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Synergistic effect of Majoon-e-Suranjaan and isometric exercises in improving rheumatoid arthritis
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Background:
Industrial workers often have musculoskeletal disorders due to the nature of their work.
Objective:
The goal was to investigate the scientific use of polyherbal gel in relieving pain and stiffness due to musculoskeletal injuries and improving activities of daily living (ADLs) in industrial workers.
Methods:
A pragmatic, single-blinded, randomized control study divided 200 musculoskeletal injury patients into four parallel groups (n = 50). Groups 1 and 2 were applied polyherbal gel via phonophoresis with therapeutic ultrasound and superficial massage. Groups 3 and 4 received diclofenac diethyl-ammonium 1% gel by phonophoresis and superficial massage. The Global Pain Relief Scale, Numeric Pain Rating Scale (NPRS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to measure pain, stiffness, and ADLs. Data was analyzed using one-way analysis of variance (ANOVA) and paired t-test to compare mean±SD of four independent groups before and after gel application. The confidence interval was 95%, with p < 0.05 considered significant.
Results:
The results revealed that polyherbal gel reduced pain (NPRS, WOMAC and Global pain relief scales) more efficiently (p≤0.000) when applied with phonophoresis as compared to applied with massage and standard diclofenac (p≤0.005), furthermore, polyherbal gel when applied with phonophoresis showed more efficient results.
Conclusion:
Industrial workers with musculoskeletal injuries benefited from the use of polyherbal gel for pain and inflammation relief. The polyherbal gel is natural, cost-effective, and easy to formulate.
It is difficult to determine from ancient writings, old human specimens, and from Art over the centuries, as to when Rheumatoid Arthritis first appeared. It may be a relatively modern condition, as it was reasonably well described in the seventeenth century. Augustin Jacob Landre-Beauvais (1772–1840), University of Paris is credited, with the first clear description of the disease in his thesis. In 1859 Sir Alfred Baring Garrod (1819–1907), the "father of rheumatology", gave the disease its current name which was finally adapted in Britain by the Ministry of Health in 1922. Some forms of Juvenile Arthritis are related to adult Rheumatoid Arthritis (aka Still’s disease). If untreated Rheumatoid arthritis can result in severe destructive joint damage and often there are associated severe systemic complications. Disease modifying agents have benefited the disease management, but it was the discovery of the anti TNF-alpha agents in the 1990s, and subsequently many additional Biologic agents, which have greatly changed the clinical outcome in Rheumatoid Arthritis.
Osteoarthritis is the most common form of arthritis among older adults. It is also one of the most common causes of physical disability among adults. Osteoarthritis (OA) is a long-term chronic disease characterized by the deterioration of the cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement. The pharmaco therapy can be associated with serious side effects and high costs. Now a day’s herbal medications have shown the potential for safe and effective management of arthritis and Unani medicine can provide an alternate therapy for Osteoarthritis. Suranjan Shireen-out of several herbal drugs in Unani Medicine is a potent and safe antiarthritic drug this has been proved in many in-vivo and in-vitro studies. Suranjan Shireen is effective against Arthralgia, Rheumatoid Arthritis and Gout. I have summarised the various clinical studies in this article to prove the therapeutic potentials of the Suranjan-shireen and Talkh with its Unani aspect to help the future scientist to explore this drug through clinical trial for treatment of various forms of OA specially in growing old age population.
Purpose: To compare the effects of proprioceptive exercises and topical glucosamine sulfate on knee osteoarthritis in terms of reducing pain and functional disability. Methods: A single-blinded randomized clinical trial (IRCT20220115053712N1) was conducted at Muhammad Physical Therapy Clinic and Rehabilitation Center, Multan, Pakistan, from November 2021 to April 2022. Eighty-four patients enrolled and were randomized into two groups; patients in Group A were treated with proprioceptive exercises while those in Group B were treated with topical glucosamine sulfate. The Numerical Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale were used to measure pain and functional activities at baseline, 9th and 18th sessions. Results: The results showed that both interventions were effective, but more in Group A (p < 0.05). Group A also showed highly significant improvement in relieving the pains associated with osteoarthritis when compared to Group B (p ≤ 0.001). Conclusion: Proprioceptive exercises are more efficient than topical glucosamine sulfate for managing knee osteoarthritis, improving functional outcomes and lowering pain intensity. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest
This study aimed to assess the synergistic effects of curcumin with and without strengthening exercises in rheumatoid arthritis (RA). Randomised controlled trial study was conducted from May 2021 to December 2021. Ninety patients were randomised into two groups. Group A was treated with strengthening exercises and curcumin. Group B was given curcumin only. Curcumin dosed at 180 mg/day was given orally to both groups. The treatment regimen was distributed as 3 sessions/week; each session lasted 45 minutes for group A. Serological findings and X-rays of the joints were also done for assessment. Pain, morning stiffness, and functional activities were assessed using the WOMAC and NPRS scale at baseline, 12 th week, and 24 th week. There was higher significant (p<0.000) reduction in quantitative values of RF, ESR and CRP, WOMAC pain, ADLs, and stiffness readings in group A. This study will project to a screening of newer and more effective interventions to treat RA.
Background: Pain remains a global public heath priority. Phonophoresis, also known as sonophoresis or ultrasonophoresis, is when an ultrasound is used to maximize the effects of a topical drug. Purpose: The objective of this study was to test, in patients injured in sports or accidents (N = 200), the efficacy of diclofenac potassium (DK) 6%, 4%, and 2% formulated gels with and without phonophoresis in comparison with market available standard diclofenac sodium (DS or DN) gel. Methods: The patients were enrolled after informed consent. By using the lottery method, 100 patients were randomly segregated into five groups without phonophoresis and repeated similarly with phonophoresis at a frequency of 0.8 MHz, an intensity of about 1.5 W/cm², and at continuous mode (2:1). Group-1 was treated with 6% DK gel, group-2 was treated with 4% DK gel, group-3 was treated with 2% DK gel, group-4 was treated with 4% DS gel and group-5 was given control gel three to four times a week for 4 weeks. The patients were screened by using NPRS and WOMAC scales. They were assessed on the baseline, 4th session, 8th session, 12th session, and 16th session. Results: Significant dose-dependently relief was observed in NPRS (Numeric Pain Rating Scale) and the WOMAC (Western Ontario McMaster Osteo-Arthritis) index for pain in disability and stiffness for each group treated with DK gel compared to DS gel. Phonophoresis increased these benefits significantly when used after topical application of DK gel or DS gel, and the dose-dependent effects of DK gel plus phonophoresis were stronger than the dose-dependent effects of DS gel plus phonophoresis. The faster and profounder relief was due to phonophoresis, which allows more penetration of the DK gel into the skin as compared to the direct application of DK gel in acute, uncomplicated soft tissue injury, such as plantar fasciitis, bursitis stress injuries, and tendinitis. In addition, DK gel with phonophoresis was well tolerated. Thus, in this personalized clinical setting, according to the degree of inflammation or injured-induced pain, disability, and stiffness, DK gel 6% with phonophoresis appeared more effective and thus more recommendable than DS gel 6% alone or DS gel 6% combined to phonophoresis.
Background
Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly.
Objectives
To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA.
Design
A systematic review of the literature.
Data sources and methods
Five databases were searched (PubMed, Cochrane Library, CINAHL, Scopus and SPORTDiscus); inclusion criteria were studies with acute exercise, a definite diagnosis of RA and disease characteristics assessed by clinical function (i.e., disease activity score, health assessment questionnaire and self-reported pain), clinical markers associated with inflammation (i.e., c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), and inflammatory cytokines (i.e., interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α)).
Results
From a total of 1544 articles, initial screening and full text assessment left 11 studies meeting the inclusion criteria. A total of 274 people were included in the studies (RA = 186; control = 88). Acute bouts of aerobic, resistance, and combined aerobic and resistance exercise did not appear to exacerbate pain symptoms in people with RA.
Conclusion
Post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA. Exercise prescription was variable between studies, which limited between-study comparisons. Therefore, future investigations in people with RA are warranted, which combine different exercise modes and intensities to examine acute effects on pain symptoms and inflammatory markers.
Registration
The PROSPERO international prospective register of systematic reviews – CRD42018091155.
Appropriate sample size calculation and power analysis have become major issues in research and publication processes. However, the complexity and difficulty of calculating sample size and power require broad statistical knowledge, there is a shortage of personnel with programming skills, and commercial programs are often too expensive to use in practice. The review article aimed to explain the basic concepts of sample size calculation and power analysis; the process of sample estimation; and how to calculate sample size using G*Power software (latest ver. 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) with 5 statistical examples. The null and alternative hypothesis, effect size, power, alpha, type I error, and type II error should be described when calculating the sample size or power. G*Power is recommended for sample size and power calculations for various statistical methods (F, t, χ2, Z, and exact tests), because it is easy to use and free. The process of sample estimation consists of establishing research goals and hypotheses, choosing appropriate statistical tests, choosing one of 5 possible power analysis methods, inputting the required variables for analysis, and selecting the "Calculate" button. The G*Power software supports sample size and power calculation for various statistical methods (F, t, χ2, z, and exact tests). This software is helpful for researchers to estimate the sample size and to conduct power analysis.
Objective
To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.
Methods
We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results
The guideline addresses treatment with disease‐modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high‐risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).
Conclusion
This clinical practice guideline is intended to serve as a tool to support clinician and patient decision‐making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision‐making process based on patients’ values, goals, preferences, and comorbidities.
Rheumatoid arthritis (RA) is the most prevalent form of inflammatory arthritis. It is a profoundly serious and severe disease that if it goes untreated could have severe consequences to the joints and health of the patient who carries this diagnosis. The treatment of RA has dramatically changed since the year 2000, with the discovery of the TNFis, then other biologics, and finally the JAKi. All these new medications with or without methotrexate in combination, tight control and treat to target have produced a revolution in the outcome of this disease. We reviewed and summarized the treatment options, and the most significant papers for each one of these new drugs. The reader could have a full picture with all the references of the recent publications. We also updated the biosimilar situation in RA, as well as the new drugs that will be coming to the market in the next 5 years.
Background:
We aimed to assess the efficacy of resistance exercise in rheumatoid arthritis (RA) in randomized controlled trials (RCTs).
Method:
PubMed, the Cochrane Library, and Embase were searched according to the index words to identify eligible RCTs, and relevant literature sources were also searched. The latest search was done in August 2019. Odds ratios (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze the main outcomes.
Result:
Seventeen RCTs were included in the meta-analysis with 512 patients in the resistance exercise group and 498 patients in the control group. The results showed that compared with the control group, resistance exercise significantly decreased disease activity score in 28 joints (DAS-28) scores (standard mean difference [SMD]: -0.69, 95% CI: -1.26 to -0.11), reduced erythrocyte sedimentation rate (ESR) (SMD: -0.86, 95% CI: -1.65 to -0.07), and shortened the time of 50 ft. walking (SMD: -0.64, 95% CI: -0.99 to -0.28). No significant difference was observed in visual analog scale (VAS) scores (SMD: -0.61, 95% CI: -1.49-0.27) and health assessment questionnaire (HAQ) scores (weighted mean difference: -0.10, 95% CI: -0.26-0.06).
Conclusion:
Resistance exercise showed reducing DAS-28 score, ESR score, and the time of 50 ft. walking in RA patients compared with the control group. However, high quality multicenter RCTs with larger sample sizes to confirm the conclusion.
Purpose
The aim of this study was to determine the local and systemic effects of isometric and concentric muscle contractions on experimental pain and performance fatigability in people with and without fibromyalgia.
Methods
Forty-seven fibromyalgia (FM: 51.3 ± 12.3 year) and 47 control (CON: 52.5 ± 14.7 year) participants performed submaximal isometric and concentric exercise for 10 min with the right elbow flexors. Assessments before and after exercise included pressure pain thresholds (PPT) of the biceps and quadriceps, central pain summation, self-reported exercising arm and whole-body pain, and maximal voluntary isometric contraction (MVIC) of the right elbow flexors and left handgrip.
Results
People with FM experienced greater reductions in local fatigue (right elbow flexor MVIC: CON: − 4.0 ± 6.7%, FM: − 9.8 ± 13.8%; p = 0.013) and similar reductions in systemic fatigue (left handgrip MVIC: − 6.5 ± 10.2%; p < 0.001) as CON participants, which were not different by contraction type nor related to baseline clinical pain, perceived fatigue, or reported pain with exercise. Following exercise both groups reported an increase in PPTs at the biceps (pre: 205.5 ± 100.3 kPa, post: 219.0 ± 109.3 kPa, p = 0.004) only and a decrease in central pain summation (pre: 6.8 ± 2.9, post: 6.5 ± 2.9; p = 0.013). FM reported greater exercising arm pain following exercise (CON: 0.7 ± 1.3, FM: 2.9 ± 2.3; p < 0.001), and both groups reported greater arm pain following concentric (isometric: 1.4 ± 2.0, concentric: 2.2 ± 2.9; p = 0.001) than isometric exercise. Neither group reported an increase in whole-body pain following exercise.
Conclusion
People with FM experienced greater performance fatigability in the exercising muscle compared to CON that was not related to central mechanisms of fatigue or pain. These results suggest changes in performance fatigability in FM may be due to differences occurring at the muscular level.
Trial registration #
NCT #: NCT03778385, December 19, 2018, retrospectively registered. IRB#: HR-3035.
Due to the exacerbation of the disease, the rehabilitation of patients with rheumatoid arthritis is often limited. The aim of the study was to analyze the impact of a comprehensive rehabilitation on a subjective perception of pain and quality of life in patients with rheumatoid arthritis depending on the level of disease activity. The study involved 58 women with rheumatoid arthritis aged 18–60, who underwent a 4-weeks comprehensive rehabilitation program. The assessment included the disease activity level on the DAS28 scale, pain intensity on the 10-point pain scale (VAS) and the value of the CRP protein. The HAQ-DI and KALU questionnaire were used to assess the quality of life. In both groups (group A—DAS28 < 4.2, group B—DAS28 ≥ 4.2) the statistically significant effects in decreasing the level of pain and improvement of quality of life were observed. This indicates the need and effectiveness of rehabilitation regardless of the level of activity of rheumatoid arthritis according to the DAS28 scale. There were no significant changes in the CRP protein level. In conclusion, the rehabilitation of patients with moderate to high disease activity is effective and the success of comprehensive rehabilitation is demonstrated by the decrease of the DAS28 score and the pain level reported by patients, as well as improving self-assessment of health and quality of life.
Rheumatoid arthritis (RA) patients may benefit from exercise for several reasons. However, whole-limb strengthening exercises for such patients remain poorly studied. We hypothesized that systemic strength training that includes the upper and lower extremities would improve strength per se and enhance the quality of life. Here, we investigated the effects of 12 weeks of upper- and lower-limb strengthening exercise on the strength and quality of life of RA patients using the International Classification of Functioning, Disability, and Health model. This was a prospective, interventional controlled trial. Forty female RA patients were recruited and assigned to two groups not based on willingness to exercise, with 20 patients in the exercise group and 20 in the control group. All patients in the exercise group received once-weekly training sessions of 60 min over 12 weeks. All participants were assessed before and after the 12-week intervention period. We measured the hand grip strength and isometric quadriceps contraction, the cross-sectional area of the rectus femoris (CSA-RF) (via ultrasonography), and performed the 30 s sit-to-stand test and the 6 min walk test (6MWT). We derived the Borg scale score after the 6MWT and assessed the extent of social participation and quality of life using a Korean version of the 36-Item Short Form Health Survey (SF-36). A total of 35 subjects completed the experiment (18 in the exercise group, 17 in the control group). After the 12-week intervention period, the lower-limb strength and the CSA-RF were significantly increased in the exercise group. The activity level did not change significantly in either group. The exercise group exhibited significant improvements in the SF-36 mental health domain scores. Thus, strengthening exercise is useful for patients with RA.
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA‐like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the “pre‐RA” stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre‐RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
Background:
Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease.
Methods:
LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach's α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC).
Results:
A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = - 0.634 to - 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ.
Conclusion:
NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.
Rheumatoid arthritis (RA) is one of the most prevalent autoimmune diseases and a prototypic inflammatory disease, affecting the small joints of the hands and feet. Chemokines and chemokine receptors play a critical role in RA pathogenesis via immune cells recruitment. Several chemokines and chemokine receptors are abundant in the peripheral blood and in the local inflamed joints of RA. Furthermore, synthetic and biologics disease modifying anti rheumatic drugs have been reported to affect chemokines expression. Thus, many studies have focused on targeting chemokines and chemokine receptors, where some have shown positive promising results. However, most of the chemokine blockers in human trials of RA treatment displayed some failures that can be attributed to several reasons in their structures and binding affinities. Nevertheless, targeting chemokines will continue to be under development, in order to improve their therapeutic potentials in RA and other autoimmune diseases. In this review we provide an up-to-date knowledge regarding the role of chemokines and chemokine receptors in RA with an emphasis on their activities on immune cells. We also discussed the effects of drugs targeting those molecules in RA. This knowledge might provide impetus for developing new therapeutic modalities to treat this chronic disease.
Unani System of medicine is one among the oldest systems that prevails till date with its efficient drugs derived from animal, plant and mineral resources. Over 2400 years ago the father of medicine, Hippocrates practiced it, however His medicine included a great deal of ancient Egyptian medicine as well as important components of the ancient Mesopotamian traditions. In Unani system of medicine, arthritis is described under a broad term Waja-ul-Mafasil which encompasses entire joint disorders like inflammatory, non-inflammatory, infectious, metabolic and other musculoskeletal disorders. A large number of drugs, single and compound formulations, have been mentioned in the context of the treatment of Waja-ul-Mafasil. Among them, Majoon Suranjan is one of the most reputed poly pharmaceutical preparations of Unani system of Medicine used in Waja-ul-Mafasil. It is attributed to Indrumakhas of Greece (Andromachos, the elder, court physician to King Nero) who formulated it in consultation with several other philosophers of his time. This Unani compound formulation contains twenty ingredients, which is used as digestive, purgative, anti inflammatory, stomachic, deobstruent, antiarthritic, nervine tonic. It is also indicated for use in phlegmatic diseases. Keywords: Majoon Suranjan, Ingredients, Arthritis, Unani Medicine.
Purpose
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is a commonly used outcome measure for osteoarthritis. There are different versions of the WOMAC (Likert, visual analogue or numeric scales). A previous review of trials published before 2010 found poor reporting and inconsistency in how the WOMAC was used. This review explores whether these problems persist.
Methods
This systematic review included randomised trials of hip and/or knee osteoarthritis published in 2016 that used the WOMAC. Data were extracted on the version used, score range, analysis and results of the WOMAC, and whether these details were clearly reported.
Results
This review included 62 trials and 41 reported the WOMAC total score. The version used and item range for the WOMAC total score were unclear in 44% (n = 18/41) and 24% (n = 10/41) of trials, respectively. The smallest total score range was 0–10 (calculated by averaging 24 items scored 0–10); the largest was 0–2400 (calculated by summing 24 items scored 0–100). All trials reported the statistical analysis methods but only 29% reported the between-group mean difference and 95% confidence interval.
Conclusion
Details on the use and scoring of the WOMAC were often not reported. We recommend that trials report the version of the WOMAC and the score range used. The between-group treatment effect and corresponding confidence interval should be reported. If all the items of the WOMAC are collected, the total score and individual subscale scores should be presented. Better reporting would facilitate the interpretation, comparison and synthesis of the WOMAC score in trials.
The pinnacle of success achieved by the medical science and the benefits accrued to the patients have become possible through the medical research where human participants in the research are exposed to hazards inherent to the experiments. To protect the human subjects and to maintain high ethical standards, the World Medical Association has adopted “The Declaration of Helsinki” in 1964. After two years of consultation with the experts throughout the world, the seventh revision of the Declaration was adopted on 19th October 2013 in Brazil. The aim of this article is to review the seventh revision of the Declaration of Helsinki in relation to medical research involving human subjects and highlight the amendments made in the latest revision which are relevant to clinical research in human subjects. The latest revision has made four substantial changes on the existing Declaration, whch include dealing with the compensation of the trial-related injuries, approval of use of placebos in the clinical trials, protection of vulnerable groups and the post-trial provisions. The implications of these amendments in the clinical research are highlighted.
Keywords: Consent; Declaration of Helsinki; ethics; experimental medicine; research; seventh revision.
Objective
To evaluate the effect of a moderate‐to‐high–intensity, aerobic and resistance exercise with person‐centered guidance in older adults with rheumatoid arthritis (RA), through a randomized controlled multicenter trial.
Methods
Older adults (ages 65–75 years) with RA (n = 74) were randomized to either a 20‐week exercise intervention at a gym (n = 36) or to home‐based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 12 months. The primary outcome was the difference in the Health Assessment Questionnaire disability index (HAQ DI) score, and the secondary outcomes were the differences in physical fitness assessed by a cardiopulmonary exercise test, an endurance test, the timed up and go test, the sit to stand test, and an isometric elbow flexion force measurement.
Results
No significant differences between the groups were found for the primary outcome, HAQ DI score. Within the intervention group there was a significant improvement in the HAQ DI score when compared to baseline (P = 0.022). Aerobic capacity (P < 0.001) and 3 of 4 additional performance‐based tests of endurance and strength significantly improved (P < 0.05) in the intervention group when compared to the control group. In the intervention group, 71% of patients rated their health as much or very much improved compared to 24% of patients in the control group (P < 0.001). At the 12‐month follow‐up, there were no significant differences in change between the 2 groups on the HAQ DI score. A significant between‐group difference was found for change in an endurance test (P = 0.022).
Conclusion
Aerobic and resistance exercise with person‐centered guidance improved physical fitness in terms of aerobic capacity, endurance, and strength in older adults with RA.
Colchicum autumnale has been known as Suranjan shireen in Unani Medicine. It belongs to the family Liliaceae and commonly known as the autumn crocus, a wild saffron and naked lady. It has been used in Unani system of medicine for various therapeutic actions as Mushil (Purgative), Mushil-e-Balgham /Mukhrij-e- Balgham (Phlegmagogue) Qabiz (Constipative), Muhallil (Resolvent), Mufatte-e-Sudad (Deobstruent) Muqawwi-e-Baah (Aphrodisiac) Mujaffif-e-Qurooh (Desiccant ulcer) Musakkin-e-Alam/ Dafi'-e-Alam (Analgesic), Dafi'-e-Niqris (anti-gout, to relieve inflammation and pain of acute gout), Mukhaddir (Anaesthetic), Muharrik e-Baah (Stimulant of sex) etc. in Unani medicine since centuries. The present article has provided a review of pharmacological actions and therapeutic uses of suranjan shireen in Unani and ethno-botanical literature in the light of available pre-clinical and clinical experimental data on Colchicum autumnale.
Background:
Physical therapists (PTs) should know how to best treat patients with inflammatory arthritis.
Objective:
To document interventions chosen by PTs for patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and whether choices follow evidence-based practice.
Methods:
Licensed musculoskeletal PTs in Quebec, Canada responded to an online survey. Descriptive statistics illustrated proportions for each treatment choice and inferential statistics explored associations with demographic and practice-related factors.
Results:
There were 298 PTs who responded to the survey. For both RA and AS respectively, most common interventions were mobility exercises (91.0%; 98.3%) and patient education (90.1%; 92.8%). For both cases, slightly >60% selected strengthening exercises. Passive forms of therapy were chosen by 36% of PTs for RA and 58% for AS. Aerobic exercise was rarely selected. PTs working in the public sector were less likely to use manual therapy for both RA (Odds Ratio (OR) 0.43, 95% confidence interval (CI) 0.22,0.86) and AS (OR 0.46, 95% CI 0.22,0.97).
Conclusions:
Most PTs chose mobility exercises and patient education, representing evidence-based approaches. Despite current recommendations, strengthening and especially aerobic exercises were not used as much. There is a need to increase awareness regarding the benefits of strengthening and aerobic exercise for these patients.
Bisphenol-A (BPA) is a toxic chemical largely produced and used in polycarbonate plastics worldwide. Majoon Suranjan (MS), a polyherbal formulation, is used as an anti-inflammatory medicine against rheumatoid arthritis. The present study aimed to evaluate BPA-induced toxicity and its possible amelioration by MS. To test our hypothesis, we performed gas chromatography-mass spectrometry (GC-MS) analysis, DNA interaction studies, genotoxicity tests, oxidative stress parameters, and histopathological examinations. GC-MS profiling of MS revealed the presence of various anti-oxidant compounds. DNA interaction studies showed that both chemicals intercalate between DNA base pairs. Next, we observed BPA-induced genotoxicity and oxidative damage. The observed effects might be due to BPA-induced reactive oxygen species production. Further, BPA changed the anti-oxidant enzyme activities, increased the malondialdehyde, alanine aminotransferase, alkaline phosphatase, and total bilirubin levels, and caused gross damage to the liver and kidney. Interestingly, these effects were significantly reversed by MS. In conclusion, MS shows protective effects against BPA-induced toxicity and could be a potential alternative medicine against BPA toxicity, especially in third-world countries where BPA uses are not strictly regulated.
• Highlights:
• Bisphenol-A (BPA) induces multiple toxic effects.
• BPA induces genotoxicity, oxidative and tissue damage.
• Majoon Suranjan (MS) ameliorates the BPA induced toxic effects.
• GC-MS profiling show various active anti-oxidant compounds in MS.
• MS is anti-genotoxic, anti-oxidant, and hepato-renal protective
Aging is the natural, biological process in all organisms, described by a notable decline in the physiological functioning and alterations in the biochemical mechanism. In this chapter, we aim to review the efficacy of traditional medicines as a supportive therapy for aging-associated disorders and stem cell therapy. Aging paves the way for noxious diseases such as cancer and neurodegenerative diseases; moreover, the aesthetic value of an individual gets depreciated. Aging leads to the senescence of stem cells and deteriorates the proliferation and differentiation potential of stem cells. With the extensive assets, traditional medicines are used as supportive therapy for various age-related ailments. Traditional medicines are well known for their anti-aging, antioxidative, anticancer properties. Various review articles and research articles were searched from scientific databases like PubMed and MEDLINE. It was found that extracts of Momordica charantia, basil plant, can delay aging process and alleviate age-related diseases. Leaf and root extracts of Tinospora cordifolia and Withania somnifera delayed aging-induced senescence in MSCs efficiently. Herbal extracts of Curcumin Longa L., Salvia miltiorrhiza, and naringin from citrus fruits and grapes have strong potential in inducing cumulative proliferation and differentiation capability of stem cells at precise concentrations. We conclude that an understanding of molecular evidence, ethnopharmacology, and mechanisms of action of herbal extracts in vivo with advancement technologies may have a translational impact on stem cell research and therapies. Further meticulous studies are needed to isolate and characterize the novel active component from herbs and formulate it as an effective drug that may be advised for alleviating age-related disorders.
Purpose: Matrix metalloproteinases, zinc dependent proteolytic enzymes, have significant
implications in extracellular matrix degradation associated with tissue damage in inflammation
and Rheumatoid arthritis. Numerous orchestrated pathways affects instigation and blockade of
metalloproteinases as well as various factors that increase the expression of MMPs including
inflammatory cytokines, hormones and growth factors. Direct inhibition of these proteolytic
enzymes or modulation of these pathways can provide protection against tissue destruction in
inflammation and rheumatoid arthritis. Inclination towards use of plant derived phytochemicals
to prevent tissue damage has been increasing day by day. Diversity of phytochemicals have been
known to directly inhibit metalloproteinases. Hence, thorough knowledge of phytochemicals is
very important in novel drug discovery.
Methods: Present communication evaluates various classes of phytochemicals, in effort to unveil
the lead molecules as potential therapeutic agents, for prevention of MMPs mediated tissue
damage in inflammation and rheumatoid arthritis. Data have been analyzed through different
search engines.
Results: Numerous phytochemicals have been studied for their role as MMPs inhibitors which
can be processed further to develop into useful drugs for the treatment of inflammation and
rheumatoid arthritis.Conclusion: In search of new drugs, phytochemicals like flavonoids, glycosides, alkaloids,
lignans & terpenes offer a wide canvas to develop into valuable forthcoming medicaments
Purpose:
Matrix metalloproteinases, zinc dependent proteolytic enzymes, have significant implications in extracellular matrix degradation associated with tissue damage in inflammation and Rheumatoid arthritis. Numerous orchestrated pathways affects instigation and blockade of metalloproteinases as well as various factors that increase the expression of MMPs including inflammatory cytokines, hormones and growth factors. Direct inhibition of these proteolytic enzymes or modulation of these pathways can provide protection against tissue destruction in inflammation and rheumatoid arthritis. Inclination towards use of plant derived phytochemicals to prevent tissue damage has been increasing day by day. Diversity of phytochemicals have been known to directly inhibit metalloproteinases. Hence, thorough knowledge of phytochemicals is very important in novel drug discovery.
Methods:
Present communication evaluates various classes of phytochemicals, in effort to unveil the lead molecules as potential therapeutic agents, for prevention of MMPs mediated tissue damage in inflammation and rheumatoid arthritis. Data have been analyzed through different search engines.
Results:
Numerous phytochemicals have been studied for their role as MMPs inhibitors which can be processed further to develop into useful drugs for the treatment of inflammation and rheumatoid arthritis.
Conclusion:
In search of new drugs, phytochemicals like flavonoids, glycosides, alkaloids, lignans & terpenes offer a wide canvas to develop into valuable forthcoming medicaments.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by a failure of spontaneous resolution of inflammation. Although the pro-inflammatory cytokines and mediators that trigger RA have been the focus of intense investigations, the regulatory and anti-inflammatory cytokines responsible for the suppression and resolution of disease in a context-dependent manner have been less well characterized. However, knowledge of the pathways that control the suppression and resolution of inflammation in RA is clinically relevant and conceptually important for understanding the pathophysiology of the disease and for the development of treatments that enable long-term remission. Cytokine-mediated processes such as the activation of T helper 2 cells by IL-4 and IL-13, the resolution of inflammation by IL-9, IL-5-induced eosinophil expansion, IL-33-mediated macrophage polarization, the production of IL-10 by regulatory B cells and IL-27-mediated suppression of lymphoid follicle formation are all involved in governing the regulation and resolution of inflammation in RA. By better understanding these immune-regulatory signalling pathways, new therapeutic strategies for RA can be envisioned that aim to balance and resolve, rather than suppress, inflammation.
Study Design: Systematic review with meta-analysis
Introduction: Joint protection (JP) has been developed as a self-management intervention to assist people with hand arthritis to improve occupational performance and minimize joint deterioration over time.
Purpose of the Study: We examined the effectiveness between JP and usual care/control on pain, hand function and grip strength levels for people with hand osteoarthritis (OA) and rheumatoid arthritis (RA).
Methods: A search was performed in 5 databases from January 1990 to February 2017. Two independent assessors applied Cochrane’s risk of bias tool, and a GRADE approach was adopted.
Results: For pain levels at short-term, we found similar effects between JP and control standardized mean difference (SMD) -0.00, 95% CI: -0.42 to 0.42, I2=49%, at mid and long-term follow-up JP was favored over usual care SMD: -0.32, 95% CI: -0.53 to -0.11, I2=0 and SMD -0.27, 95% CI: -0.41 to -0.12, I2=9% respectively. For function levels at mid and long-term follow-up JP was favored over usual care SMD -0.49, 95% CI: -0.75 to -0.22, I2=34% and SMD -0.31, 95% CI: -0.50 to -0.11, I2=56% respectively. For grip strength levels, at long term JP was inferior over usual care Mean Difference (MD) 0.93, 95% CI: -0.74 to 2.61, I2= 0%.
Conclusions: This systematic review provides the most updated evidence on the effectiveness of joint protection programs vs. usual care/control in patients with rheumatoid arthritis and hand osteoarthritis on clinical outcomes. Evidence of very-low to low quality indicates that the effects of joint protection programs compared to usual care/control on pain and hand function are too small to be clinically important at short-, intermediate- and long-term follow-ups for people with hand arthritis.
Keywords: joint protection, hand osteoarthritis, rheumatoid arthritis
Prospero registration number: CRD42018090698
Suranjan Talkh: a review of an anti-arthritic Unani drug
- M Z Siddiqui
- S Akhtar
Siddiqui MZ and Akhtar S. Suranjan Talkh: a
review of an anti-arthritic Unani drug. Int J Res
Anal Rev 2019; 6: 328-32.
Effects of aerobic and resistance exercise in older adults with rheumatoid arthritis: a randomized controlled trial
- E Lange
- D Kucharski
- S Svedlund
- K Svensson
- G Bertholds
- Gjertsson I Mannerkorpi
- Lange
- W W Buchanan
- C A Kean
- W F Kean
- K D Rainsford
Buchanan WW, Kean CA, Kean WF and Rainsford KD. Rheumatoid arthritis. Inflammopharmacology 2024; 32: 3-11.