Sunday, 8 May 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs)- Gout - Treatment In conventional medicine - Acetaminophen

Kyle J. Norton (Scholar and Master of Nutrients, all right reserved)Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. According to 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(*).

Types of Musculo-Skeletal disorders in elder

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


Gout mostly effected one joint is an acute and recurrent condition of arthritis as a result of uric acid building up in blood, inducing joint inflammation.



A. In conventional medicine perspective
A.1. Acetaminophen
Acetaminophen is an analgesic drug used by conventional medicine for treatment of headaches, arthritis, etc., as well as reducing fever, often as an alternative to aspirin without causing gastrointestinal adverse effecta. Acetaminophen such as Tylenol can help to relive the pain of Gout.
b. Side effects if overdose, are not limit to
b.1. Nausea and vomiting
b.2. Appetite loss
b.3. Sweating
b.4. Diarrhea
b.5. Irritability
b.6. Abdominal pain
b.7. Etc.
The University of Adelaide, in a double-blind, placebo-controlled trial, showed that application of acetaminophen was associated with adverse effects of suppression of serum neutralizing antibody response and increased nasal symptoms and signs(233) and hepatic  damage(234) and toxicity(234).
Dr. Bhargava VO and Dr. Hirate J., said, " the relative contribution of the gastrointestinal tract and liver to the oral first-pass effect of acetaminophen may be dose-dependent"(235).

A.2. The study of Gout–what are the treatment options? indicated that The options available for the treatment of acute gout (236)are

a. NSAIDs, also known as nonsteroidal anti-inflammatory agents/analgesics are commonly prescribed to control gout attacks in patients with hyperuricaemia.
Colchicine, due to economic affordable to many patients has been prescribed for treatment of gout with less adverse effects such as better tolerated, especially in patients with peptic ulcer, gastrointestinal bleeding or dyspepsia or who are taking anticoagulants(237), in acute gout patients.
According to the joint study led by the Lanzhou University in review of researched articles from 1983 until August 2014 suggested, beside "pain relief as the primary outcome, Tenderness, swelling, patients' global assessments of response to treatment, and investigators' global assessments of response to treatment were reported as the secondary outcomes"(238) with certain adverse effects depending to types of medicine and dose manner.

b. Side effects are not limit to
Dr. Bjarnason I, and the research team at King’s College School of Medicine and Dentistry, in the study of Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans, suggested "Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation)" and
"NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems"  and "The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials"(239).
Dr. Davies NM and colleagues at the University of Sydney insisted, Non-steroidal anti-inflammatory drugs (NSAIDs) may also cause damage distal to the duodenum, through involving specific biochemical and subcellular organelle damage followed by inflammatory tissue reaction(240).
Furthermore, Dr. Davies NM said, "Because NSAIDS are widely prescribed and some are available without a prescription, heightened awareness of these toxicologic manifestations throughout the GI tract may reduce morbidity"(241).

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(233) Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in rhinovirus-infected volunteers by Graham NM1, Burrell CJ, Douglas RM, Debelle P, Davies L.(PubMed)
(234) Hepatic differentiation of human adipose tissue-derived mesenchymal stem cells and adverse effects of arsanilic acid and acetaminophen during in vitro hepatic developmental stage by Kwon MJ1, Kang SJ, Park YI, Yang YH, Bang SI, Park YH, So B, Cho MH, Kang HG.(PubMed)
(235) Gastrointestinal, liver, and lung extraction ratio of acetaminophen in the rat after high dose administration by Bhargava VO1, Hirate J.(PubMed)
(236) Gout--what are the treatment options? by Schlesinger N1, Dalbeth N, Perez-Ruiz F.(PubMed)
(237) Preventing acute gout when starting allopurinol therapy. Colchicine or NSAIDs? by Kot TV1, Day RO, Brooks PM.(PubMed)
(238) Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis by Zhang S1, Zhang Y1, Liu P1, Zhang W1, Ma JL1, Wang J2,3.(PubMed)
(239) 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)
(240) Detection and prevention of NSAID-induced enteropathy by Davies NM1, Saleh JY, Skjodt NM.(PubMed)
(241) Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine by Davies NM1.(PubMed)

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