged cartilage(269). Osteotomies about the hip may be used for the prevention and treatment of osteoarthrosis(270), only if the mechanical causes of the potential or established osteoarthritis is clear and the operation succeeds in reducing the pathologically excessive joint loads(271).

5. Joint replacement
Joint replacement is a surgical procedure of orthopedic surgery to relief pain and to place the damaged joint surfaces(272). Over 1 million surgical procedure have been perform in elective total knee and hip replacements annually in the United States alone(273). According to study, over 70 % of patients who received rapid mobilization of total joint replacement patients recover safely and reduced the overall length of hospital stay(274).

Joint replacement is considered as a treatment only for patients with severe joint pain or dysfunction that can not be alleviated by non  invasive treatments. But, according to Odense University Hospital, hip replacement can be postponed in patients with severe hip osteoarthritis if patients  participate in a education and supervised exercise program(275).

6. Etc.


B. In herbal  and traditional Chinese medicine perspective
B.1. Life style modification according herbal and TCM medicine specialist
Life style modification has shown to be beneficiary for patients with osteoartritis to improve musculoskeletal and bone health and reduce disability,according to the University of Tasmania(276). Modern herbal and TCM medicine specialists may suggest the following
1. Lose some weight
Over weight and obesity are found to associate the risk factors and risks of rapid progression of the disease(277)(278). In the discussion of obesity versus osteoarthritis, Dr. Sartori-Cintra AR and the research team at  Universidade Estadual de Campinas, indicated that obesity is associated to wide range of diseases, such as osteometabolic diseases, including osteoporosis and osteoarthritis and suggested that physical activity combined with changes in diet composition can reverse the inflammatory and leptin resistance, reducing progression or preventing the onset of osteoarthritis(236).

2. Exercise
Exercise, today is less popular leisure-time activity in many countries throughout the Western world, especially in the youth due to promotion of information collection through mobile phone. According to study, moderate exercise, reduced the risk on the onset and progression of osteoarthritis joint disease(279). According to Boston University Arthritis, habitual physical activity post no risk of knee OA for men or women, during the 18th biennial examination (1983-85), in the study of 1,415 subjects had a mean age of 73 years(279). Walking is found to be the most preference of aerobic exercise tested in the older with knee osteoarthritis, depending to the distance, walking distance improves 26%, 31%, and 15% of pain and physical function, according to Dr.Stephen P. Messier,
Ph.D(280).
Combination of weight loss and exercise in older adults with knee osteoarthritis showed to improve level of leptin of which related to the biomarkers for earlier diagnosis in patient with OA(281).

B.2. Diet modification according herbal and TCM medicine specialist
1. Top foods to reduce risk of inflammation
Low-grade inflammation has found to play a pathophysiological role in OA, according to Dr. Jeremy Sokolove, Dr. Christin M. Lepus, OA is tightly linked to joint damage, the immune response to such damage, result of  chronic inflammation causes of propagation and progression toward the disease(282).
According to Medical University Innsbruck, the relationship between diet, immunity, and the microbiota, may be necessary for us to rethink of the develop diet-based approaches to prevent or treat many diseases(283).
1. 1.Garlic
Garlic (Allium sativum) is a species in the onion genus, belongings to family Amaryllidaceae, native to central Asia, used popularly in traditional and Chinese medicine to treat common cold and flu(306), strengthen immunity(292), etc.... Recent studies also showed that garlic exhibits its anti-inflammatory effects against chronic inflammatory disease(284) through phytochemical allicin(285) and other mechanisms(286).

1.2. Ginger
Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belongings to the family Zingiberaceae, native to Tamil, used in traditional and Chinese medicine to treat rheumatoid arthritis(291) and osteoarthritis(287) through its anti inflammatory, antioxidant and immune-modulatory effects(288)(289)(290), speed up wounding healing(290)(291), etc.

1.3. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belongings to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as anti-oxidant(293)(294), anti inflammations(295), etc. agent. Epidemiological studies also found that the efficacy of turmeric for treatment for low grade inflammatory diseases through its anti inflammatory(295)(296), antioxidant(297)(298) and immunmodulatory(299)(300) activities.

1.4. Green tea
Green tea contains more amount of antioxidants than any drinks or food with 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, green tea has been cultivated for commercial purposes all over the world. Epidemiological studies suggested that green tea  induced weight loss(301)(302), improved chronic inflammatory diseases through its antioxidant(303)(304), anti inflammatory(305)(306) and immune modulatory(307)(308) activities.

1.5. Shiitake mushrooms
Shiitake mushroom is an edible mushroom, genus Lentinula, belonging to family Marasmiaceae, native to East Asia and widely cultivated for consumption for its health benefits and commercial purpose in many Asian countries. Recent studies showed that Shiitake mushrooms are also consisted properties of  enhanced immune system(309)(310)(311) against inflammation(312)(313) causes of chronic inflammatory diseases(314), etc..

2. Cold water fish Salmon
Salmon is the common name for Salmonidae. They are anadromous, born in fresh water, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within to five years returning to the exacted location where they were born to reproduce and die.

Nutrients
1. Protein
2. Omega-3 fatty acids
3. B vitamins
4. Vitamin D
5. Astaxanthin
is a potent antioxidant that stimulates the development of healthy fish nervous systems and enhances the fish's fertility and growth rate.
6. Selenium
7. Tryptophan
8. Magnesium
9. Phosphorus
10. Etc.

Intake of salmon calcitonin, a hormone produced by the thyroid gland of salmon or a synthetic polypeptide of the same sequence found in salmon(360) has shown to reduce OA pathogenesis and bone resorption, according to the study of 10 7-month-old female Sprague Dawley rat model by Nordic Bioscience A/S at Danmark(354) and counteract of type II collagen (CII), degradation and related surface erosions of articular cartilage in ovariectomized rat model(355), probably through the effects of subchondral trabecular bone changes and on osteoarthritic cartilage lesions(356). The change of both markers of bone and cartilage degradation in osteoarthritis has made salmon calitonin a potential new treatment opportunities for OA(358).
In treatment of symptomatic knee osteoarthritis, intake of salmon calcitonin showed an effect on sum of pain, function, stiffness, and total scores, the biomarkers of bone and joint metabolism but not in patients with symptomatic knee OA(357), according to 2 phase of 3 trials study by Nordic Bioscience, Denmark.
According to the Université Catholique de Louvain, oral salmon calcitonin, also improved functional disability and reduced levels of biomarkers of which can predict of joint space narrowing induced cartilage loss(359). 
The high amount of Omega 3 fatty acid also make salmon of the dietary nutrients for the modulation of inflammation and metabolic health including prevention reduced risk of progression of osteoarthritis(361).

3. Nuts and seeds Olive
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.

Olive Oil: Fat Content
1. Saturated fats
a. Palmitic acid
b. Stearic acid
c. Arachidic acid
d. ehenic acid
e. Myristic acid
f. Lignoceric acid
2. Unsaturated fat3. Monounsaturated fats
a. Oleic acid
b. Palmitoleic acid
3. Polyunsaturated fats
a. Linoleic acid
b. Linolenic acid

Monounsaturated fatty acids found abundantly in olive oil, may be beneficiary for reduced inflammation(362) and expression of lubricin to preserve the articular cartilage and then the entire joint, in rat model(362), as well as improving the disease associated loss of weight(363), such as osteoarthritis.
In a pilot double-blinded, randomized, clinical trial of topical virgin olive oil versus piroxicam gel in osteoarthritis of the knee, conducted by Ardabil University of Medical Science, researchers showed that the use of  olive oil in the experiment is more effective than medical gel for knee osteoarthritis, probably due to its phytochemiocals oleuropein and hydroxy tyroso(364).
Other in the study of fruit and vegetable antioxidants of simple and polyphenols, showed that olive vegetation water (OVW) and its combination with glucosamine exhibit anti inflammatory processes, and may be considered as an effective therapyfor treatment of rheumatoid and osteoarthritis(365).In mechanical inflammatory arthritis (osteoarthritis, OA), The Olive leaf extract (OLE) also inhibit inflammatory process, including ear edema, myeloperoxidase (MPO) production, and may be beneficiary for the treatment of OA in humans(366).

B.3. The Preventive Minerals and Vitamins
1. Minerals for osteoarthritis
Certain minerals such as calcium(316)(317), magnesium, selenium, zinc, and iron; may be a good sources of pain reliever for patient with osteoarthritis, according to the studies(325). According to the randomized to four double-blinded treatments for 12 weeks by Minnesota Applied Research Center, Glucosamine sulfate (1500 mg/d), Aquamin (2400 mg/d) and Combined treatment composed of Glucosamine sulfate (1500 mg/d) have shown effectively in improvements in symptoms of pain and stiffness of osteoarthritis(315).
1.1. Calcium
The osteoporosis association of Canada recommended at 3 serving of milk and alternative serving of yogurt, cheese, calcium-fortified beverages, puddings, custards, etc for 50 plus elder(318). In deed, as we get older the function of replacement of osteoclasts in any areas of damaged or weakened bone are slower due to reduced process of  bone remodelling(319) of which may involve the utilization of body in calcium aborption(319).

1.2. Magnesium
According to the study by Central South University,dietary magnesium (Mg) of elder patients is associated to reduce risk of radiographic knee osteoarthritis (OA), joint space narrowing (JSN)(320), especially in white population(321).
According to joint study lead by Dr. Zeng C, Serum Magnesium Concentration is found to be deficient in patient with osteoarthritis(322). In deed, patient with osteoarthritis is found to have a decreased bone levels of Mg, in comparison of radiographic bone density and bone mineral density (BMD) in patient with Musculoskeletal disorders (MSDs)(323),

1.3. Selenium
In male STR/1N mice model, dietary selenium and other vitamins not only  is found to have an decreased risk of osteoartritis, OA, but also play an important role in prevention or therapy of mechanically induced OA(324). In deed, according to the joint study by College of Medicine of Xi'an Jiaotong University, alterations in selenium metabolism and apoptosis due to inability of MYC mediated metabolism and apoptosis signaling pathway may contribute to the pathogenesis of KBD, a special type of endemic osteoarthritis(326). Patient with osteoarthritis is found to have a low level of  selenium in comparison to osteopororsis(323).

1.4. Zinc
Zinc may plays an important role for the development of osteoarthritis, according to Randers Regional Hospital, patient with osteoarthritis are found to have significantly higher serum zinc concentrations and lower urine zinc concentrations in comparison to patient with osteoporosis(327).
High level of zinc in patient with osteoarthritis may be a influence of  bone turnover and femoral head bone density and biomechanical properties(328).
In the inflammatory effects, according to the Harran University, plasma trace element concentrations do not exhibit change in immunoregulatory cytokines in OA patient(329).

1.5. Copper
Used topical Copper-salicylate gel has shown to relief pain for patients with the hip or knee osteoarthritis with side effects of more skin rashes(330). Other topical Cu-Indo gel has shown effectively against joint inflammation in the MIA-treated rat model of osteoarthritis(332). 
In a comparison of caeruloplasmin-bound copper in serum copper levels in 49 patients with active rheumatoid arthritis, in 33 patients with osteoarthritis, research found that caeruloplasmin-bound and non-caeruloplasmin bound  are  both elevate in serum copper levels in the rheumatoid group, as compared to patient with osteoarthritis(331).

1.5. Iron
Reduced in take of rich iron dietary foods and supplements may be necessary for patient with with osteoarthritis and rheumatoid arthritis, according to studies, synovial iron deposition is found to associate to patient with osteoarthritis and rheumatoid arthritis(334). Hereditary hemochromatosis (HH), a hereditary disease cause of excessive intestinal absorption of dietary iron, may have a contribution to the synovial iron overload in induction of the progression of HH-related OA(333).

2. Top vitamins for osteoarthritis
According to Anatomisches Institut der CAU zu Kiel, Olshausenstr, diet supplemented with the vitamins E, C, A, B6, B2, play an important role in prevention or therapy of mechanically induced OA, due to the effects of their antioxidant activity(335).
3.1. Vitamin A
Intake of free radical scavengers and antioxidants such as carotenoids have been known for influence the development and progression of osteoarthritis (OA)(339), according to the Nagoya University Graduate School of Medicine, high serum values of beta-/gamma-tocopherols (Vitamin A) were found to be significantly associated with a reduced risk of OR for radiographic kneeosteoarthritis(338). In Race differentiation, according to the University of North Carolina at Chapel Hill, radiographic kneeosteoarthritis and tocopherol isoforms are complex and may vary by ethnicity and sex(340).

3.2. Vitamin C
In a case-control study enrolled 180 knee osteoarthritis (KOA), Low intake of dietary vitamin D and vitamin C has shown to induced a high risk factor of KOA(344)Vitamin C as an antioxidant has shown to reduce oxidative stress causes of dysfunction in chondrocytes and articular cartilage degradation in patient with OA(342) induced by H2O2 by regulating multiple regulatory pathways(341). Intake of vitamin C supplement has reduced risk of OA incidence but not in decreased progression of knee in patient with OA(343).

3.3. Vitamin E
In comparison of the effectiveness of vitamin E and B vitamin in patient with knee OA, Dr. Dehghan M said "decrease in total pain severity was reported higher in B vitamin group than E vitamin"(336).
In the study of the pro-oxidant and antioxidant status in patient with OA, high levels of serum of vitamin E is associated to reduced risk of oxidative stress causes of osteoarthritis through regulation in response to increased oxidative stress(345). The study of total otal cartilage degeneration in rat models, also insisted that Vitamin E expressed not only in hondroprotective activity but also exhibited a beneficial effects of HA on articular cartilage(346).
Unfortunately, a double blind, placebo controlled trial, 136 patients with knee OA  from American College of Rheumatology clinical and radiographic criteria did not support the beneficial effect of Vitamin E in the management of knee OA, in improved cartilage volume loss or symptoms(347).

3.4.Vitamin D
Vitamin D is associated to the development and progression of osteoarthritis, as l dietary vitamin D intake increases the risk of progression of knee ROA, effecting the bone density(348). Vitamin D deficiency also has found to induced risk of progression(349) and worsening of knee osteoarthritis in patient(350). According to the study of a total of 880 randomly selected subjects (mean age 61 years [range 51-79 years], 50% women) at baseline, conducted by the University of Tasmania, sunlight exposure and serum 25(OH)D levels are found to associate with decreased knee cartilage loss(351).
In deed, Other vitamin such as vitamin D is found to modify disease progression in knee OA, through
reduce knee pain, loss of knee cartilage volume, risk knee structural abnormalities and strengthen lower limb muscle strength(337).

3.5. B vitamin
According to the Shahrekord University of Medical Science, in the studyof mean score of WOMAC questionnaire at VASs of knee pain, total pain severity, knee joint stiffness, showed that the B vitamin decrease stiffness in knee joint(352). In deed, high consumption of the mixture of B vitamins and diclofenac have been found effectively in reduced pain and inflammation for patient with osteoarthritis and used in a total knee arthroplasty(353).

B. 4. The Supplements for osteoarthitis
1. Glucosamine
Glucosamine, a compound of the simple sugar glucose and the amino acid glutamine, is a precursor for glycosaminoglycans(194), a major component of joint cartilage(195). Treatment of glucosamine sulfate, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, or nutrients, such as antioxidants and omega-3 fatty acids showed to prevent cartilage degeneration and treat arthritis, according to study(195).

2. Chondroitin
Sulfated glycosaminoglycan (GAG), found in cartilage around joints in the body id a chemical composed of alternating sugars (N-acetylgalactosamine and glucuronic acid).
The chemical compound has been used as nonsteroidal anti-inflammatory drugs for treatment of osteoarthritis by it self or combination with viscosupplementation, according to study(367).
The comparison of piascledine 300 and chondroitin sulfate for treatment of knee osteoarthritis study, also insisted that  3 capsules chondroitin sulfate per day or one capsule of avocado soybean unsaponifiable (ASU) improved the WOMAC-index decreased in both groups for approx. 50% to the end of therapy(368).
According to the Birmingham VA Medical Center, chondroitin, reliefs pain for patient with knee osteoarthritis with little adverse effects when compared with control(369) and its combination  with glucosamine showed a greater effect in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis(370)(371),

3. Avocado soybean unsaponifiables (ASU)
 Avocado soybean unsaponifiables (ASU) is a natural vegetable extract composed of  one-third avocado oil and two-thirds soybean oil, may be used effectively for treatment of knee osteoarthritis to replace the use of analgesics and nonsteroidal antiinflammatory drugs (NSAIDs), according to the three-month, prospective, randomized, double-blind, placebo-controlled, parallel-group trial(372).  In patients with symptomatic osteoarthritis (OA) of the knee or hip, The extract inhibited functional disability, especially for patient with hip OA(373).
According to the Erasmus University Hospital of Brussels, daily intake of 300mg or 600mg of ASU, reduced intake of NSAIDs and analgesics by more than 50% in 71% in patient aged 45 to 80 years with femoro-tibial knee osteoarthritis(374) and improved symptoms of patients with OA of the knee and hip, according to the Universities of Exeter and Plymouth, Devon(375) probably through modulating OA pathogenesis by inhibiting a number of molecules and pathways(376), such as preventing the osteoarthritic osteoblast-induced inhibition of matrix molecule production in induced cartilage repair (377),

B.5.. Topical Remedy
1. Topical Ginger 
Ginger, one of the herbal medicine used as cooking spice and best known for its treatment in warming the stomach, use as topical remedy, it has been found to consist the potential for treatment of osteoarthritis, 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).

2. Capsaicin cream
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).

B.6.  Electrostimulation
Use of electricity for treatment of pain, muscle dysfunction and sarcopenia can be dated back to Ancient Egyptians and later the Greeks and Romans(421). According to the Abteilung für Physikalische Medizin und Rehabilitation, transcutaneous electrostimulation may be effectively and positively in influence of pain and function, mobility, and quality of life in patients suffering from OA(422). Unfortunately, in the review of 14 trials resulting in the inclusion of 18 small trials in 813 patients, found that electrosimulation does not offer pain relief for effective for pain relief. for patient with osteoarthritis of the knee with the relative droping out rate as high as 95%(423).


B.7. The alternative natural treatment 
Beside suggesting certain herbal medicine for treatment of osteoarthritis, modern herbal and TCM medicine doctors may also combine other natural treatment for alleviating symptoms of the disease
1. Use Ice or Heat Therapies therapy
Ice therapy such as repeated, rather than continuous, ice applications may be considered as an effective treatment for some patient with osteoarthritis(380) as it reduces swelling and pain(380), if the therapy is applied correctly to avoid side effects, and prevent possible further injury, but according to Dr. Mac Auley DC. as the therapy has shown to impair reflex activity and motor function  up to 30 following treatment.(378). The doctor also said that guidance on the duration, frequency, or length of ice treatment may be depending on the particular ice therapy, injury location, or severity(379). Heat therapy has shown to loosen tissues and relax stiff joints may also benefits to some patient of osteoartritis(381). According to the study by University of Haifathermal and athermal short-wave diathermyhave shown effectively for the management of knee osteoarthritis(382).

2. Acupuncture
The most oldest form of medical treatment in traditional Chinese medicine has been known for its function in relief pain(383) and functional limitation(384) for chronic patient, including patient with moderate or severe chronic knee pain(383), peripheral joint osteoarthritis(384) and hip osteoarthritis(385) with many different techniques, such as acupuncture techniques, moxibustion, transcutaneous electrical nerve stimulation(392).
In pain management, acupuncture is found to significant reduce pain intensity, improve functional mobility and quality of life in patient with osteoarthritis (386). According to the University of York, in patient with knee osteoarthritis, in a systematic review with network meta-analysis, indicated that
acupuncture is considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term, but due to poor quality of the study(387), larger sample size and multi sample studies are necessary to confirm this claim.
Dr. Vas J. and Dr..White A said "... optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments"(388)

3. Massage Therapy
Massage therapy has been used in traditional Chinese medicine over thousands of year for treatment of osteoarthritis (OA)(392)(389), especially for OA patient for short-term pain relief(389). In a sixty-eight adults with radiographically confirmed OA, massage therapy seems to be most efficacious relief pain, stiffness, and improve physical function limitation for patient OA of the knee(390).
According to the joint study by the University Medical Center and Avans University of Applied Scienc, in a systematic review of randomised clinical trials, said that there is a evidence indicated that massage improves function in the short term compared to no treatment in people with knee arthritis(391)

4. Spa therapy
Spa therapy may be one the effective technique for treatment of lower back pain, according to some studies(392)(393)9394). In patient with rheumatoid arthritis, spa therapy showed to relief symptoms of pain, stiffness and mobility(395). According to the joint study by the  University of Siena and Spa Centre of Fonteverde Natural Spa Resort, the clinical trials conducted exhibited the support of spa therapy on pain, function and quality of life in hand OA(396), if used conjunction with the application of thermal treatments(396). In patient with knee osteoarthritis, especially in European countries, although the spa treatment is still the subject of debate, the existence of data of some clinical trials suggested a beneficial effect of spa therapy on pain, function and quality of life in knee OA if the treatment cover the duration from six to nine months(397).
In the study conducted by the University of Siena, Viale Bracci, spa therapy showed effectively in modified plasma levels of leptin and adiponectin of which are, important mediators of cartilage metabolism and related to the development of knee osteoarthritis(398)

5. Hydrotherapy
Hydrotherapy, using water for the treatment of disease has shown some beneficiary for treating pain in patient with lower back pain(399), joint hemorrhages(400) and multiple sclerosis(401). In patient with knee osteoarthritis, water therapy reduced knee pain and increased knee function in participants with knee OA as effectively as conventional based therapy(402).
In a randomized controlled trial conducted among 152 older persons with chronic symptomatic hip or knee OA by the University of Sydney, hydrotherapy or Tai Chi classes showed to enhance large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA(403).
In lower limb osteoarthritis, the study of 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA suggested that water exercise induced significantly reduction in pain and improvement in physical function of the participants after 1 year with a favourable cost--benefit outcome(404).
Unfortunately, the water gym study conducted by the Universidade Estadual Paulista Júlio Mesquita Filho, showed no beneficiary in improving symptoms of individuals with knee OA(405).

6. Tai Chi
Tai chi, an ancient form of mind-body exercise or technique used in Chinese with meditative movements that promote balance and healing of the mind and body induced mental concentration, physical balance, muscle relaxation, and relaxed breathing(406).
In chronic diseases, such as osteoarthritis, Tai Chi improve physical performance(408), such as walking distance (6MWD) and knee extensor strength and pain(408) and stiffness of patient with osteoarthritis(407) and knee osteoarthritis(408)(409).
In the assessing  the effectiveness of Tai Chi for knee osteoarthritis, conducted by Tufts University School of Medicine, Tai Chi therapy improved WOMAC pain(411) and stiffness scores, physical(411) and lower-extremity function, knee proprioception, ect., after 12, 24 and 48 weeks(410).

7. Yoga
An ancient form of medical technique originated from India, is become a popular multimodal mind-body exercise in the Western world for promoted flexibility, strength, endurance, and balance(412). According to the study by the University of Minnesota, Minneapolis (CC, JFW), Yoga 45 to 90 mins per session for 6 to 12 wks, reduced pain, stiffness, and swelling, inpatient with osteoarthritis of the knees(413) or osteoarthritis but the study showed an inconclusive outcome on physical function and psychosocial well-being(412).

8. Chiropractic
 Chiropractic is one the alternative therapy for diagnosis and treatment of Musculoskeletal disorders (MSDs), including osteoarthritis. It is one the primary care of hip osteoarthritis in Denmark(425)
According to the Cleveland Chiropractic College, chiropractic increased range of motion, improved balance and gait speed, and decreased disability after a 12-week course in a 70 year old geriatric patient with left hip pain, a history of repetitive falls, poor balance, myofascial dysfunction, and hip osteoarthritis(424) of that may contribute to a conservative management options for patient with hip osteoarthritis(426).
Chiropractic management showed to decreased WOMAC scores and increases in hip range of motion in patient of hip osteoarthritis, according to the study by Autralia(427) and may provide a short-term benefit to relieve hip pain for patients with hip osteoarthritis waiting for hip surgery(428), according to the report of Scandinavian College of Chiropractic. 
Used in conjunction with heat, chiropractic spinal manipulation,showed more effective for the treatment of low back pain in patient of osteoarthritis (OA) in comparison of the application of moist heat or chiropractic spinal manipulation alone(429).

9. Chinese Herbal Bath Therapy
Chinese herbal bath therapy (CHBT) has been used traditionally for its effects on analgesics and anti-inflammation against pain, especially for patient with knee osteoarthritis(495). According to the joint study by  reviewed of a total of 529 abstracts identified from 7 English
and Chinese databases conducted by the Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Tufts University and Tufts University School of Medicine, the therapy effectively reduced pain, improved physical performance, and wellness in comparison to  standard western treatment with little or no adverse effects(496).


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).


B.2.2. Herbal and traditional Chinese medicine formulas
1. Phytodolor (STW 1)
Phytodolor, a fixed herbal formulation containing alcoholic extracts of aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and golden rod herb (Solidago virgaurea), has been used for treatment in painful inflammatory or degenerative rheumatic diseases(483), probably due to its antiinflammatory, antioedematous, antioxidative and analgesic properties(483).
According to the University Hospital Zurich, in the review of the data base of randomized controlled trials (RCTs), STW1 can be used as non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain in patient with musculoskeletal disorders, including osteoarthritis(484). DR. Gundermann KJ and Dr.Müller J. in the study of painful inflammatory or degenerative rheumatic diseases, said" Phytodolor (STW 1) is a reasonable alternative to NSAIDs and to cyclooxygenase(COX)-2-inhibitors such as rofecoxib"(483) and "STW 1 has a high drug safety"(483) with little side effects(486).
The formula although is found to be effective in some extension in treating pain for patient with MD, some research suggested that most popular CAM therapies for pain from arthritis-related conditions, should be gone through additional high quality research, especially for herbals and homeopathy(485).
2. Reumalex 
Reumalex, is a herbal medicine formula containing 100 mg White Willow bark, 40 mg, Guaiacum Resin BHP, 35 mg Black Cohosh, 25 mg Extract of Sarsparilla  and 17 mg  Extract of Poplar Bark.  In a 2 months without cross-over study, in 82 subjects with chronic arthritic pain, Dr. Mills SY and the research team at the University of Exeter showed that Reumalex, the herbal medicine improved the pain symptoms through its mild analgesic effect(487).

3. Gitadyl
 Gitadyl is another herbal medicine formula containing 110 mg feverfew, 90 mg American aspen and 60 mg milfoil(488). According to a double-blind, randomized, cross-over study conducted by Hvidovre Hospital, in comparison of the effectiveness of herbal formula Gitadyl and conventional medicine ibuprofen(490) in patients with osteoarthritis, researchers found that Gitadyl can be used for treatment of such as reduced pain(488) and working ability(488) of patient with osteoarthritis who are prone to bleeding or who develop gastrointestinal (GI) symptoms from NSAIDs(489),

4. SKI306X
SKI306X, is a herbal formula containing Clematis mandshurica (CM), Prunella vulgaris (PV), and Trichosanthes kirilowii (TK),
According to the study by the Hanyang University Hospital for Rheumatic Diseases, SKI3006X, reduced pain and improve physical performance(498) by inhibited degradation of glycosaminoglycan (GAG) through its expression on  anti inflammatory(497)(499) and analgesic(499)properties in interleukin (IL)-1β induced gene expression in human OA(497). In a a double-blind placebo controlled study of 96 patients with classical osteoarthritis of the knee, SKI 306X at 100mm demonstrated its clinical efficacy in comparison to placebo, according to the Chung-Ang University(500).

5. Duhuo Jisheng Wan (DJW)
Duhuo Jisheng Wan (DJW)or Duhuo Jisheng Tang (DJT) is a Chinese herbal formula containing over 18 individual herbs(501) has been used for treatment of knee osteoarthritis with limit scientific evidence(502), according to the Nestlé Research Center(503), but in a randomized, double-blind, double-dummy, controlled trial of a total of 200 patients suffering from OA of the knee, researcher at the Chiang Mai University, showed to improve walking pain, standing pain and stiffness, with approximately 30% of patients in both groups experienced mild adverse events(504).
The Taipei City Hospital study of Duhuo Jisheng Wan(DJW) also supported the effectiveness of the herbal formula in reduced pain, stiffness and improved physical functioning as well as other symptoms of degenerative osteoarthritis of the knee(502).

6. Huo-Luo-Xiao-Ling (HLXL) Dan
Huo-Luo-Xiao-Ling (HLXL) Dan is a Chinese herbal formula containing Ru Xiang (Boswellia carterii Birdw.), Mo Yao (Commiphora myrrha Engl.), Dang Gui (Angelica sinensis (Oliv.) Diels) and Dan Shen (Salvia miltiorrhiza Bge), used over thousands of year in Chinese history for treatment in alleviating pain caused rheumatoid arthritis (RA) and other inflammatory disorders(505)(508). On a Phase II clinical trial at Kernan Hospital of the University of Maryland School of Medicine, the herbal formula moderately inhibited hyperanalgesic (severe pain killing)(508) with no side effect in comparison to placebo(506) in patient with osteoarthritis OA. The phase II clinical trials also showed treatment of HLXL-Dan was not superior to placebo in pain relief or functional improvement in patients with knee OA if use only in 8 weeks(507).

7. Si Miao Fang
SI Miao Fang is a herbal formula comprised of Phellodendri Chines Cortex, Atractylodis rhizoma, Coicis Semen, and Achyranthis bidentatae Radix used in traditional Chinese medicine for pain relief, due to inflammation and and analgesics(509) in patient with gouty arthritis(510) and rheumatoid arthritis(511). In osteoarthritic rat model, according to the China Academy of Chinese Medical Sciences, herbal formula inhibited expression of matrix metalloproteinases (MMPs) -3 and -13 and aggrecanases (ADAMTS) -4 and -5, induced OA causes of cartilage matrix degradation, by increasing proteoglycan and collagen content(512) through its interferes with secretion of pro-inflammatory cytokines and inflammatory mediators(512).

8. Other Chinese herbal prescription for treatment of OA, according to Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc. may also include Shu Jing Huo Xue Tang
 Shu Jing Huo Xue Tang can be prescribed for treatment of  patient with osteoarthritis caused by blood stagnation and blood stasis induced chronic pain syndromes, through its effect in suppressed neuropathic pain behaviors(514), including adjuvant arthritis(515). According to the article of Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc(513), the formula can also used for treatment of OA patient due to the effects in induced blood downward movement, strengthened the movement of bone, relived pain, improved joint function and inhibited inflammation causes of swollen of the joint lining and (513).

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(32) Association between spine disc degeneration and type II collagen degradation in postmenopausal women: the OFELY study by Garnero P1, Sornay-Rendu E, Arlot M, Christiansen C, Delmas PD.(PubMed)
(33) Regeneration of the intervertebral disc with nucleus pulposus cell-seeded collagen II/hyaluronan/chondroitin-6-sulfate tri-copolymer constructs in a rabbit disc degeneration model. by Huang B1, Zhuang Y, Li CQ, Liu LT, Zhou Y.(PubMed)
(34) Targets, models and challenges in osteoarthritis research by Thysen S1, Luyten FP2, Lories RJ3.(PubMed)
(35) Ecology of arthritis. by Peterson RO1, Vucetich JA, Fenton G, Drummer TD, Larsen CS.(PubMed)
(36) Handout on Health: Osteoarthritis(NIH)
(37) Age-related changes in the musculoskeletal system and the development of osteoarthritis. by Loeser RF1.(PubMed)
(38) Metabolic triggered inflammation in osteoarthritis by Wang X1, Hunter D2, Xu J3, Ding C4.(PubMed)
(39) [Osteoarthritis. Etiology, typing, staging and histological grading].[Article in German] by Söder S1, Aigner T.(PubMed)
(40) [Typing, grading and staging of osteoarthritis: histopathological assessment of joint degeneration].[Article in German] by Aigner T1, Söder S.(PubMed)
(41) Association of rheumatoid arthritis and primary osteoarthritis with changes in the glycosylation pattern of total serum IgG by Parekh RB, Dwek RA, Sutton BJ, Fernandes DL, Leung A, Stanworth D, Rademacher TW, Mizuochi T, Taniguchi T, Matsuta K, et al.(PubMed)
(42) Abnormal biomechanics of the foot and ankle by Donatelli RA.(PubMed)
(43) Lateral compartment osteoarthritis of the knee: Biomechanics and surgical management of end-stage disease by Scott CE1, Nutton RW, Biant LC.(PubMed)
(44) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review by Richmond SA1, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA.(PubMed)
(45) The association between joint stress from physical activity and self-reported osteoarthritis: an analysis of the Cooper Clinic data by Rogers LQ1, Macera CA, Hootman JM, Ainsworth BE, Blairi SN.(PubMed)
(46) Why is obesity associated with osteoarthritis? Insights from mouse models of obesity by Griffin TM1, Guilak F.(PubMed)
(47) Diet-induced obesity differentially regulates behavioral, biomechanical, and molecular risk factors forosteoarthritis in mice by Griffin TM1, Fermor B, Huebner JL, Kraus VB, Rodriguiz RM, Wetsel WC, Cao L, Setton LA, Guilak F.(PubMed)
(48) Sarcopenia: a histological and immunohistochemical study on age-related muscle impairment. by Tarantino U1, Scimeca M2,3, Piccirilli E4, Tancredi V5, Baldi J4, Gasbarra E4, Bonanno E6.(PubMed)
(49) Age-related changes in the musculoskeletal system and the development of osteoarthritis by Loeser RF1.(PubMed)
(50) Joint injury causes knee osteoarthritis in young adults by Roos EM1.(PubMed)
(51) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. by Lohmander LS1, Englund PM, Dahl LL, Roos EM.(PubMed)
(52) Age-Related Sarcopenia in Humans Is Associated with Reduced Synthetic Rates of Specific Muscle Proteins1,2 by D. N. Proctor, P. Balagopal*, and K. S. Nair*,3(The Journal of Nutrition)
(53) Muscle strength, pain and disability in patients with osteoarthritis by Steultjens MP1, Dekker J, van Baar ME, Oostendorp RA, Bijlsma JW.(PubMed)
(54) Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint by Schilke JM1, Johnson GO, Housh TJ, O'Dell JR.(PubMed)
(55) How do sex and gender affect knee OA? By Jennie McKee(AAOS)
(56) Osteoarthritis of the hip and knee: sex and gender differences by O'Connor MI1.(PubMed)
(57) [The prevalence of radiological osteoarthritis in relation to age, gender, birth-year cohort, and ethnic origins].[Article in German] by Spahn G1, Schiele R, Hofmann GO, Schiltenwolf M, Grifka J, Vaitl T, Schneider S, Liebers F, Klinger HM.(PubMed)
(58) The genetic epidemiology of osteoarthritis by Valdes AM1, Spector TD.(PubMed)
(59) Clinical significance of bone changes in osteoarthritis, Monitoring Editor: Gerolamo Bianchi
Tuhina Neog(PMC)
(60) Mechanobiology: Cartilage and Chondrocyte edited by J. F. Stoltz
(61) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. by Richmond SA1, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA.(PubMed)
(62) Primary osteoarthritis and occupations: a national cross sectional survey of 10 412 symptomatic patients by Rossignol M1, Leclerc A, Hilliquin P, Allaert FA, Rozenberg S, Valat JP, Avouac B, Coste P, Savarieau B, Fautrel B.(PubMed)
(63) Analysis of osteoarthritis in a mouse model of the progeroid human DNA repair syndrome trichothiodystrophy by Botter SM1, Zar M, van Osch GJ, van Steeg H, Dollé ME, Hoeijmakers JH, Weinans H, van Leeuwen JP.(PubMed)
(64) Questions and Answers about Gout(NIH)
(65) Are joints affected by gout also affected by osteoarthritis? by Roddy E1, Zhang W, Doherty M.(PubMed)
(66) Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout by de Klerk E1, van der Heijde D, Landewé R, van der Tempel H, Urquhart J, van der Linden S.(PubMed)
(67) Paget's disease of bone(Wikipedia)
(68) Paget's disease of bone: a review by Colina M1, La Corte R, De Leonardis F, Trotta F.(PubMed)
(69) Septic arthritis complicating hip osteoarthritis by Donell S1, Williamson DM, Scott DL.(PubMed)
(70) Osteoarthritis: another component of metabolic syndrome? by Velasquez MT1, Katz JD.(PubMed)
(71) [Metabolic syndrome and a course of osteoarthrosis].[Article in Russian] by Korochina IE, Bagirova GG.(PubMed)
(72) Risk of cardiovascular disease in patients with osteoarthritis: a prospective longitudinal study. by Rahman MM1, Kopec JA, Anis AH, Cibere J, Goldsmith CH.(PubMed)
(73) Cardiovascular disease and osteoarthritis: common pathways and patient outcomes. by Fernandes GS1, Valdes AM.(PubMed)
(74) Risk of Type 2 Diabetes among Osteoarthritis Patients in a Prospective Longitudinal Study by Rahman MM1, Cibere J2, Anis AH3, Goldsmith CH4, Kopec JA5.(PubMed)
(75) Osteoarthritis—the impact of a serious disease by F. C. Breedveld
(76) Bone loss at subchondral plate in knee osteoarthritis patients with hypertension and type 2 diabetes mellitus. by Wen CY1, Chen Y, Tang HL, Yan CH, Lu WW, Chiu KY.(PubMed)
(77) The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. by Maetzel A1, Li LC, Pencharz J, Tomlinson G, Bombardier C; Community Hypertension and Arthritis Project Study Team.(PubMed)
(78) Association of atherosclerosis with presence and progression of osteoarthritis: the Rotterdam Study by Hoeven TA1, Kavousi M, Clockaerts S, Kerkhof HJ, van Meurs JB, Franco O, Hofman A, Bindels P, Witteman J, Bierma-Zeinstra S.(PubMed)
(79) Positive association between increased popliteal artery vessel wall thickness and generalized osteoarthritis: is OA also part of the metabolic syndrome? by Kornaat PR1, Sharma R, van der Geest RJ, Lamb HJ, Kloppenburg M, Hellio le Graverand MP, Bloem JL, Watt I.(PubMed)
(80) Asymptomatic peripheral vascular disease in total knee arthroplasty: preoperative prevalence and risk factors. by Park IH1, Lee SC, Park IS, Nam CH, Ahn HS, Park HY, Gondalia VH, Jung KA.(PubMed)
(81) Baseline factors associated with congestive heart failure in patients receiving etoricoxib or diclofenac: multivariate analysis of the MEDAL program by Krum H1, Curtis SP, Kaur A, Wang H, Smugar SS, Weir MR, Laine L, Brater DC, Cannon CP.(PubMed)
(82) Baseline factors associated with congestive heart failure in patients receiving etoricoxib or diclofenac: multivariate analysis of the MEDAL program by Krum H1, Curtis SP, Kaur A, Wang H, Smugar SS, Weir MR, Laine L, Brater DC, Cannon CP.(PubMed)
(83) Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review. by Marks JL1, van der Heijde DM, Colebatch AN, Buchbinder R, Edwards CJ.(PubMed)
(84) Urinary excretion of pyridinium crosslinks of collagen correlated with joint damage in arthritis by Astbury C1, Bird HA, McLaren AM, Robins SP.(PubMed)
(85) Diabetes-induced osteoarthritis: from a new paradigm to a new phenotype by Berenbaum F1.(PubMed)
(86) [Pulmonary infiltrates with blood eosinophilia in a 62-year-old patient].[Article in German] by Kohlhäufl M1, Weber N, Morresi-Hauf A, Geiger D, Raith H, Häussinger K.(PubMed)
(87) Radiographic osteoarthritis and serum cholesterol by Al-Arfaj AS1.(PubMed)
(88) Are joints affected by gout also affected by osteoarthritis? by Edward Roddy, Weiya Zhang, and Michael Doherty(PMC)
(89) Are There Other Options Besides Medications for Gout and Osteoarthritis? by Julie Chen, M.D.
(90) The relationship between chondrocalcinosis and osteoarthritis in Saudi Arabia by Al-Arfaj AS1.(PubMed)
(91) Analysis of the association between chondrocalcinosis and osteoarthritis: a community based study by Sanmarti R1, Kanterewicz E, Pladevall M, Pañella D, Tarradellas JB, Gomez JM.(PubMed)
(92) SDC4: OA joint effort by Michael J. Haas, Senior Writer(SciBX)
(93) Syndecan-4 regulates ADAMTS-5 activation and cartilage breakdown in osteoarthritis by Echtermeyer F1, Bertrand J, Dreier R, Meinecke I, Neugebauer K, Fuerst M, Lee YJ, Song YW, Herzog C, Theilmeier G, Pap T.(PubMed)
(94) Definition of bone necrosis by the pathologis by Cristina Fondi and Alessandro Franchi(PMC)
(95) Regeneration of human bones in hip osteonecrosis and human cartilage in knee osteoarthritis with autologous adipose-tissue-derived stem cells: a case series by Pak J1.(PubMed)
(96) The Relationship between Osteoporosis and Osteoarthritis of the Knee: A Report of 2 Cases with SuspectedOsteonecrosis by Horikawa A1, Miyakoshi N2, Shimada Y2, Kodama H1.(PubMed)
(97) Proximal tibial stress fracture associated with mild osteoarthritis of the knee: case report. by Curković M1, Kovac K, Curković B, Babić-Naglić D, Potocki K.(PubMed)
(98) Management of knee osteoarthritis presenting with tibial stress fractures by Ng YC1, Sathappan SS, Wong HP.(PubMed)
(99) Proximal tibial stress fractures associated with primary degenerative knee osteoarthritis by Sourlas I1, Papachristou G, Pilichou A, Giannoudis PV, Efstathopoulos N, Nikolaou VS.(PubMed)
(100) Osteoarthritis In-Depth Report(The NewYork time)
(101) Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: a prospective, population-based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register by Schrama JC1, Espehaug B, Hallan G, Engesaeter LB, Furnes O, Havelin LI, Fevang BT.(PubMed)
(102) Incidence of infectious complications in hip and knee arthroplasties in rheumatoid arthritis and osteoarthritispatients.[Article in English, Portuguese] by da Cunha BM1, de Oliveira SB, Santos-Neto L.(PubMed)
(103) The Basics of Osteoarthritis(WebMD)
(104) Osteoarthritis Diagnosis(Spine health)
(105)The Pathogenesis of Rheumatoid Arthritis: Pivotal Cytokines Involved in Bone Degradation and Inflammation by CLIFTON O. BINGHAM III(The Journal of Rheumatology)
(106) Biologic basis of osteoarthritis: state of the evidence. by Malemud CJ1.(PubMed)
(107) Diverse expression of selected cytokines and proteinases in synovial fluid obtained from osteoarthritic and healthy human knee joints by Sauerschnig M1,2, Stolberg-Stolberg J3, Schulze A4, Salzmann GM5, Perka C6, Dynybil CJ7.(PubMed)
(108) Osteoarthritis Diagnosis(Arthritis foundation)
(109) The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis. by Menashe L1, Hirko K, Losina E, Kloppenburg M, Zhang W, Li L, Hunter DJ.(PubMed)
(110) How important is MRI for detecting early osteoarthritis? by Changhai Ding*, Flavia Cicuttini and Graeme Jones(Natrue Clinical Pratctice Rheumatology)
(111) The meniscus in knee osteoarthritis by Englund M1, Guermazi A, Lohmander LS.(PubMed)
(112) The role of the meniscus in knee osteoarthritis: a cause or consequence? by Englund M1, Guermazi A, Lohmander SL.(PubMed)
(113) Meniscus pathology, osteoarthritis and the treatment controversy by Englund M1, Roemer FW, Hayashi D, Crema MD, Guermazi A.(PubMed)
(114) Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments by Zhang W1, Gignac MA, Beaton D, Tang K, Anis AH; Canadian Arthritis Network Work Productivity Group(PubMed)
(115) Occupational lifting is associated with hip osteoarthritis: a Japanese case-control study. by Yoshimura N1, Sasaki S, Iwasaki K, Danjoh S, Kinoshita H, Yasuda T, Tamaki T, Hashimoto T, Kellingray S, Croft P, Coggon D, Cooper C.(PubMed)
(116) Occupation and osteoarthritis by Genti G.(PubMed)
(117) Risk factors for knee osteoarthritis in Japanese women: heavy weight, previous joint injuries, and occupational activities by Yoshimura N1, Nishioka S, Kinoshita H, Hori N, Nishioka T, Ryujin M, Mantani Y, Miyake M, Coggon D, Cooper C.(PubMed)
(118) Neuromuscular electrical stimulation for muscle strengthening in elderly with knee osteoarthritis - a systematic review by de Oliveira Melo M1, Aragão FA, Vaz MA.(PubMed)
(119) Effectiveness of exercise for osteoarthritis of the knee: A review of the literature. by Iwamoto J1, Sato Y, Takeda T, Matsumoto H.(PubMed)
(120) Effectiveness of exercise for osteoarthritis of the knee: A review of the literature by Iwamoto J1, Sato Y, Takeda T, Matsumoto H.(PubMed)
(121) Articular Cartilage Degeneration: Etiologic Association With Obesity by Deryk G. Jones, MD(PubMed)
(122) Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study by Baum T1, Joseph GB, Nardo L, Virayavanich W, Arulanandan A, Alizai H, Carballido-Gamio J, Nevitt MC, Lynch J, McCulloch CE, Link TM.(PubMed)
(123) The evolving role of obesity in knee osteoarthritis by MaryFran R. Sowers and Carrie A. Karvonen-Gutierrez(PMC)
(124) Solid-state NMR spectroscopy provides atomic-level insights into the dehydration of cartilage by Xu J1, Zhu P, Morris MD, Ramamoorthy A.(PubMed)
(125) Geriatric Rehabilitation Manual By Timothy L. Kauffman
(126) Dietary intake of trans fatty acids and systemic inflammation in women by Mozaffarian D1, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, Rimm EB.(PubMed)
(127) Health effects of trans-fatty acids: experimental and observational evidence by Mozaffarian D1, Aro A, Willett WC.(PubMed)
(128) Metabolic triggered inflammation in osteoarthritis by Wang X1, Hunter D2, Xu J3, Ding C4.(PubMed)
(129) Arachidonic acid metabolism: role in inflammation by Samuelsson B1.(PubMed)
(130) Antagonizing arachidonic acid-derived eicosanoids reduces inflammatory Th17 and Th1 cell-mediatedinflammation and colitis severity. by Monk JM1, Turk HF1, Fan YY1, Callaway E1, Weeks B2, Yang P3, McMurray DN4, Chapkin RS5.(PubMed)
(130) Effect of fruit and vegetable antioxidants on total antioxidant capacity of blood plasma by Harasym J1, Oledzki R2.(PubMed)
(131) Dietary antioxidants: immunity and host defense by Puertollano MA1, Puertollano E, de Cienfuegos GÁ, de Pablo MA.(PubMed)
(132) Cellular immunity in osteoarthritis: novel concepts for an old disease by Liossis SN1, Tsokos GC.(PubMed)
(133) Free Radicals, Antioxidants in Disease and Health by Lien Ai Pham-Huy,1 Hua He,2 and Chuong Pham-Huy3(PMC)
(134) Studies on free radicals, antioxidants, and co-factors by Khalid Rahman(PMC)
(135) New insights into the mechanisms of polyphenols beyond antioxidant properties; lessons from the green tea polyphenol, epigallocatechin 3-gallate by Hae-Suk Kim,a Michael J. Quon,c and Jeong-a Kima,b(PMC)
(136) Green tea catechin, epigallocatechin-3-gallate (EGCG): mechanisms, perspectives and clinical applications by Singh BN1, Shankar S, Srivastava RK.(PubMed)
(137) Dietary polyphenols and mechanisms of osteoarthritis by Shen CL1, Smith BJ, Lo DF, Chyu MC, Dunn DM, Chen CH, Kwun IS.(PubMed)
(138) Green tea: a new option for the prevention or control of osteoarthritis by Katiyar SK, Raman C.(PubMed)
(139) Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans role of oxidative stress by K Esposito, F Nappo, R Marfella, G Giugliano, F Giugliano, M Ciotola(Circulation)
(140) Green tea polyphenol epigallocatechin 3-gallate in arthritis: progress and promise by Ahmed S1.(PubMed)
(141) Preparation and antioxidant activity of green tea extract enriched in epigallocatechin (EGC) and epigallocatechin gallate (EGCG) by Hu J1, Zhou D, Chen Y.(PubMed)
(142) Genetically determined body weight loss in mice fed diets containing salmon oil by LeBoeuf RC1, Veldee MS.(PubMed)
(143) Supplementation of n3 long-chain polyunsaturated fatty acid synergistically decreases insulin resistance withweight loss of obese prepubertal and pubertal children by López-Alarcón M1, Martínez-Coronado A, Velarde-Castro O, Rendón-Macías E, Fernández J.(PubMed)
(144) Effects of megadoses of dietary vitamin E on the antioxidant status of rats fed lard or salmon oil by Flader D1, Brandsch C, Hirche F, Eder K.(PubMed)
(145) Omega 3 fatty acids promote macrophage reverse cholesterol transport in hamster fed high fat diet by Kasbi Chadli F1, Nazih H, Krempf M, Nguyen P, Ouguerram K.(PubMed)
(146) Cholesterol, inflammation and innate immunity by Tall AR1, Yvan-Charvet L2.(PubMed)
(147) In vitro fatty acid enrichment of macrophages alters inflammatory response and net cholesterol accumulation by Wang S1, Wu D, Lamon-Fava S, Matthan NR, Honda KL, Lichtenstein AH.(PubMed)
(148) Uncoupling lipid metabolism from inflammation through fatty acid binding protein-dependent expression of UCP2. byXu H1, Hertzel AV1, Steen KA1, Wang Q2, Suttles J3, Bernlohr DA4.(PubMed)
(149) Low-dose aspirin and omega-3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion by Lazzarin N1, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME, Arduini D.(PubMed)
(150) Omega-3 fatty acids in inflammation and autoimmune diseases. by Simopoulos AP1.(PubMed)
(151) Chronic and acute effects of walnuts on antioxidant capacity and nutritional status in humans: a randomized, cross-over pilot study by McKay DL1, Chen CY, Yeum KJ, Matthan NR, Lichtenstein AH, Blumberg JB.(PubMed)
(152) Effect of a walnut meal on postprandial oxidative stress and antioxidants in healthy individuals by Haddad EH1, Gaban-Chong N, Oda K, Sabaté J.(PubMed)
(153) Olive oil and walnut breakfasts reduce the postprandial inflammatory response in mononuclear cells compared with a butter breakfast in healthy men by Jiménez-Gómez Y1, López-Miranda J, Blanco-Colio LM, Marín C, Pérez-Martínez P, Ruano J, Paniagua JA, Rodríguez F, Egido J, Pérez-Jiménez F.(PubMed)
(154) manganese(The world healthier foods)
(155) The role of manganese superoxide dismutase in inflammation defense by Li C1, Zhou HM(PubMed)
(156) An acute intake of a walnut-enriched meal improves postprandial adiponectin response in healthy young adults by Lozano A1, Perez-Martinez P, Marin C, Tinahones FJ, Delgado-Lista J, Cruz-Teno C, Gomez-Luna P, Rodriguez-Cantalejo F, Perez-Jimenez F, Lopez-Miranda(PubMed)
(157) Links between osteoarthritis and diabetes: implications for management from a physical activity perspective by Piva SR1, Susko AM2, Khoja SS2, Josbeno DA2, Fitzgerald GK2, Toledo FG3.(PubMed)
(158) Antioxidant and cytotoxic activities of three species of tropical seaweeds by Chia YY1, Kanthimathi MS2,3, Khoo KS4, Rajarajeswaran J5, Cheng HM6, Yap WS7.(PubMed)
(159) Brown seaweed fucoidan: biological activity and apoptosis, growth signaling mechanism in cancer by Senthilkumar K1, Manivasagan P, Venkatesan J, Kim SK.(PubMed)
(160) Anticoagulant, Antioxidant and Antitumor Activities of Heterofucans from the Seaweed Dictyopteris delicatul by Kaline Dantas Magalhaes,1,2,† Leandro Silva Costa,1,3,† Gabriel Pereira Fidelis,1 Ruth Medeiros Oliveira,1 Leonardo Thiago Duarte Barreto Nobre,1 Nednaldo Dantas-Santos,1,2 Rafael Barros Gomes Camara,1 Ivan Rui Lopes Albuquerque,1,2 Sara Lima Cordeiro,1 Diego Araujo Sabry,1 Mariana Santana Santos Pereira Costa,1 Luciana Guimaraes Alves,1 and Hugo Alexandre Oliveira Rocha1,2(PMC)
(161) [Nutritional evaluation and physiological effects of edible seaweeds].[Article in Spanish] by Jiménez-Escrig A1, Goñi Cambrodón I.(PubMed)
(162) Extracts from dulse (Palmaria palmata) are effective antioxidants and inhibitors of cell proliferation in vitro by Yuan YV1, Carrington MF, Walsh NA.(PubMed)
(163) THE WORLD HEALTHIEST FOODS - PART II - VEGETABLES by Kyle J. Norton
(164) Role of bilirubin as antioxidant in neonatal jaundice and effect of ethanolic extract of sweet lime peel on experimentally induced jaundice in rat by Nag N1, Halder S, Chaudhuri R, Adhikary S, Mazumder S.(PubMed)
(165) Phytochemicals and antioxidant capacity of tortillas obtained after lime-cooking extrusion process of whole pigmented mexican maize by Aguayo-Rojas J1, Mora-Rochín S, Cuevas-Rodríguez EO, Serna-Saldivar SO, Gutierrez-Uribe JA, Reyes-Moreno C, Milán-Carril(PubMed)
(166) Antioxidant and anticholinesterase activities of eleven edible plants by Boğa M1, Hacıbekiroğlu I, Kolak U.(PubMed)
(167) Aging Hearts and Arteries: A Scientific Quest, Chapter 4: Blood Vessels and Aging: The Rest of the Journey(NIH)
(168) Does antioxidant vitamin supplementation protect against muscle damage? by McGinley C1, Shafat A, Donnelly AE(PubMed)
(169) Effects of dietary supplementation with vitamins C and E on muscle function during and after eccentric contractions in humans by Shafat A1, Butler P, Jensen RL, Donnelly AE.(PubMed)
(170) Effects of Dairy Products Consumption on Health: Benefits and Beliefs-A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases by Rozenberg S1, Body JJ2, Bruyère O3, Bergmann P4, Brandi ML5, Cooper C6,7, Devogelaer JP8, Gielen E9, Goemaere S10, Kaufman JM11, Rizzoli R12,Reginster JY13(PubMed)
(171) Dairy products, yogurts, and bone health by Rizzoli R1.(PubMed)
(172) Got osteoarthritis? Maybe milk can help by Sahni S1, McLean RR.(PubMed)
(173) Milk consumption and progression of medial tibiofemoral knee osteoarthritis: data from the Osteoarthritis Initiative by Lu B1, Driban JB, Duryea J, McAlindon T, Lapane KL, Eaton CB(PubMed)
(174) Osteoarthritis as a misdiagnosis in elderly patients by Spiera H1.(PubMed)
(175) Differential diagnosis of rheumatic disease in the elderly by O'Duffy JD(PubMed)
(176) Free Radicals, Antioxidants in Disease and Health by Lien Ai Pham-Huy,1 Hua He,2 and Chuong Pham-Huy3(PMC)
(177) Superoxide Anion and Its Functions(Beta Forces)
(178) Free radicals and antioxidants in normal physiological functions and human disease by Valko M1, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J.(PubMed)
(179) Free radicals, metals and antioxidants in oxidative stress-induced cancer by Valko M1, Rhodes CJ, Moncol J, Izakovic M, Mazur M.(PubMed)
(180) Vitamin A, immunity, and infection by Semba RD1.(PubMed)
(181) Vitamin A as an immunomodulating agent by Rumore MM1.(PubMed)
(182) The effect of newborn vitamin A supplementation on infant immune functions: trial design, interventions, and baseline data by Ahmad SM1, Raqib R2, Qadri F3, Stephensen CB4(PubMed)
(183) Effect of dietary vitamin C on the growth performance and innate immunity of juvenile cobia (Rachycentron canadum) by Zhou Q1, Wang L, Wang H, Xie F, Wang T.(PubMed)
(184) The treatment of poliomyelitis and other virus diseases with vitamin C by KLENNER FR.(PubMed)
(185) Vitamin E-enhanced IL-2 production in old mice: naive but not memory T cells show increased cell division cycling and IL-2-producing capacity by Adolfsson O1, Huber BT, Meydani SN.(PubMed)
(186) Vitamin E and immune response in the aged: molecular mechanisms and clinical implications. by Meydani SN1, Han SN, Wu D.(PubMed)
(187) Vitamin E and infectious diseases in the aged by Han SN1, Meydani SN.(PubMed)
(188) Zinc and its role in immunity and inflammation by Bonaventura P1, Benedetti G1, Albarède F2, Miossec P3.(PubMed)
(189) Zinc homeostasis and immunosenescence by Maywald M1, Rink L2.(PubMed)
(190) Dietary zinc deficiency induced-changes in the activity of enzymes and the levels of free radicals, lipids and protein electrophoretic behavior in growing rats by Yousef MI1, El-Hendy HA, El-Demerdash FM, Elagamy EI.(PubMed)
(191) Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis by Rosenbaum CC1, O'Mathúna DP, Chavez M, Shields K.(PubMed)
(192) 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)
(193) Vitamin E has a dual effect of anti-inflammatory and antioxidant activities in acetic acid–induced ulcerative colitis in rat by Gulgun Tahan, MD,*† Erman Aytac, MD,* Huseyin Aytekin, MD,‡ Feyza Gunduz, MD,† Gulen Dogusoy, MD,§ Seval Aydin, MD,¶ Veysel Tahan, MD,** and Hafize Uzun, MD(PMC)
(194) Glucosamine inhibits the synthesis of glycosaminoglycan chains on vascular smooth muscle cell proteoglycans by depletion of ATP by Little PJ1, Drennon KD, Tannock LR.(PubMed)
(195) Effects of Glucosamine and Chondroitin Sulfate on Cartilage Metabolism in OA: Outlook on Other Nutrient Partners Especially Omega-3 Fatty Acid by Jörg Jerosch(PubMed)
(196) NON-PHYSIOLOGICAL AMINO ACID (NPAA) THERAPY TARGETING BRAIN PHENYLALANINE REDUCTION: PILOT STUDIES IN PAHENU2 MIC by Kara R. Vogel,1 Erland Arning,2 Brandi L. Wasek,2 Teodoro Bottiglieri,2 and K. Michael Gibson1,(PubMed)
(197) DLPA (D, L Phenylalanine)(Whole health Chicago)
(198) PHENYLALANINE(WebMD)
(199) Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. by Kim LS1, Axelrod LJ, Howard P, Buratovich N, Waters RF.(PubMed)
(200) Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study by Debbi EM1, Agar G, Fichman G, Ziv YB, Kardosh R, Halperin N, Elbaz A, Beer Y, Debi R.(PubMed)
(201) Green tea polyphenol treatment is chondroprotective, anti-inflammatory and palliative in a mouse posttraumatic osteoarthritis model by Daniel J Leong, Marwa Choudhury, Regina Hanstein, David M Hirsh, Sun Jin Kim, Robert J Majeska, Mitchell B Schaffler, John A Hardin, David C Spray, Mary B Goldring, Neil J Cobelli, and Hui B Sun(PMC)
(202) Tea catechins reduce inflammatory reactions via mitogen-activated protein kinase pathways in toll-like receptor 2 ligand-stimulated dental pulp cells by Hirao K1, Yumoto H, Nakanishi T, Mukai K, Takahashi K, Takegawa D, Matsuo T.(PubMed)
(203) Green Tea Catechins and Cardiovascular Health: An Update by Pon Velayutham, Anandh Babu, and Dongmin Liu(PubMed)
(203) [The inhibitory effects of catechin derivatives on the activities of human immunodeficiency virus reverse transcriptase and DNA polymerases].[Article in Chinese] by Tao P1.(PubMed)
(204) Differential inhibitory effects of some catechin derivatives on the activities of human immunodeficiency virus reverse transcriptase and cellular deoxyribonucleic and ribonucleic acid polymerases. by Nakane H1, Ono K.(PubMed)
(205) Antioxidative effects of green tea polyphenols on free radical initiated and photosensitized peroxidation of human low density lipoprotein. by Liu Z1, Ma LP, Zhou B, Yang L, Liu ZL.(PubMed)
(206) Antioxidant effects of green tea polyphenols on free radical initiated peroxidation of rat liver microsomes. byCai YJ1, Ma LP, Hou LF, Zhou B, Yang L, Liu ZL.(PubMed)
(207) The effect of bioactive compounds in tea on lipid metabolism and obesity through regulation of peroxisome proliferator-activated receptors by Lee SJ1, Jia Y.(PubMed)
(208) Green tea (-)-epigallocatechin-3-gallate reduces body weight with regulation of multiple genes expression in adipose tissue of diet-induced obese mice. by Lee MS1, Kim CT, Kim Y.(PubMed)
(209) Green tea catechins, caffeine and body-weight regulation by Westerterp-Plantenga MS1.(PubMed)
(210) Total polyphenols, catechin profiles and antioxidant activity of tea products from purple leaf coloured tea cultivars. byKerio LC1, Wachira FN, Wanyoko JK, Rotich MK.(PubMed)
(211) Effects of quercetin and catechin on hepatic glutathione-S transferase (GST), NAD(P)H quinone oxidoreductase 1 (NQO1), and antioxidant enzyme activity levels in rats. by Wiegand H1, Boesch-Saadatmandi C, Regos I, Treutter D, Wolffram S, Rimbach G.(PubMed)
(212) Phenolic profile of edible honeysuckle berries (genus lonicera) and their biological effects by Jurikova T1, Rop O, Mlcek J, Sochor J, Balla S, Szekeres L, Hegedusova A, Hubalek J, Adam V, Kizek R.(PubMed)
(213) Bioactivites of two common polyphenolic compounds: Verbascoside and catechin by Sipahi H1,2, Gostner JM3, Becker K2, Charehsaz M1, Kirmizibekmez H4, Schennach H5, Aydin A1, Fuchs D2.(PubMed)
(214) Evaluation of the antioxidant effects of four main theaflavin derivatives through chemiluminescence and DNA damage analyses by Yuan-yuan Wu,1,2 Wei Li,1,3 Yi Xu,1,2 En-hui Jin,1,2 and You-ying Tu(PMC)
(215) Theaflavin-3-gallate and theaflavin-3'-gallate, polyphenols in black tea with prooxidant properties by Babich H1, Gottesman RT, Liebling EJ, Schuck AG.(PubMed)
(216) Radical-scavenging abilities and antioxidant properties of theaflavins and their gallate esters in H2O2-mediated oxidative damage system in the HPF-1 cells by Yang Z1, Jie G, Dong F, Xu Y, Watanabe N, Tu Y.(PubMed)
(217)  Antimicrobial activity of 10 different plant polyphenols against bacteria causing food-borne disease by Taguri T1, Tanaka T, Kouno I.(PubMed)
(218) Antibacterial spectrum of plant polyphenols and extracts depending upon hydroxyphenyl structure by Taguri T1, Tanaka T, Kouno I.(PubMed)
(219) Antimicrobial activities of tea catechins and theaflavins and tea extracts against Bacillus cereus by Friedman M1, Henika PR, Levin CE, Mandrell RE, Kozukue N.(PubMed)
(220) Antioxidant and cytotoxic activity of polyphenolic compounds isolated from the leaves of Leucenia leucocephala by Haggag EG1, Kamal AM, Abdelhady MI, El-Sayed MM, El-Wakil EA, Abd-El-Hamed SS.(PubMed)
(221) Preformulation studies of myricetin: a natural antioxidant flavonoid by Yao Y1, Lin G1, Xie Y1, Ma P2, Li G3, Meng Q4, Wu T3.(PubMed)
(222) Chemical components from the leaves of Ardisia insularis and their cytotoxic activity by Van NT1, Vien TA, Van Kiem P, Van Minh C, Nhiem NX, Long PQ, Anh LT, Kim N, Park S, Kim SH.(PubMed)
(223) Isolated flavonoids against mammary tumour cells LM2 by Carli CB1, de Matos DC, Lopes FC, Maia DC, Dias MB, Sannomiya M, Rodrigues CM, Andreo MA, Vilegas W, Colombo LL, Carlos IZ.(PubMed)
(224) Myricetin suppresses differentiation of 3 T3-L1 preadipocytes and enhances lipolysis in adipocytes. by Wang Q1, Wang ST1, Yang X1, You PP1, Zhang W2.(PubMed)
(225) Cyanidin 3-O-β-D-Glucoside Improves Bone Indices by Kaume L1, Gilbert W1, Smith BJ2, Devareddy L1.(PubMed)
(226) Dual Role of Cyanidin-3-glucoside on the Differentiation of Bone Cells. by Park KH1, Gu DR2, So HS3, Kim KJ1, Lee SH4.(PubMed)
(227) Anti-inflammatory effects of polyphenolic-enriched red raspberry extract in an antigen-induced arthritis rat model by Jean-Gilles D1, Li L, Ma H, Yuan T, Chichester CO 3rd, Seeram NP.(PubMed)
(228) Anti-inflammatory effects of black rice, cyanidin-3-O-beta-D-glycoside, and its metabolites, cyanidin and protocatechuic acid by Min SW1, Ryu SN, Kim DH.(PubMed)
(229) Lipoprotein lipase activity of adipose tissue, skeletal muscle and post-heparin plasma in primary endogenous hypertriglyceridaemia: relation to lipoprotein pattern and to obesity by Taskinen MR, Nikkilä EA, Kuusi T.(PubMed)
(230) Cyanidin-3-O-β-glucoside improves obesity and triglyceride metabolism in KK-Ay mice by regulating lipoprotein lipase activity by Wei X1, Wang D, Yang Y, Xia M, Li D, Li G, Zhu Y, Xiao Y, Ling W.(PubMed)
(231) Physical Activity and Arthritis Overview(CDC)
(232) Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength by Peeler J1, Christian M, Cooper J, Leiter J, MacDonald P.(PubMed)
(233) Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis? by Takacs J1, Anderson JE, Leiter JR, MacDonald PB, Peeler JD.(PubMed)
(234) Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength by Peeler J1, Christian M, Cooper J, Leiter J, MacDonald P.(PubMed)
(235) Weight loss over 48 months is associated with reduced progression of cartilage T2 relaxation time values: data from the osteoarthritis initiative by Serebrakian AT1, Poulos T, Liebl H, Joseph GB, Lai A, Nevitt MC, Lynch JA, McCulloch CE, Link TM.(PubMed)
(236) Obesity versus osteoarthritis: beyond the mechanical overload.[Article in English, Portuguese] by Sartori-Cintra AR1, Aikawa P2, Cintra DE3.(PubMed)
(237) Effect of low-level laser therapy (904 nm) and static stretching in patients with knee osteoarthritis: a protocol of randomised controlled trial by Ferreira de Meneses SR1,2, Hunter DJ3, Young Docko E4, Pasqual Marques A5.(PubMed)
(238) The efficacy of tramadol/acetaminophen combination tablets (Ultracet®) as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID). by Park KS1, Choi JJ, Kim WU, Min JK, Park SH, Cho CS.(PubMed)
(239) Efficacy and safety of tramadol/acetaminophen tablets (Ultracet) as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal antiinflammatory drug: a multicenter, randomized, double-blind, placebo-controlled trial by Emkey R1, Rosenthal N, Wu SC, Jordan D, Kamin M; CAPSS-114 Study Group.(PubMed)
(240) Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials by Remy C1, Marret E, Bonnet F.(PubMed)
(241) Tylenol Side Effects Center(RXlist)
(242) Cost effectiveness of COX 2 selective inhibitors and traditional NSAIDs alone or in combination with a proton pump inhibitor for people with osteoarthritis(The BMJ)
(243) Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans by Bjarnason I1, Hayllar J, MacPherson AJ, Russell AS.(PubMed)
(244) Detection and prevention of NSAID-induced enteropathy by Davies NM1, Saleh JY, Skjodt NM.(PubMed)
(245) Patient preference and willingness to pay for knee osteoarthritis treatments. by Posnett J1, Dixit S2, Oppenheimer B2, Kili S3, Mehin N4.(PubMed)
(246) A model of additive effects of mixtures of narcotic chemicals by Shirazi MA1, Linder G.(PubMed)
(247) Pain medications - narcotics(NIH)
(248) Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial by Bennell KL1, Egerton T1, Martin J1, Abbott JH2, Metcalf B1, McManus F1, Sims K3, Pua YH4, Wrigley TV1, Forbes A5, Smith C5, Harris A6, Buchbinder R7.(PubMed)
(249) Physiotherapy management of knee osteoarthritis by Page CJ1, Hinman RS, Bennell KL.(PubMed)
(250) Policy statement: Description of physical therapy(World federation of physical therapy)
(251) Occupational Therapy - As defined by the Canadian Association of Occupational Therapists(Canadian Association of Occupation Therapists)
(252) Integrating lifestyle approaches into osteoarthritis care by Garver MJ1, Focht BC2, Taylor SJ3.(PubMed)
(253) Occupational therapists' pain knowledge: a national survey by Reyes AN1, Brown CA1.(PubMed)
(254) Occupational therapy-based and evidence-supported recommendations for assessment and exercises in handosteoarthritis by Kjeken I1(PubMed)
(255) Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review by H Bliddal,1 A R Leeds,2,3,4 and R Christensen1(PubMed)
(256) Strength cycle training: effects on muscular strength and aerobic conditioning. by Van Zant RS1, Bouillon LE.(PubMed)
(257) Effect of resistance training and aerobic conditioning on muscular strength and submaximal fitness for individuals with chronic heart failure: influence of age and gender. by Swank AM1, Funk DC, Manire JT, Allard AL, Denny DM.(PubMed)
(258) A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. by Bennell KL1, Hinman RS.(PubMed)
(259) Osteoarthritis(Medline Plus)
(260) Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. by Jansen MJ1, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA.(PubMed)
(261) Manual therapy for osteoarthritis of the hip or knee: a systematic review by Review published: 2011.Bibliographic details: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Manual Therapy 2011; 16(2): 109-117. [PubMed]
(262) The Incremental Effects of Manual Therapy or Booster Sessions in Addition to Exercise Therapy for Knee Osteoarthritis: A Randomized Clinical Trial by Abbott JH1, Chapple CM, Fitzgerald GK, Fritz JM, Childs JD, Harcombe H, Stout K.(PubMed)
(263) Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels by Ahmed I1, Gertner E.(PubMed)
(264) Tests and Procedures, Cortisone shots(Mayo Clinic)
(265) [Complications of knee arthroscopy].[Article in German] by Mayr HO1, Stoehr A2.(PubMed)
(266) Arthroscopy(NHS choice)
(267) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma by Sakata R1, McNary SM1, Miyatake K1, Lee CA1, Van den Bogaerde JM1, Marder RA1, Reddi AH2.(PubMed)
(268) Non-surgical treatment of osteoarthritis-related pain in the elderl by Saulat Mushtaq,3 Rabeea Choudhary,2 and Carla R. Scanzello(PMC)
(269) Knee Osteotomy(The Knee Society)
(270) Osteotomies about the hip for the prevention and treatment of osteoarthrosis by Millis MB1, Murphy SB, Poss R.(PubMed)
(271) Osteotomies of the hip in the prevention and treatment of osteoarthritis by Millis MB, Poss R, Murphy SB.(PubMed)
(272)
(273) Parachutes and Preferences - A Trial of Knee Replacement by Katz JN1.(PubMed)
(274) Rapid mobilization decreases length-of-stay in joint replacement patients by Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J 3rd.(PubMed)
(276) Lifestyle modifications to improve musculoskeletal and bone health and reduce disability--a life-course approach by Jones G1, Winzenberg TM2, Callisaya ML3, Laslett LL4.(PubMed)
(277) Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis by Messier SP1, Gutekunst DJ, Davis C, DeVita P.(PubMed)
(278) Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis by Christensen R1, Bartels EM, Astrup A, Bliddal H.(PubMed)
(279) Exercise and osteoarthritis by David J Hunter1,2 and Felix Eckstein3,4(PMC)
(280) Diet and Exercise for Obese Adults with Knee Osteoarthritis by Stephen P. Messier, Ph.D(PMC)
(281)Adipokines: Biomarkers for osteoarthritis? by Thitiya Poonpet and Sittisak Honsawek(PMC)
(282) Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations by Jeremy Sokolove and Christin M. Lepus(PubMed)
(283) Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease by Kirsty Brown,† Daniella DeCoffe,† Erin Molcan, and Deanna L. Gibson(PubMed)
(284) Allium sativum (garlic) suppresses leukocyte inflammatory cytokine production in vitro: potential therapeutic use in the treatment of inflammatory bowel disease by Hodge G1, Hodge S, Han P.(PubMed)
(285) Neuroprotective effect of allicin against traumatic brain injury via Akt/endothelial nitric oxide synthase pathway-mediated anti-inflammatory and anti-oxidative activities by Chen W1, Qi J2, Feng F3, Wang MD1, Bao G1, Wang T1, Xiang M3, Xie WF4.(PubMed)
(286) Anti-inflammatory activity of sulfur-containing compounds from garlic by Lee da Y1, Li H, Lim HJ, Lee HJ, Jeon R, Ryu JH.(PubMed)
(287)  Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip by Drozdov VN1, Kim VA, Tkachenko EV, Varvanina GG.(PubMed)
(288) Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition , by Benzie IFF, Wachtel-Galor S, editors. Boca Raton (FL): CRC Press; 2011.(PubMed)
(289) Immunity: plants as effective mediators by Sultan MT1, Butt MS, Qayyum MM, Suleria HA.(PubMed)
(299) 6-Shogaol inhibits chondrocytes' innate immune responses and cathepsin-K activity by Villalvilla A1, da Silva JA, Largo R, Gualillo O, Vieira PC, Herrero-Beaumont G, Gómez R.(PubMed)
(290) Zingiber officinale: A Potential Plant against Rheumatoid Arthritis by Al-Nahain A1, Jahan R2, Rahmatullah M1.(PubMed)
(291) Theoretical and experimental study on lipophilicity and wound healingactivity of ginger compounds by Bakht MA1, Alajmi MF2, Alam P2, Alam A3, Alam P3, Aljarba TM3.(PubMed)
(292) A Single Meal Containing Raw, Crushed Garlic Influences Expression of Immunity- and Cancer-Related Genes in Whole Blood of Humans by Charron CS1, Dawson HD1, Albaugh GP1, Solverson PM1, Vinyard BT2, Solano-Aguilar GI1, Molokin A1, Novotny JA3.(PubMed)
(293) A Newly Designed Curcumin Analog Y20 Mitigates Cardiac Injury via Anti-Inflammatory and Anti-Oxidant Actions in Obese Rats by Qian Y1, Zhong P2, Liang D1, Xu Z1, Skibba M1, Zeng C3, Li X1, Wei T3, Wu L4, Liang G1.(PubMed)
(294) Protective effects of various dosage of Curcumin against morphine induced apoptosis and oxidative stress in rat isolated hippocampus by Motaghinejad M1, Karimian M2, Motaghinejad O3, Shabab B4, Yazdani I5, Fatima S2.(PubMed)
(295) Antioxidant and anti-inflammatory effects of curcuminoid-piperine combination in subjects with metabolic syndrome: A randomized controlled trial and an updated meta-analysis by Panahi Y1, Hosseini MS2, Khalili N2, Naimi E2, Majeed M3, Sahebkar A4.(PubMed)
(296)  Anti-Inflammatory Effects of Novel Standardized Solid Lipid Curcumin Formulations by Nahar PP1, Slitt AL, Seeram NP.(PubMed)
(297) In vitro Antioxidant Potential in Sequential Extracts of Curcuma caesia Roxb. Rhizomes by Reenu J1, Azeez S1, Bhageerathy C1.(PubMed)
(298) Polyphenolic composition and antioxidant activities of 6 new turmeric(Curcuma longa L) accessions by Chinedum E1, Kate E, Sonia C, Ironkwe A,Andrew I.(PubMed)
(299) Curcuma as a functional food in the control of cancer and inflammation by Schaffer M1, Schaffer PM, Zidan J, Bar Sela G.(PubMed)
(300) Curcumin induces apoptosis in breast cancer cell lines and delays the growth of mammary tumors in neu transgenic mice by Masuelli L1, Benvenuto M, Fantini M, Marzocchella L, Sacchetti P, Di Stefano E, Tresoldi I, Izzi V, Bernardini R, Palumbo C, Mattei M, Lista F, Galvano F, Modesti A, Bei R.(PubMed)
(301) Beneficial effects of oolong tea consumption on diet-induced overweight and obese subjects by He RR1, Chen L, Lin BH, Matsui Y, Yao XS, Kurihara H.(PubMed)
(302) Thermogenic ingredients and body weight regulation by Hursel R1, Westerterp-Plantenga MS.(PubMed)
(303) Determination of tea components with antioxidant activity by Cabrera C1, Giménez R, López MC.(PubMed)
(304) Structural determination and DPPH radical-scavenging activity of two acylated flavonoid tetraglycosides in oolong tea (Camellia sinensis) by Lee VS1, Chen CR, Liao YW, Tzen JT, Chang CI.(PubMed)
(305) Evaluation of anti-inflammatory effects of green tea and black tea: A comparative in vitro study by Chatterjee P1, Chandra S, Dey P, Bhattacharya S.(PubMed)
(306) Anti-inflammatory and anti-oxidative effects of the green tea polyphenol epigallocatechin gallate in human corneal epithelial cells by Cavet ME1, Harrington KL, Vollmer TR, Ward KW, Zhang JZ.(PubMed)
(307) Immunomodulatory effects of EGCG fraction of green tea extract in innate and adaptive immunity via T regulatory cells in murine model by Kuo CL1, Chen TS, Liou SY, Hsieh CC.(PubMed)
(308) Immunomodulating effects of epigallocatechin-3-gallate from green tea: mechanisms and applications by Pae M1, Wu D.(PubMed)
(309) Structure and inducing tumor cell apoptosis activity of polysaccharides isolated from Lentinus edodes by Wang KP1, Zhang QL, Liu Y, Wang J, Cheng Y, Zhang Y.(PubMed)
(310) Structure and immuno-stimulating activities of a new heteropolysaccharide from Lentinula edodes by Xu X1, Yan H, Zhang X.(PubMed)
(311) Dietary supplementation with rice bran fermented with Lentinus edodes increases interferon-γ activity without causing adverse effects: a randomized, double-blind, placebo-controlled, parallel-group study by Choi JY, Paik DJ, Kwon DY, Park Y1.(PubMed)
(312) Anti-inflammatory effects of five commercially available mushroomspecies determined in lipopolysaccharide and interferon-γ activated murine macrophages by Gunawardena D1, Bennett L, Shanmugam K, King K, Williams R, Zabaras D, Head R, Ooi L, Gyengesi E, Münch G.(PubMed)
(313) Effect of shiitake (Lentinus edodes) extract on antioxidant and inflammatory response to prolonged eccentric exercise by Zembron-Lacny A1, Gajewski M, Naczk M, Siatkowski I.(PubMed)
(314) Both common and specialty mushrooms inhibit adhesion molecule expression and in vitro binding of monocytes to human aortic endothelial cells in a pro-inflammatory environment by Martin KR1.(PubMed)
(315) A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilottrial by Frestedt JL1, Walsh M, Kuskowski MA, Zenk JL.(PubMed)
(316) The use of calcium and vitamin D in the management of osteoporosis by John A Sunyecz(PubMed)
(317) Calcium and vitamin D nutrition and bone disease of the elderly by Gennari C1.(PubMed)
(318) Calcium: An Important Nutrient that Builds Stronger Bones(Osteoarthritis Canada)
(319) Bone Health and Osteoporosis: A Report of the Surgeon General(NCBI)
(320) Association between Dietary Magnesium Intake and Radiographic Knee Osteoarthritis. by Zeng C1, Li H1, Wei J2, Yang T1, Deng ZH1, Yang Y1, Zhang Y1, Yang TB2, Lei GH1(PubMed)
(321) Association of dietary magnesium intake with radiographic knee osteoarthritis: results from a population-based study by Qin B1, Shi X, Samai PS, Renner JB, Jordan JM, He K.(PubMed)
(322) Relationship between Serum Magnesium Concentration and Radiographic Knee Osteoarthritis. by Zeng C1, Wei J1, Li H1, Yang T1, Zhang FJ1, Pan D1, Xiao YB1, Yang TB1, Lei GH2.(PubMed)
(323) Comparison of bone tissue trace-element concentrations and mineral density in osteoporotic femoral neck fractures and osteoarthritis by Karaaslan F1, Mutlu M2, Mermerkaya MU1, Karaoğlu S3, Saçmaci Ş4, Kartal Ş4.(PubMed)
(324) Dietary vitamins and selenium diminish the development of mechanically induced osteoarthritis and increase the expression of antioxidative enzymes in the knee joint of STR/1N mice by Kurz B1, Jost B, Schünke M.(PubMed)
(325) Synovial fluid and plasma selenium, copper, zinc, and iron concentrations in patients with rheumatoid arthritis and osteoarthritis by Yazar M1, Sarban S, Kocyigit A, Isikan UE.(PubMed)
(326) Expression profiles of genes involved in apoptosis and selenium metabolism in articular cartilage of patients with Kashin-Beck osteoarthritis by Wu SX1, Wang WZ2, Zhang F3, Wu CY3, Dennis BS3, Qu CJ4, Bai YD5, Guo X6.(PubMed)
(327) Differences in zinc status between patients with osteoarthritis and osteoporosis by Ovesen J1, Møller-Madsen B, Nielsen PT, Christensen PH, Simonsen O, Hoeck HC, Laursen MB, Thomsen JS.(PubMed)
(328) Differences in zinc status, bone turnover and femoral head bone density and biomechanical properties between patients with osteoarthritis and osteoporosis by Thomsen JS1, Nielsen PT, Christensen PH, Simonsen O, Hoeck HC, Laursen MB, Møller-Madsen B, Ovesen J.(PubMed)
(329) Synovial fluid and plasma selenium, copper, zinc, and iron concentrations in patients with rheumatoid arthritis and osteoarthritis by Yazar M1, Sarban S, Kocyigit A, Isikan UE.
(330) Copper-salicylate gel for pain relief in osteoarthritis: a randomised controlled trial.
Shackel NA1, Day RO, Kellett B, Brooks PM.(PubMed)
(331) Serum copper and zinc in rheumatoid arthritis and osteoarthritis by Grennan DM, Knudson JM, Dunckley J, MacKinnon MJ, Myers DB, Palmer DG.(PubMed)
(332) Effect of a topical copper indomethacin gel on inflammatory parameters in a rat model of osteoarthritis by Yassin NZ1, El-Shenawy SM1, Abdel-Rahman RF1, Yakoot M2, Hassan M3, Helmy S4.(PubMed)
(333) Iron overload in a murine model of hereditary hemochromatosis is associated with accelerated progression ofosteoarthritis under mechanical stress by Camacho A1, Simão M2, Ea HK3, Cohen-Solal M3, Richette P3, Branco J4, Cancela ML5.(PubMed)
(334) Synovial iron deposition in osteoarthritis and rheumatoid arthritis by Ogilvie-Harris DJ, Fornaiser VL.(PubMed)
(335) Dietary vitamins and selenium diminish the development of mechanically induced osteoarthritis and increase the expression of antioxidative enzymes in the knee joint of STR/1N mice. by Kurz B1, Jost B, Schünke M.(PubMed)
(336) Comparative effectiveness of B and e vitamins with diclofenac in reducing pain due to osteoarthritis of the knee by Dehghan M1(PubMed).
(337) Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial by Cao Y1, Jones G, Cicuttini F, Winzenberg T, Wluka A, Sharman J, Nguo K, Ding C.(PubMed)
(338) Association of serum carotenoids, retinol, and tocopherols with radiographic knee osteoarthritis: possible risk factors in rural Japanese inhabitants by Seki T1, Hasegawa Y, Yamaguchi J, Kanoh T, Ishiguro N, Tsuboi M, Ito Y, Hamajima N, Suzuki K.(PubMed)
(339) Serum carotenoids and radiographic knee osteoarthritis: the Johnston County Osteoarthritis Project by De Roos AJ1, Arab L, Renner JB, Craft N, Luta G, Helmick CG, Hochberg MC, Jordan JM.(PubMed)
(340) A case-control study of serum tocopherol levels and the alpha- to gamma-tocopherol ratio in radiographic kneeosteoarthritis: the Johnston County Osteoarthritis Project by Jordan JM1, De Roos AJ, Renner JB, Luta G, Cohen A, Craft N, Helmick CG, Hochberg MC, Arab L.(PubMed)
(341) Ascorbic acid provides protection for human chondrocytes against oxidative stress by Chang Z1, Huo L1, Li P1, Wu Y1, Zhang P1.(PubMed)
(342) Potential involvement of oxidative stress in cartilage senescence and development of osteoarthritis: oxidative stress induces chondrocyte telomere instability and downregulation of chondrocyte function by Yudoh K1, Nguyen vT, Nakamura H, Hongo-Masuko K, Kato T, Nishioka K.(PubMed)
(343) Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidenc by Laurent G Ameye1 and Winnie SS Chee1(PMC)
(344) Elucidation of dietary risk factors in osteoarthritis knee—a case-control study by Sanghi D1, Mishra A, Sharma AC, Raj S, Mishra R, Kumari R, Natu SM, Agarwal S, Srivastava RN.(PubMed)
(345) Status of lipid peroxidation, glutathione, ascorbic acid, vitamin E and antioxidant enzymes in patients withosteoarthritis by Surapaneni KM1, Venkataramana G.(PubMed)
(346) Intra-articular hyaluronate, tenoxicam and vitamin E in a rat model of osteoarthritis: evaluation and comparison of chondroprotective efficacy by Ozkan FU1, Uzer G2, Türkmen I3, Yildiz Y3, Senol S4, Ozkan K3, Turkmensoy F3, Ramadan S5, Aktas I1(PubMed)
(347) Supplementary vitamin E does not affect the loss of cartilage volume in knee osteoarthritis: a 2 year double blind randomized placebo controlled study by Wluka AE1, Stuckey S, Brand C, Cicuttini FM.(PubMed)
(348) Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: The Rotterdam Study by Bergink AP1, Uitterlinden AG, Van Leeuwen JP, Buurman CJ, Hofman A, Verhaar JA, Pols HA.(PubMed)
(349) Vitamin D deficiency is associated with progression of knee osteoarthritis by Zhang FF1, Driban JB2, Lo GH3, Price LL4, Booth S5, Eaton CB6, Lu B7, Nevitt M8, Jackson B9, Garganta C10, Hochberg MC11, Kwoh K12, McAlindon TE2.(PubMed)
(350) Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies by Felson DT1, Niu J, Clancy M, Aliabadi P, Sack B, Guermazi A, Hunter DJ, Amin S, Rogers G, Booth SL.(PubMed)
(351) Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian older adult cohort study by Ding C1, Cicuttini F, Parameswaran V, Burgess J, Quinn S, Jones G.(PubMed)
(352) Comparative effectiveness of B and e vitamins with diclofenac in reducing pain due to osteoarthritis of the knee by Dehghan M1.(PubMed)
(353) B-vitamin mixture improves the analgesic effect of diclofenac in patients with osteoarthritis: a double blind study by Magaña-Villa MC1, Rocha-González HI, Fernández del Valle-Laisequilla C, Granados-Soto V, Rodríguez-Silverio J, Flores-Murrieta FJ, Carrasco-Portugal MC,Reyes-García JG.(PubMed)
(354) Oral salmon calcitonin reduces cartilage and bone pathology in an osteoarthritis rat model with increased subchondral bone turnover by Nielsen RH1, Bay-Jensen AC, Byrjalsen I, Karsdal MA.(PubMed)
(355) The effect of oral calcitonin on cartilage turnover and surface erosion in an ovariectomized rat model by Sondergaard BC1, Oestergaard S, Christiansen C, Tankó LB, Karsdal MA.(PubMed)
(356) Effects of calcitonin on subchondral trabecular bone changes and on osteoarthritic cartilage lesions after acute anterior cruciate ligament deficiency by Behets C1, Williams JM, Chappard D, Devogelaer JP, Manicourt DH.(PubMed)
(357) Treatment of symptomatic knee osteoarthritis with oral salmon calcitonin: results from two phase 3 trials by Karsdal MA1, Byrjalsen I2, Alexandersen P3, Bihlet A2, Andersen JR2, Riis BJ2, Bay-Jensen AC2, Christiansen C2; CSMC021C2301/2 investigators.(PubMed)
(358) Biochemical markers identify influences on bone and cartilage degradation in osteoarthritis--the effect of sex, Kellgren-Lawrence (KL) score, body mass index (BMI), oral salmon calcitonin (sCT) treatment and diurnal variation by Karsdal MA1, Byrjalsen I, Bay-Jensen AC, Henriksen K, Riis BJ, Christiansen C.(PubMed)
(359) Oral salmon calcitonin reduces Lequesne's algofunctional index scores and decreases urinary and serum levels of biomarkers of joint metabolism in knee osteoarthritis by Manicourt DH1, Azria M, Mindeholm L, Thonar EJ, Devogelaer JP.(PubMed)
(360) Calcitonin(The free dictionary)
(361) Dietary omega-3 fatty acids aid in the modulation of inflammation and metabolic healt by Angela M. Zivkovic, Natalie Telis, J. Bruce German, and Bruce D. Hammock(PubMed)
(362) Extra-virgin olive oil diet and mild physical activity prevent cartilage degeneration in an osteoarthritis model: an in vivo and in vitro study on lubricin expression by Musumeci G, Trovato FM, Pichler K, Weinberg AM, Loreto C, Castrogiovanni P.(PubMed)
(363) Protective effects upon experimental inflammation models of a polyphenol-supplemented virgin olive oil diet by Martínez-Domínguez E1, de la Puerta R, Ruiz-Gutiérrez V.(PubMed)
(364) A pilot double-blinded, randomized, clinical trial of topical virgin olive oil versus piroxicam gel in osteoarthritis of the knee.in Bohlooli S1, Jastan M, Nakhostin-Roohi B, Mohammadi S, Baghaei Z.(PubMed)
(365) Hydrolyzed olive vegetation water in mice has anti-inflammatory activity by Bitler CM1, Viale TM, Damaj B, Crea R.(PubMed)
(366) Mechanisms of olive leaf extract-ameliorated rat arthritis caused by kaolin and carrageenan. by Gong D1, Geng C, Jiang L, Wang L, Yoshimura H, Zhong L.(PubMed)
(367) Osteoarthritis in Latin America: Study of Demographic and Clinical Characteristics in 3040 Patients by Reginato AM1, Riera H, Vera M, Torres AR, Espinosa R, Esquivel JA, Felipe OJ, Blas JR, Rillo O, Papasidero S, Souto R, Rossi C, Molina JF, Ballesteros F,Radrigan F, Guibert M, Chico A, Gil ML, Camacho W, Urioste L, Garcia AK, Iraheta I, Gutierrez CE, Duarte M, Castañeda O, Coimbra I, Muñoz Louis R, Reveille J, Quintero M; Pan-American League of Associations for Rheumatology (PANLAR) Osteoarthritis Study Group(PubMed)
(368) Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee by Pavelka K1, Coste P, Géher P, Krejci G.(PubMed)
(369) Chondroitin for osteoarthritis by Singh JA1, Noorbaloochi S, MacDonald R, Maxwell LJ.(PubMed)
(370) Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib by Hochberg MC1, Martel-Pelletier J2, Monfort J3, Möller I4, Castillo JR5, Arden N6, Berenbaum F7, Blanco FJ8, Conaghan PG9, Doménech G10, Henrotin Y11,Pap T12, Richette P13, Sawitzke A14, du Souich P15, Pelletier JP2; on behalf of the MOVES Investigation Group(PubMed)
(371) Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis by Clegg DO1, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW,Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ.(PubMed)
(372) Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial by Blotman F1, Maheu E, Wulwik A, Caspard H, Lopez A.(PubMed)
(373) Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. by Maheu E1, Mazières B, Valat JP, Loyau G, Le Loët X, Bourgeois P, Grouin JM, Rozenberg S.(PubMed)
(374) Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study by Appelboom T1, Schuermans J, Verbruggen G, Henrotin Y, Reginster JY.(PubMed)
(375) Avocado-soybean unsaponifiables (ASU) for osteoarthritis - a systematic review by Ernst E1.(PubMed)
(376) Management of Osteoarthritis with Avocado/Soybean Unsaponifiables by Christiansen BA1, Bhatti S2, Goudarzi R3, Emami S4.(PubMed)
(377) Avocado/soybean unsaponifiables prevent the inhibitory effect of osteoarthritic subchondral osteoblasts on aggrecan and type II collagen synthesis by chondrocytes by Henrotin YE1, Deberg MA, Crielaard JM, Piccardi N, Msika P, Sanchez C.(PubMed)
(378) Ice therapy: how good is the evidence? by Mac Auley DC1.(PubMed)
(379) Do textbooks agree on their advice on ice? by MacAuley D1.(PubMed)
(380) Should I use heat or ice to ease knee pain from osteoarthritis?[No authors listed](PubMed)
(381) Osteoarthritis-dependent changes in antinociceptive action of Nav1.7 and Nav1.8 sodium channel blockers: An in vivo electrophysiological study in the rat by Rahman W1, Dickenson AH2(PubMed)
(382) Effectiveness of thermal and athermal short-wave diathermy for the management of knee osteoarthritis: a systematic review and meta-analysis by Laufer Y1, Dar G.(PubMed)
(383) Acupuncture for chronic knee pain: a randomized clinical trial by Hinman RS1, McCrory P2, Pirotta M3, Relf I3, Forbes A4, Crossley KM5, Williamson E6, Kyriakides M3, Novy K3, Metcalf BR1, Harris A7, Reddy P8, Conaghan PG9, Bennell KL1.(PubMed)
(384) Acupuncture for peripheral joint osteoarthritis by Manheimer E1, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM.(PubMed)
(385) Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial by Bennell KL1, Egerton T1, Martin J1, Abbott JH2, Metcalf B1, McManus F1, Sims K3, Pua YH4, Wrigley TV1, Forbes A5, Smith C5, Harris A6, Buchbinder R7.(PubMed)
(386) Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. by Manyanga T1, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, Shay BL.(PubMed)
(387) Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis by Corbett MS1, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, Sutton AJ, Macpherson H, Woolacott NF.(PubMed)
(388) Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis--an exploratory review by Vas J1, White A.(PubMed)
(389) Gait analysis of patients with knee osteoarthritis before and after Chinese massage treatment by Qingguang Z, Min F, Li G, Shuyun J, Wuquan S, Jianhua L, Yong L.(PubMed)
(390) Massage therapy for osteoarthritis of the knee: a randomized controlled trial by Perlman AI1, Sabina A, Williams AL, Njike VY, Katz DL.(PubMed)
(391) Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review by Bervoets DC1, Luijsterburg PA1, Alessie JJ2, Buijs MJ2, Verhagen AP1.(PubMed)
(392) Complementary and alternative medicine in osteoarthritis by De Luigi AJ1.(PubMed)
(393) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials by Pittler MH1, Karagülle MZ, Karagülle M, Ernst E.(PubMed)
(394) The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study by Tefner IK1, Németh A, Lászlófi A, Kis T, Gyetvai G, Bender T.(PubMed)
(395) Balneotherapy (or spa therapy) for rheumatoid arthritis by Verhagen AP1, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie R, de Vet HC.(PubMed)
(396) May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action by Fortunati NA1, Fioravanti A2, Seri G1, Cinelli S2, Tenti S3.(PubMed)
(397) Spa therapy: can be a valid option for treating knee osteoarthritis? by Tenti S1, Cheleschi S, Galeazzi M, Fioravanti A.(PubMed)
(398) Effects of spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. by Fioravanti A1, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P.(PubMed)
(399) Effectiveness of Back School program versus hydrotherapy in elderly patients with chronic non-specific low back pain: a randomized clinical trial by Costantino C1, Romiti D.(PubMed)
(400) Effects of therapeutic exercise and hydrotherapy on pain severity and knee range of motion in patients with hemophilia: a randomized controlled trial by Mazloum V1, Rahnama N1, Khayambashi K1.(PubMed)
(401) Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial by Castro-Sánchez AM1, Matarán-Peñarrocha GA, Lara-Palomo I, Saavedra-Hernández M, Arroyo-Morales M, Moreno-Lorenzo C.(PubMed)
(402) Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial by Silva LE1, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, Natour J.(PubMed)
(403) Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes by Fransen M1, Nairn L, Winstanley J, Lam P, Edmonds J.(PubMed)
(404) Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis by Cochrane T1, Davey RC, Matthes Edwards SM.(PubMed)
(405) Effect of watergym in knee osteoarthritis by Guerreiro JP1, Claro RF1, Rodrigues JD1, Freire BF1.(PubMed)
(406) The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis by Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, Yeung AS.(PubMed)
(407) The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses by Chen YW1, Hunt MA1, Campbell KL1, Peill K2, Reid WD3.(PubMed)
(408) Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: a cross-sectional study of floor/ceiling effects and construct validity by Driban JB1, Morgan N2,3, Price LL4, Cook KF5, Wang C6.(PubMed)
(409) Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial by Wang C1, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, McAlindon T.(PubMed)
(410) Tai Chi for treating knee osteoarthritis: designing a long-term follow up randomized controlled trial by Wang C1, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, Okparavero A, McAlindon T.(PubMed)
(411) Efficacy of Tai Chi on pain, stiffness and function in patients with osteoarthritis: a meta-analysis by Yan JH1, Gu WJ, Sun J, Zhang WX, Li BW, Pan L.(PubMed)
(412) Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review by Cheung C1, Park J, Wyman JF.(PubMed)
(413) Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study by Kolasinski SL1, Garfinkel M, Tsai AG, Matz W, Van Dyke A, Schumacher HR.(PubMed)
(414) Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms. by Therkleson T1.(PubMed)
(415) Ginger Therapy for Osteoarthritis: A Typical Case by Therkleson T1.(PubMed)
(416) Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms by Therkleson T1(PubMed)
(417) Zucapsaicin(Wikipedia)
(418) Civamide cream 0.075% in patients with osteoarthritis of the knee: a 12-week randomized controlled clinical trial with a longterm extension by Schnitzer TJ1, Pelletier JP, Haselwood DM, Ellison WT, Ervin JE, Gordon RD, Lisse JR, Archambault WT, Sampson AR, Fezatte HB, Phillips SB, Bernstein JE.(PubMed)
(419) High strength capsaicin cream for osteoarthritis pain: rapid onset of action and improved efficacy with twice daily dosing by Schnitzer TJ1, Posner M, Lawrence ID.(PubMed)
(420) Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain.
Chrubasik S1, Weiser T, Beime B.(PubMed)
(421) Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting by Heidland A1, Fazeli G, Klassen A, Sebekova K, Hennemann H, Bahner U, Di Iorio B.(PubMed)
(422) Osteoarthritis: physical medicine and rehabilitation--nonpharmacological management.
Stemberger R1, Kerschan-Schindl K.(PubMed)
(423) Transcutaneous electrostimulation for osteoarthritis of the knee by Rutjes AW1, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P.(PubMed)
(424) Chiropractic care of a 70-year-old female patient with hip osteoarthritis by Strunk RG1, Hanses M.(PubMed)
(425) Prevalence of hip osteoarthritis in chiropractic practice in Denmark: a descriptive cross-sectional and prospective study by Poulsen E1, Christensen HW, Overgaard S, Hartvigsen J.(PubMed)
(426) A randomized controlled trial of chiropractic management of the lower limb kinetic chain for the treatment of hiposteoarthritis: a study protocol by de Luca K1, Pollard H, Brantingham J, Globe G, Cassa T.(PubMed)
(427) Chiropractic management of the kinetic chain for the treatment of hip osteoarthritis: an Australian case series by de Luca K1, Pollard H, Brantingham J, Globe G, Cassa T.(PubMed)
(428) Effects of chiropractic care on pain and function in patients with hip osteoarthritis waiting for arthroplasty: a clinical pilot trial by Thorman P1, Dixner A, Sundberg T.(PubMed)
(429) Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone by Beyerman KL1, Palmerino MB, Zohn LE, Kane GM, Foster KA.(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)
(486) EFFECT OF A PROPRIETARY HERBAL MEDICINE ON THE RELIEF OF CHRONIC ARTHRITIC PAIN: A DOUBLE-BLIND STUDY by S. Y. MILLS, R. K. JACOBY*, M. CHACKSFIELD and M. WILLOUGHBY(Rheumatology)
(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 
(494) [Comparative analysis on composition principles of traditional Chinese medicine prescriptions for osteoporosis and osteoarthritis].[Article in Chinese] by Zheng ZR, Tang SH.(PubMed)
(495) Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 by Patricia M. Barnes, M.A., and Barbara Bloom, M.P.A., Division of Health Interview Statistics, National Center for Health Statistics; and Richard L. Nahin, Ph.D., M.P.H., National Center for Complementary and Alternative Medicine, National Institutes of Health
(496) Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials by Chen B1, Zhan H1, Chung M2, Lin X1, Zhang M1, Pang J1, Wang C3.(PubMed)
(497) Assessment of comparative pain relief and tolerability of SKI306X compared with celecoxib in patients with rheumatoid arthritis: a 6-week, multicenter, randomized, double-blind, double-dummy, phase III, noninferiority clinical trial by Song YW1, Lee EY, Koh EM, Cha HS, Yoo B, Lee CK, Baek HJ, Kim HA, Suh YI, Kang SW, Lee YJ, Jung HG.(PubMed)
(498) SKI306X inhibition of glycosaminoglycan degradation in human cartilage involves down-regulation of cytokine-induced catabolic genes by Choi CH1, Kim TH2, Sung YK2, Choi CB2, Na YI3, Yoo H4, Jun JB2.(PubMed)
(499) Effects of SKI306X on arachidonate metabolism and other inflammatory mediators by Kim JH1, Ryu KH, Jung KW, Han CK, Kwak WJ, Cho YB.(PubMed)
(500) Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study by Jung YB1, Roh KJ, Jung JA, Jung K, Yoo H, Cho YB, Kwak WJ, Kim DK, Kim KH, Han CK(PubMed)
(501) Du Huo Ji Sheng Tang(American Dragon)
(502) Duhuo Jisheng Tang for treating osteoarthritis of the knee: a prospective clinical observation by Jung-Nien Lai,1 Huey-Jeng Chen,2 Chao-Chung Chen,3 Jer-Huei Lin,4 Jing-Shiang Hwang,5 and Jung-Der Wang(PMC)
(503) Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence by Ameye LG1, Chee WS.(PubMed)
(504) Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial [ISRCTN70292892] by Teekachunhatean S1, Kunanusorn P, Rojanasthien N, Sananpanich K, Pojchamarnwiputh S, Lhieochaiphunt S, Pruksakorn S.(PubMed)
(505) Chinese Herbal Formula Huo-Luo-Xiao-Ling Dan Protects against Bone Damage in Adjuvant Arthritis by Modulating the Mediators of Bone Remodeling by Siddaraju M. Nanjundaiah,1 David Y.-W. Lee,2 Brian M. Berman,3 and Kamal D. Moudgil(Hindawi Publishing Corporation)
(506) Dose Escalation Study Of Chinese Herbs In Osteoarthritis Of The Knee (TCM-OAK)(Clinical trial. Gov)
(507) Huo-Luo-Xiao-Ling (HLXL)-Dan, a Traditional Chinese Medicine, for patients with osteoarthritis of the knee: a multi-site, randomized, double-blind, placebo-controlled phase II clinical trial by Lao L1, Hochberg M2, Lee DY3, Gilpin AM4, Fong HH5, Langenberg P6, Chen K7, Li EK8, Tam LS9, Berman B10.(PubMed)
(508) Anti-hyperalgesic and anti-inflammatory effects of the modified Chinese herbal formula Huo Luo Xiao Ling Dan (HLXL) in rats by Lao L1, Fan AY, Zhang RX, Zhou A, Ma ZZ, Lee DY, Ren K, Berman B.(PubMed)
(509) Experimental Study on Anti-Inflammatory Effect and Analgesic Effect of Simiao Powder by Jing Yun, Li weilin
(510) Randomized and controlled clinical study of modified prescriptions of Simiao Pill in the treatment of acute gouty arthritis by Shi XD1, Li GC, Qian ZX, Jin ZQ, Song Y.(PubMed)
(511) [Effects and mechanisms of Simiao pill on adjuvant arthritis rats model].[Article in Chinese]by Wang X1, Zhang X, Zhang L, Li Y.(PubMed)
(512) Treatment with SiMiaoFang, an anti-arthritis chinese herbal formula, inhibits cartilage matrix degradation in osteoarthritis rat model by Xu Y1, Liu Q, Liu ZL, Lim L, Chen WH, Lin N.(PubMed)
(513) Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc.
(514) Anti-hypersensitivity effects of Shu-jing-huo-xue-tang, a Chinese herbal medicine, in CCI-neuropathic rats by Shu H1, Arita H, Hayashida M, Zhang L, An K, Huang W, Hanaoka K.(PubMed)
(515) Study of sokei-kakketu-to (shu-jing-huo-xue-tang) in adjuvant arthritis rats by Kanai S1, Taniguchi N, Higashino H.(PubMed)