Degenerative arthritis

Aging (skin and other tissues), myocardial infarct or stroke, inflammation, rheumatoid arthritis, atherosclerosis, pulmonary disorders (asthma and chronic obstructive pulmonary diseases), radiation injury, organ transplant rejection, psoriasis, hypertension, AIDS, multiple types of cancer, neuro-degenerative diseases (Parkinson s), diabetes, muscular dystrophy... 

Osteoarthritis arthritis associated with degenerative changes of the joints... 

As was already mentioned, piroxicam also is a nonsteroidal, anti-inflammatory drug. It is used in inflammatory and degenerative diseases of the musculoskeletal system that are accompanied by painful symptoms. It is used for rheumatic heart disease, nonspecific infectious polyarthritis, gouty arthritis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, nenralgia, myalgia, and other diseases associated with inflammation. Synonyms for piroxicam are feldene, dexicam, roxenan, and others. 

A. Glucocorticoid treatment of rheumatoid arthritis does not eradicate all symptoms, nor does it reverse the degenerative process. Suppression of the hypothalamic-pituitary-adrenal axis is an unwanted side effect of glucocorticoid therapy. While development of a sense of well-being may be attributed to the relief of symptoms, it is not the primary basis for employing the potent glucocorticoids. 

It is used in the treatment of inflammatory and degenerative forms of rheumatism, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and spondyloarthritis. 

Since the recognition of the biological role of lycopene in the prevention of chronic diseases, the emphasis of the scientific community has been in the area of cancer, with special focus on prostate cancer. However, based on the hypothesis that oxidative stress may be an important etiological factor in the causation of most of the degenerative diseases and that lycopene is a potent antioxidant, the scientific community has started to study its role in diseases other than the ones reviewed in this chapter. These health disorders include skin and ocular diseases, rheumatoid arthritis, periodontal diseases, and inflammatory disorders. The scientific information pertaining to the role of lycopene in these diseases is still in its infancy. However, the rationale for undertaking these studies is scientifically valid and it is hoped that in the next 3-5 years several studies will be reported in the literature. 

Dietary choices, sedentary occupations and lack of exercise are responsible for obesity and associated conditions including cardiovascular diseases and diabetes. Smoking, excessive alcohol intake and improper drug use curtail both life and its quality. As life expectancy increases it is mirrored by the increase in degenerative diseases such as arthritis, osteoporosis, cardiovascular disease, cancer, hearing and eyesight decline, and brain cell deterioration (Alzheimer s). 

Band keratopathy was first described in 1848 and is a chronic degenerative condition characterized by the deposition of calcium carbonate salts in the superficial corneal layers, most frequently in the interpalpebral area. Although there are many reported cases of idiopathic band keratopathy, some of which seem to have a hereditary component, the most common causes are associated with chronic ocular inflammation and systemic conditions resulting in altered calcium metabolism. Band keratopathy is typically seen in eyes with chronic uveitis, severe superficial keratitis, corneal ulcers, chemical burns, interstitial keratitis (IK), trachoma, phthisis bulbi, and prolonged glaucoma. The chronic anterior uveitis of juvenile idiopathic arthritis is frequently associated with band keratopathy, with one study reporting its development in 66% of patients with juvenile idiopathic arthritis. 

Psoriasis generally appears at the joints, limbs and scalp but may appear anywhere on the body. At least 10% those with psoriasis develop psoriatic arthritis, a degenerative disease of the joints and connective tissue. Approximately 1 million people in the U.S. have psoriatic arthritis. Psoriatic arthritis usually develops between the ages of 30 and 50 but can develop without the lesions characteristic of psoriasis (Natl Psoriasis Foundation, 2005, Specific forms of psoriasis, psoriasis.org). Of those with psoriatic arthritis, about 20% will develop spinal involvement. The inflammation associated with spinal involvement can lead to vertebral fusion as in alkylosing spondylitis. 

The maintenance of the normal, anomalous viscosity index of synovial fluid is essential for its proper function as a lubricant between joint surfaces. The concentration and the degree of polymerization of hyaluronic acid in synovial fluids of patients with rheumatoid arthritis and other degenerative joint diseases have been the subjects of widespread investigation. Ragan and Meyer (R1) ascribed the changes in synovial fluid in... 

Orthopedists are trained in treating several degenerative diseases such as arthritis, osteoporosis, carpal tunnel syndrome, and so on. The treatment options may vary from making diet changes, medications, steroid injections, and incorporating exercise in the daily routine to surgical procedures and hormone replacement therapy. 

It can be seen in Table 3 that many common disease states are being treated by self-medication with nutraceuticals joint pain, particularly caused by rheumatoid arthritis or osteoarthritis (OA) is both widespread, and also often treated with glucosamine, chondroitin, and MSM by this population. Impotence and insomnia have high incidence amongst this population, and are treated with dehydroepiandrosterone (DHEA) and melatonin, respectively, but there is also a substantial incidence of degenerative eye conditions, often treated... 

Serious skin reactions (Stevens-Johnson syndrome and Lyell s syndrome) caused temporary withdrawal of isoxi-cam in several countries, even though an analysis of 1800 patients with rheumatoid arthritis or degenerative joint disease failed to confirm an increased risk (2). 

Substances capable of interaction with ROS are claimed to play an important role in the prevention of cancer. Some compoimds of the unsaponifiable fraction from virgin oil (oleuropein, tyrosol, sterols and triterpenoids) were assayed to determine their cytostatic activity in McCoy cells (originated from synovial fluid from a patient suffering degenerative arthritis) [92]. Oleuropein and the sterol+triterpenoid fraction potently inhibited cell growth at 6 Xg/ml (83 and 89% respectively), a concentration recommended by the protocols of the National Cancer Institute of USA [93]. IC50 for oleuropein and sterol+terpenoid fraction was 4.4 and 0.11 ig/ml, respectively. Tyrosol exhibited lower inhibition IC50 was 10 pg/ml. 

Synovial fluid in the joint capsule has a very high HA content, where it serves as both a lubricant and as a shock absorber. The level and molecular size of HA decreases with inflammatory and degenerative forms of arthritis. A major commercial use of HA, in a modified form, is to replace such degraded joint HA, as discussed in another part of this review. 

HA is a major molecule in joint fluid, and plays a major role in that tissue in joint motion and maintenance of normal joint homeostasis. In inflammatory diseases of the joint such as rheumatoid arthritis (RA), and in degenerative joint disease such as osteoarthritis (OA), the levels and average molecular size of HA chains are much reduced. Expressions of both HASl and 2 are decreased, while the hyaluronidases are increased in the various forms of arthritis, compared to control, with a concomitant decrease in average molecular sizes [112]. 

Arthritis causing inflammatory and degenerative changes around joints affects 43 million in the United States, and CDC projects that this will rise to 60 million by 2020. It can be caused by more than 100 different diseases, but the commonest are osteoarthritis and rheumatoid arthritis. New medications, such as the anti-tumor necrotic factor a-blockers, raise fresh challenges to clinical study methodology because of limitations on nonclinical toxicity predictors and the application of biologic measurements on a traditional drug appraisal system. 

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