Medical Advisor Journals

Friday, December 4, 2015

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine; The Herbal Formulas

Kyle J. Norton, Master of Nutrients
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.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
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

The Treatment

B. In herbal and traditional Chinese medicine perspective

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).

All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

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Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months

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References

(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)

Thursday, December 3, 2015

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine; The Individual Herbal Medicine

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).

All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months

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(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)

(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

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia Treatments In conventional medicine perspective

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.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) is 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).

Fibromyalgia

The Treatment
A. In conventional medicine perspective
FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise), and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents(27).
A.1. Non medication
1. Psychological control
According to the study by Monash University and Monash Medical Centre suggested that FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important “up-stream” process in FM mechanisms and is amenable to intervention(28).
2. Cognitive-behavioral and operant-behavioral therapy
In the study to focus on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS), found that focused on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS)(29).
3. Exercise
In the reviewing the available evidence addressing the effects of exercise on central pain modulation in patients with chronic pain showed that a dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares(30).
4. Physical therapy
Based on anecdotal evidence or small observational studies physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia(31)
5. Ozone therapy
In the study to determine the efficacy of ozone therapy in patients with fibromyalgia received 24 sessions of ozone therapy during a 12-week period, found that Significant improvement was also seen both in depression scores and in the Physical Summary Score of the SF-12. Transient meteorism after ozone therapy sessions was the most frequently reported side-effect(32).

A.2. Medications
The aim of medicine is to relieve the symptoms of the disease
In anarrative review from meta-analyses and systematic reviews published since 2005. For a few medications, findings from multiple recent trials are synthesized if a systematic review had not yet been published. Classes of medications are first reviewed, followed by an overview of four common pain disorders: neuropathic pain, low back pain, fibromyalgia and osteoarthritis, showed that stepped care approach based upon existing evidence includes (1) simple analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs); (2) tricyclic antidepressants (if neuropathic, back or fibromyalgia pain) or tramadol; (3) gabapentin, duloxetine or pregabalin if neuropathic pain; (4) cyclobenzaprine, pregabalin, duloxetine, or milnacipran for fibromyalgia; (5) topical analgesics (capsaicin, lidocaine, salicylates) if localized neuropathic or arthritic pain; and (6) opioids(33).

B. Alternative treatments
Several types of alternative medicine have some potential for future clinical research. However, due to methodological inconsistencies across studies and the small body of evidence, no firm conclusions can be made at this time. Regarding alternative treatments, acupuncture and several types of meditative practice show the most promise for future scientific investigation. Likewise, magnesium, l-carnitine, and S-adenosylmethionine are nonpharmacological supplements with the most potential for further research. Individualized treatment plans that involve several pharmacological agents and natural remedies appear promising as well.(34)
In other studies to valuate complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM), researchers found that there is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. Complementary or alternative medical (CAM) has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications)(34a)..

Wednesday, December 2, 2015

Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs): Fibromyalgia: The Prevention

Fibromyalgia

According to the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia in the newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites(a) as a result in responding to pressure.

The Prevention and management

1. Vitamin D
Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. In a study of Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression showed that Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health(23).
2. Omega 3 fatty acid
In the study to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids, five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA), found thatthese patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported(24).
3. Caffeine
In a study of forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo, found that the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia(25).
4. Coenzyme Q10
CoQ10 treatment restored mitochondrial dysfunction and the mtDNA copy number, decreased oxidative stress, and increased mitochondrial biogenesis. The results suggest that CoQ10 could be an alternative therapeutic approach for FM(26).

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/2306288
(23) http://www.ncbi.nlm.nih.gov/pubmed/16850115
(24) http://www.ncbi.nlm.nih.gov/pubmed/20090445
(25) http://www.ncbi.nlm.nih.gov/pubmed/2667860
(26) http://www.ncbi.nlm.nih.gov/pubmed/22898267

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis Treatment of Herbal and TCM medicine Other alternative treatment

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 Haifa, thermal 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).

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References