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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. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).
Types of Musculo-Skeletal disorders in elder(2)
3. Rheumatoid Arthritis
4. Polymalgia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
Polymyalgia Arthritis (Rheumatica)
Polymalgia 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.
Free radicals are atoms, molecules, or ions with unpaired electrons through chemical bonds with other atoms or molecules during a chemical reaction. They may have positive, negative or zero charge.
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, 127)(177,128), but the production of free radical sometime can be excessive, leading to formation of a large number of free radicals(178,129)(179,130). The domino effects have shown to induce many chronic illness, such as cancers(179,130).
a. Vitamin A
vitamin A plays an essential roles in enhancing a broad range of immune processes, including white blood cells activation and proliferation(180,132)of T-helper-cell differentiation, the production of specific antibody in regulation of the immune response(182,133).
b. Vitamin C
Due to recent promotion of western diet in some developed country, deficiencies of micronutrients are emerging as the limiting factors in ensuring children's optimal health, according Bayer Consumer Care Ltd(134). Deficiency of vitamin C and zinc in fact, interfere with normal children's growth and development(134). Researchers found that vitamin C raised the concentration in the blood of total immunoglobulin(183,135) in promotion of the ability of antibodies and phagocytic cells to clear pathogens(184,136).
c. Vitamin D
Deficiency of vitamin D is found to associate to nonspecific musculoskeletal pain. According to Maccabi Healthcare Services, improvement of levels of 25OHD reduced Polymyalgia pain induced by the use of statins(131).
c. Vitamin E
According to Dr. Moriguchi S and Dr. Muraga M., vitamin E plays an essential role in enhanced immunity especially in cellular immunity with aging(137). Deficiency of vitamin E is found to induces the decreased differentiation of immature T cells associated to the increased infectious diseases and the incidence of tumors(137)
Zinc, having a regulatory role in the immune system, as a antioxidant is essential mineral improved immune system by enhancing the proper function of T and B cells(188,138) which belong to a group of white blood cells known as lymphocytes, in fighting against damaging free radicals(190,139).
2. Antioxidants and inflammation
Diet included vitamin E significantly reduce the levels of inflammation by analyzing the pro and anti-inflammatory cytokines in the blood serum(193,140).
a. Glucosamine and chondroitin
Glucosamine used for treatment of osteoporosis and prevent the degenerative collagen, has been found to consist anti-inflammatory properties through reduction of the expression of proinflammatory cytokines such as C-reactive protein (hsCRP), interleukin (IL)-1β, IL-6(141). The supplement also exhibited a significant reduction in pain intensity at movement and resting state, according to a Russian study(142).
b DLPA (dl- phenylalanine)
DLPA, a mixture of D-Phenylalanine and L-Phenylalanine, is a nutritional supplement amino acid(196,143). Taltirelin, a thyrotropin-releasing hormone analog, showed effectively to relieve inflammatory persistent pain through iots antiallodynic action(144).
c. Methylsulfonylmethane, also known DMSO2 is an organosulfur compound with the formula (CH3)2SO2 showed to exhibit anti inflammatory effects in attenuated production of mitochondrial reactive oxygen species (ROS)(145).
In a randomized, double-blind, placebo-controlled trial of Fifty men and women, 40-76 years of age MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events, after 12 weeks(199,146)(200,147).
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(177,128) Superoxide Anion and Its Functions(Beta Forces)
(178,129) 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)
(179,130) Free radicals, metals and antioxidants in oxidative stress-induced cancer by Valko M1, Rhodes CJ, Moncol J, Izakovic M, Mazur M.(PubMed)
(131) Muscle pain and serum creatine kinase are not associated with low serum 25(OH) vitamin D levels in patients receiving statins by Kurnik D1, Hochman I, Vesterman-Landes J, Kenig T, Katzir I, Lomnicky Y, Halkin H, Loebstein R.
(180,132) Cellular immunity in osteoarthritis: novel concepts for an old disease by Liossis SN1, Tsokos GC.(PubMed)
(182,133) Free Radicals, Antioxidants in Disease and Health by Lien Ai Pham-Huy,1 Hua He,2 and Chuong Pham-Huy3(PMC)
(134) Essential role of vitamin C and zinc in child immunity and health by Maggini S1, Wenzlaff S, Hornig D.(PubMed)
(183,135) 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)
(184,136) Green tea catechin, epigallocatechin-3-gallate (EGCG): mechanisms, perspectives and clinical applications by Singh BN1, Shankar S, Srivastava RK.(PubMed)
(137) Vitamin E and immunity by Moriguchi S1, Muraga M.(PubMed)
(188,138) Green tea: a new option for the prevention or control of osteoarthritis by Katiyar SK, Raman C.(PubMed)
(190,139) 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)
(193,140) Green tea polyphenol epigallocatechin 3-gallate in arthritis: progress and promise by Ahmed S1.(PubMed)
(141) Associations between glucosamine and chondroitin supplement use and biomarkers of systemic inflammation by Kantor ED1, Lampe JW, Navarro SL, Song X, Milne GL, White E.(PubMed)
(142) [A role of melatonin in the treatment of low back pain].[Article in Russian] by Kurganova YM, Danilov AB.(PubMed)
(144) Taltirelin, a thyrotropin-releasing hormone analog, alleviates mechanical allodynia through activation of descending monoaminergic neurons in persistent inflammatory pain by Eto K1, Kim SK, Nabekura J, Ishibashi H.(PubMed)
(145) Methylsulfonylmethane inhibits NLRP3 inflammasome activation by Ahn H1, Kim J1, Lee MJ1, Kim YJ2, Cho YW3, Lee GS4.(PubMed)
(199, 146) 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, 147) 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)