Thursday, 24 March 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Polymyalagia Arthritis (Rheumatica): Medical treatment In conventional medicine

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.


A. In conventional medicine perspective
A.2. Medical treatment
1. Tocilizumab (TCZ)
1.1. The effectiveness
Tocilizumab (TCZ),the first humanized anti proinflammatory agent in the interleukin-6 receptor-
inhibiting monoclonal antibody developed to treat rheumatoid arthritis, may also be efectively for treatment of PMR(152) becauses of its significant improvement of the patient's clinical and biochemical PMR activity(152).
In the study to assess the outcomes of 10 patients with relapsing/refractory GCA, TAK, or PMR treated with tocilizumab (TCZ), found that TCZ led to clinical and serological improvement in patients with PMR, through reduced symptoms of disease activity, inflammatory markers(153).

2.2. The adverse effects are not limit to
q. Dizziness
b. Headache
c. Allergic effects, such as rash; hives; itching; difficulty breathing, etc.
d. Skin changes
e. Tiredness or weakness
f. Etc.

2. Corticosteroids [CS] and nonsteroidal antiinflammatory drugs [NSAIDs])
2.1. Corticosteroids, a drug, a common presentation in primary care, and non-selective non-steroidal anti-inflammatory drugs (sometimes also referred to as traditional NSAIDs or tNSAIDs) are the first choice of treating of Polymalagia Arthritis, but the use of CS and NSAIDs in the treatment of PMR is associated with important long-term morbidity, according to Gabriel SE, Sunku J, Salvarani C.(154).
 The total of 176 patients in whom polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) diagnosed between 1968 and 1980 study, treated with corticosteroids, showed no patient suffered a serious disease complication after starting treatment. Regular follow-up enabled the minimum effective corticosteroid dose to be used. Complications of treatment were infrequent(155).

2.2. The adverse effects ate not limit to
a. Corticosteroids [CS]
a.1. Corticosteroid withdrawal syndrome
a.2. Hyperglycemia
a.3. Insulin resistance
a.4. Diabetes mellitus
a.5. Osteoporosis
a.6. Depression
a.7. Colitis
a.8. Etc.

b. Nonsteroidal antiinflammatory drugs [NSAIDs]
NSAIDs may cause large intestinal ulcers, bleeding, and perforationoccasionally(156), mostly in duodenum of which represent a range of asymptomatic pathologies but some are life threatening(156).The use of the medication are also found to induce important long-term morbidity(157).

(152) Effective control of polymyalgia rheumatica with tocilizumab by Al Rashidi A1, Hegazi MO, Mohammad SA, Varghese A.(PubMed)
(153) Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica by Unizony S1, Arias-Urdaneta L, Miloslavsky E, Arvikar S, Khosroshahi A, Keroack B, Stone JR, Stone JH.(PubMed)
(154) Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica by Gabriel SE1, Sunku J, Salvarani C, O'Fallon WM, Hunder GG.(PubMed)
(155) Polymyalgia rheumatica and corticosteroids: how much for how long? by Behn AR, Perera T, Myles AB.(PubMed)

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