Monday, 21 March 2016

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

Kyle J. Norton (Scholar)

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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


                  Polymyalagia Arthritis (Rheumatica)

Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which causes pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdle as a result of the presence of a synovitis in proximal joints and periarticular structures.
                              The Phytochemicals 

Significantly inflammation has been found to accompany with patient with Polymyalgia Rheumatica(PMR). Certain phytochemicals have found effectively for treatment of  inflammatory symptoms of patient with PMR, including the following

1. Polyphenols(-)-epigallocatechin-3-gallate (EGCG)(Green tea)
Polyphenols(-)-epigallocatechin-3-gallate (EGCG) processed anti viral and bacterial effects through immune expression such as chronic or acute inflammation(115). Dr. Xiao J and the research team at the Shenzhen Institute of Advanced Technology suggested, pure extract of (-) epigallocatechin gallate (EGCG) inhibited inflammation through antioxidant activities against oxidative stress and down regulated pro-inflammatory markers(116).
According to the Universitat de Girona (UdG), Polyphenols(-)-epigallocatechin-3-gallate (EGCG) also showed to reduce pain in attenuated alterations by diminishing apoptotic gene overexpression in skeletal muscles(117)

2. Curcumin
Curcumin, a phytochemical found in turmeric used in the Indian cooking recipe has found to process the antioxidants and anti inflammatory effects, epidemiologically.
It inhibited muscle pain, muscle damage, inflammation and delayed onset muscle soreness, the SportsMed Canterbury study suggested.(118), through attenuatd inflammatory responses and production of reactive oxygen species (ROS) that sustain both inflammation and oxidative stress(119).
In fact Dr. Anand P and the research team at the University of Texas M.D. Anderson Cancer Center, said, curcumin beside inhibited pain in many therapeutic levels but also linked to suppression of inflammation; angiogenesis, tumorigenesis and diseases of the cardiovascular, pulmonary, and neurological systems(120).

3. Resveratrol
Resveratrol (RES), a well-known antioxidant and anti-inflammatorycompound, found abundantly in red wine, exerted numerous pharmacological effects, including hepatoprotection and cadioprotection(121). According to the University of Arizona study, resveratrol facilitated acute and chronic pain through activation of AMPK, the enzyme played a key role as a master regulator of cellular energy homeostasis(122).

4. Boswellic acid
Gum-resin extracts of Boswellia serrata have been traditionally used in folk medicine for centuries to treat various chronic inflammatory diseases. Recent study showed that the acid are also responsible for inhibition of pro-inflammatory enzymes(123). Dr Bishnoi M and the research team at the University Institute of Pharmaceutical Sciences, suggested that the phytochemical also may help to reduce the therapeutic doses of conventional NSAIDs and side effects when used conjunction with nimesulide(124).

5. Cucurbitacins 
Cucurbitacins found in the common pumpkins and gourds  processed anti-inflammatory and analgesic activity in reduced pain through inhibition of the neurogenic (first phase) and inflammatory phase (second phase) of formalin-induced pain(125). The phytochemical also  inhibit pain caused by chronic rheumatic disease through anti pro inflammayory cytokine activity(126).

(115) Compounds derived from epigallocatechin-3-gallate (EGCG) as a novel approach to the prevention of viral infections by Hsu S.(PubMed)
(116) Epigallocatechin gallate attenuates fibrosis, oxidative stress, and inflammation in non-alcoholic fatty liver disease rat model through TGF/SMAD, PI3 K/Akt/FoxO1, and NF-kappa B pathways by Xiao J1, Ho CT, Liong EC, Nanji AA, Leung TM, Lau TY, Fung ML, Tipoe GL.(PubMed)
(116) (-)-Epigallocatechin-3-gallate (EGCG) attenuates functional deficits and morphological alterations by diminishing apoptotic gene overexpression in skeletal muscles after sciatic nerve crush injury by Renno WM1, Al-Maghrebi M, Al-Banaw A(PubMed)).
(118) Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS) by Nicol LM1, Rowlands DS, Fazakerly R, Kellett J.(PubMed)
(119) Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva®): a randomised, placebo-controlled trial by Drobnic F1, Riera J1, Appendino G2, Togni S3, Franceschi F3, Valle X4, Pons A5, Tur J5.(PubMed)
(120) Biological activities of curcumin and its analogues (Congeners) made by man and Mother Anand P1, Thomas SG, Kunnumakkara AB, Sundaram C, Harikumar KB, Sung B, Tharakan ST, Misra K, Priyadarsini IK, Rajasekharan KN, Aggarwal BB.(PubMed)
(121) Resveratrol nanoparticle system improves dissolution properties and enhances the hepatoprotective effect of resveratrol through antioxidant and anti-inflammatory pathways by Lee CW1, Yen FL, Huang HW, Wu TH, Ko HH, Tzeng WS, Lin CC.(PubMed)
(122) Resveratrol engages AMPK to attenuate ERK and mTOR signaling in sensory neurons and inhibits incision-induced acute and chronic pain by Tillu DV1, Melemedjian OK, Asiedu MN, Qu N, De Felice M, Dussor G, Price TJ.(PubMed)
(123) Boswellia serrata, a potential antiinflammatory agent: an overview by Siddiqui MZ1.(PubMed)
(124) Potentiation of antinociceptive effect of NSAIDs by a specific lipooxygenase inhibitor, acetyl 11-keto-betaboswellic acid by Bishnoi M1, Patil CS, Kumar A, Kulkarni SK.(PubMed)
(125) Anti-inflammatory and analgesic effects of cucurbitacins from Wilbrandia ebracteata by Peters RR1, Farias MR, Ribeiro-do-Valle RM.(PubMed)
(126) Nitric oxide and cyclooxygenase may participate in the analgesic and anti-inflammatory effect of thecucurbitacins fraction from Wilbrandia ebracteata by Peters RR1, Baier Krepsky P, Siqueira-Junior J, da Silva Rocha JC, Marques Bezerra M, de Albuquerque Ribeiro R, de Brum-Fernandes AJ, Rocha Farias M,Castro da Rocha FA, Ribeiro-do-Valle RM(PubMed)

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