Treatment Of Arthralgia Research Articles

Xuetongsu ameliorates synovial inflammatory hyperplasia in rheumatoid arthritis by inhibiting JAK2/STAT3 and NF-κB signaling pathways

Ethnopharmacological relevanceSynovial inflammatory hyperplasia is the key pathological process that leads to further joint damage in rheumatoid arthritis (RA) progress. Kadsura heteroclita (Roxb) Craib, also called Xuetong in Chinese Tujia ethnomedicine, is utilized for its medicinal properties, including promoting blood circulation, dispelling “wind evil”, and relieving “damp evil”. It has been used in the treatment of arthralgia and RA, within Tujia ethnomedicinal practices. Xuetongsu (XTS), the main component of Xuetong, has been shown to inhibit the proliferation of RA fibroblast-like synovial cells (RAFLS) cells. However, the molecular mechanism of XTS in RA treatment requires further investigation. Aim of the studyTo observe the therapeutic effect of XTS on synovial inflammatory hyperplasia in rheumatoid arthritis, focusing on its underlying molecular mechanisms involving the janus kinase 2 (JAK2)/transducer/activator of transcription 3 (STAT3) and nuclear factor kappa B (NF-κB) signaling pathways. Materials and methodsProtein-protein interaction (PPI) and molecular docking were used to find the main targets of XTS treatment for RA. In lipopolysaccharide (LPS)-induced RAFLS and RAW264.7 cells in vitro models, the levels of inflammatory cytokines were analyzed using enzyme linked immunosorbent assay (ELISA), and the expression of JAK2, STAT3, and NF-κB signaling pathways, as well as cyclooxygenase-2 (COX-2), were analyzed through western blotting test. A hemolysis assay was used to certify the biosecurity of XTS. A model of adjuvant arthritis (AIA) was established in 40 male rats, and different doses of XTS were administered, followed by an automatic blood routine, ELISA assay, hematoxylin and eosin (H&E) staining, and radiological analysis of the effect of no XTS on blood cytokines, histological changes, and improvement of posterior paw bone destruction in AIA rats. The protein levels of inflammatory cytokines were analyzed by immunofluorescence, immunohistochemistry, or Western blot. Finally, H&E staining was used to detect the damage of XTS on the heart, liver, spleen, lung, and kidney of AIA rats. ResultsOur results demonstrate that XTS effectively inhibited LPS-induced inflammatory responses in RAFLS and RAW264.7 cells by modulating the JAK2/STAT3 and NF-κB signaling pathways. Moreover, XTS administration in the AIA rats model significantly ameliorated paw swelling. Histological analysis revealed that XTS also suppressed the inflammatory response in paw tissue by modulating the JAK2/STAT3 and NF-κB signaling pathways. Importantly, during the treatment, XTS exhibited excellent safety profiles, as it did not induce any abnormalities in blood routine parameters or cause organ damage in the rats. ConclusionsOur findings highlight XTS as a promising natural agent for inhibiting synovial hyperplasia in RA. XTS holds great potential as an unprecedented natural agent for developing novel therapeutic strategies to target synovial hyperplasia in RA.

Professor SHAO Ming-xi's experience in differentiation and treatment of arthralgia in breast cancer with acupuncture, moxibustion and tuina

Professor SHAO Ming-xi 's experience in treatment of arthralgia in breast cancer is summarized. Professor SHAO believes that the dysfunction of liver, spleen and kidney is the primary and the invasion of the exogenous wind, cold and damp is the secondary in arthralgia in breast cancer. Emphasized on syndrome/pattern differentiation, this disorder is identified as 4 patterns, i.e. liver qi stagnation, blockage by phlegm and stasis, qi and blood deficiency and obstruction by wind, cold and damp. Acupuncture-moxibustion is applied to Hegu (LI 4), Taichong (LR 3) and Waiguan (TE 5). The supplementary acupoints are selected on the base of syndrome/pattern differentiation. Tuina is combined with acupuncture-moxibustion and the reinforcing and reducing techniques are used appropriately. Shaoyang meridian is specially considered, due to which, Waiguan (TE 5) and Zhongzhu (TE 3) of triple energizer meridian of hand-shaoyang and Yanglingquan (GB 34) and Zulinqi (GB 41) of gallbladder meridian of foot-shaoyang are combined. Additionally, it stresses the combination of the local and distal acupoints and the coordination of various therapies of TCM to achieve the better effect.

Ozone therapy in dentistry and in the treatment of temporomandibular disorder

The use of ozone in dentistry has gained popularity in recent years due to its antimicrobial, anti-inflammatory, analgesic and biocompatibility properties, as well as being an extremely safe method. The objective of this research is to evaluate the efficacy of ozonotherapy in the treatment of arthralgias and disorders of the temporomandibular joint of muscular order. The objective of this work is to perform a rapid review regarding ozone therapy in dentistry as the main focus in the treatment of temporomandibular disorders.

Experience of Professor Fan Yongsheng in treating arthralgia with insect drugs

National-level famous traditional Chinese medicine( TCM) doctor Professor Fan Yong-sheng has high-level accomplishments in the treatment of arthralgia. According to clinical diagnosis and dialectic,TCM with appropriate medicinal properties were flexibly applied,with a remarkable efficacy. Especially in the application of insect drugs,he has accumulated abundant clinical experience.According to the main syndromes of arthralgia and pathogenic site,patient' s constitution,Scorpio,Scolopendra,Pheretima,Vespae Nidus,Bombyx Batryticatus,Manis Squama,Bungarus Parvus,Zaocys,Agkistrodon,Cicadae Periostracum,Aspongopus,Eupolyphaga Steleophaga,Silkworm Sand were properly selected. Attention was also paid to the compatibility between insect drugs and antirheumatic drugs,blood-activating drugs and tonifying drugs. In the premise of safe and effective application in the treatment of arthralgia,insect drugs show such efficacies as antipyretic,activating collaterals and relieving pain.

Acupuncture for treating aromatase inhibitor-related arthralgia in breast cancer: a systematic review and meta-analysis.

Acupuncture has been used as a complementary medical treatment for arthralgia and other types of pain. The objective of this review is to assess the effectiveness of acupuncture in the treatment of arthralgia in patients with breast cancer who were treated with aromatase inhibitors (AIs). A literature search was performed, without language restrictions, of 10 databases from their inception through February 2014. The literature reviewed included randomized clinical trials (RCTs) and clinical trials that compared real versus sham acupuncture for the treatment of AI-related musculoskeletal symptoms (AIMSS). The methodologic quality of these trials was assessed by using the modified Jadad Quality Scale. Meta-analytic software (RevMan 5.0) was used to analyze the data. Five To compare the effects of real versus sham acupuncture, five RCTs were assessed by meta-analysis and quality analysis. Three of the RCTs reported favorable effects with regard to use of acupuncture in reducing pain and joint-related symptoms, while the other two RCTs did not. The meta-analysis showed trends toward reduced pain and stiffness in patients given acupuncture compared with those who received sham treatment (n=82; pain, mean difference: -2.07 [95% confidence interval (CI), -4.72 to 0.57]; p=0.12; stiffness, mean difference: -86.10 [95% CI, -249.11 to 76.92]; p=0.30), although these differences were not statistically significant. Acupuncture has been reported as a safe and promising treatment for AIMSS, but the present analysis indicated that the effects were not statistically significant. Other outcome measurements, such as imaging studies, would be worth including in future studies to further confirm the efficacy of acupuncture in AIMSS.

Medikamentöse Therapie bei Kiefergelenkschmerzen

Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.

Abstract P6-09-08: COMPliance and Arthralgia in Clinical Therapy: The COMPACT trial, assessing the incidence of arthralgia, therapy costs and compliance within the first year of adjuvant anastrozole therapy

Abstract Background: Aromatase Inhibitors (AI) are well established as adjuvant treatment for postmenopausal (PMP) women with hormone receptor positive (HR+) early breast cancer (EBC). However, phase III clinical trials have reported higher rates of arthralgia associated with AI than tamoxifen. This study aims to collect real world data on the effects of AI-associated arthralgia on patient compliance, patient outcomes and on treatment of arthralgia. Methods: COMPACT is an open, prospective, non-interventional, non-randomized study (NCT00857012) run in Germany. PMP women with HR+ EBC who had been on adjuvant anastrozole (ANA) for 3–6 months were enrolled and stratified by initial adjuvant ANA or switch from tamoxifen. All patients received regular standardized information about breast cancer from baseline to week 20 to support treatment compliance. Data on demographics, arthralgia, related therapies, other side effects and QoL were collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on arthralgia and compliance within the first year of ANA therapy. Secondary endpoints include incidence of arthralgia, therapy costs, reasons for non-compliance, and influence of arthralgia on clinical outcome. Results: Between Apr 2009 and Mar 2011, 2313 patients were enrolled, 2007 on upfront ANA and 306 on switch from tamoxifen. The mean age at baseline was 64.5 years, mean BMI 27.7. Only 17.0% of patients had received HRT prior to their EBC. At baseline, 41.9% reported symptoms relating to skeleton or musculature. 12.0% reported arthralgia existing prior to ANA treatment and 13.2% stated a worsening of pre-existing arthralgia or new arthralgia after starting ANA. Predictors for non-adherence to AI therapy were former non-adherence, general symptom load on the side effect scale GASE, and low benefit expectation at treatment start. Risk of arthralgia was related to BMI (lowest for patients with BMI ≤24.1 kg/m2, highest with BMI >30.5 kg/m2 at all time points; OR>1) and upfront therapy (switch patients had a reduced risk of 68% at 6 and 61% at 9 months compared to patients with ANA upfront, p = 0.002). Patients with prior chemotherapy had lower rates of arthralgia before start of ANA (10.4% vs 13.3%, p = 0.036) but higher rates after the start of ANA and before study start (27.0% vs 22.5%, p = 0.013). Patients with arthralgia showed higher compliance rates at all time points (p < 0.001). Conclusion: COMPACT identified arthralgia and musculoskeletal symptoms as common complaints in PMP women with EBC. ANA treatment both increased the number of women with such symptoms and aggravated these in some patients. Higher BMI and upfront AI predicted for risk of AI associated arthralgia. However, COMPACT also showed that AI-associated arthralgia did not lead to non-compliance in most patients. This data may help to better understand compliance issues with adjuvant AI treatment. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-08.

PD06-07: COMPliance and Arthralgias in Clinical Therapy (COMPACT): Assessment of the Incidence and Severity of Arthralgia, Treatment Costs and Compliance within the First Year of Adjuvant Anastrozole Therapy.

Abstract Introduction: Aromatase inhibitors (AI) are well established as adjuvant endocrine treatment for postmenopausal (PMP) women with HR+ early breast cancer (EBC). However, according to retrospective data, compliance to adjuvant endocrine therapy for EBC may drop to below 70% after one year and to as low as 50% by year 4. In clinical trials, AI are significantly more frequently associated with arthralgia than tamoxifen. Yet, prospective real world data on the effects of AI-associated arthralgia on patient compliance, patient outcomes as well as treatment costs of arthralgia are lacking. Methods: COMPACT is an open, prospective, non-interventional study assessing the incidence and severity of arthralgia, treatment costs, and compliance within the first year of adjuvant anastrozole therapy in PMP women with HR+ EBC. The study is sponsored by AstraZeneca Germany and supported by three major German health insurance funds [GWQ ServicePlus AG, DAK, TK]. Patients on adjuvant treatment for 3–6 months were enrolled at 620 breast centres and practices throughout Germany and stratified by, a) initial adjuvant anastrozole therapy or, b) switch from tamoxifen to anastrozole. All patients receive regular standardized information about EBC from baseline to week 20 to support treatment compliance. Data on patient demographics, occurrence of and treatment of arthralgia, and quality of life will be collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on arthralgia, assessed with a visual analogous scale (VAS) via patient questionnaire, and compliance to anastrozole in both strata, assessed by patient and investigator questionnaire. Secondary endpoints include the incidence of arthralgia, treatment costs, reasons for non-compliance, and the influence of arthralgia on clinical outcome. For a subgroup of patients data on arthralgia treatment and compliance will be validated with corresponding data of the participating health insurance funds. Results: Between April 2009 and February 2011, 2313 patients were recruited, 2007 receiving upfront anastrozole and 306 patients on switch therapy. Preliminary baseline data for 2313 patients show the following patient characteristics: mean age 64.5 years, mean BMI 27.7. Only 16.8% of patients had received hormone replacement therapy prior to their cancer. 41.5% of patients had concomitant symptoms relating to skeleton or musculature, and 11.9% stated arthralgias existing prior to anastrozole treatment. 13.1% reported a worsening of pre-existing arthralgias or new arthralgia after starting on anastrozole treatment. Conclusion: COMPACT aims to provide valid real world data on the incidence and severity of AI-associated arthralgia, treatment modalities and treatment costs. Our results will help to understand and better counsel patients about AI-associated arthralgia to improve adherence to AI-treatment, breast cancer outcomes, and therapy costs. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD06-07.

Treatment of arthralgias and spondyloarthropathy associated with inflammatory bowel disease

Joint involvement is the most frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). Arthralgias are common and spondyloarthropathy may affect peripheral joints and the axial skeleton, as well as the tendons. The broad spectrum of joint manifestations requires a therapeutic concept that takes the potential influence of agents on the underlying bowel disease into consideration. This review will focus on the current therapeutic approach to the different manifestations of IBD-related joint disease and will outline baseline treatment, the use of conventional agents and biologicals. TNF antagonists have dramatically changed the care of patients. In particular, TNF antagonists have emerged as the most effective treatment for ankylosing spondylitis, which has often been refractory to therapy in the past. For patients who fail to respond to TNF antagonists, several novel agents will provide more treatment choices in the future. Recent insights into disease mechanisms of IBD have revealed at...