Moringa leaf for gout

Uric acid is the end product of purine metabolism in the human body which has no physiological function, which is regarded as a waste product that can cause inflammation when it exceeds the normal limits (Wibowo, 2004). Limit of normal levels of uric acid in the blood of man according Wiryowidagdo (1966) in general for adult males ranged from 3.5 to 7.2 mg / dl and for women from 2.6 to 6.0 mg / dl. In pathophysiological conditions may be increased levels of uric acid in the blood exceeds the normal limits is called hyperuricemia. According Wibowo (2004) hyperuricemia can be caused by high levels of excess production of uric acid, uric acid excretion through the kidneys is reduced, or a combination of both. Hyperuricemia can lead to deposition of uric acid crystals in the joints, causing pain with symptoms of red swelling, known as gout or arthritis gout.

Hyperuricemia is one of the rheumatic diseases whose symptoms can be seen easily, including pain in the joints. Pain in joints closely associated with metabolic activity of connective tissue and musculoskeletal system. Although no cause of death, the disease damages resulting impact on the economic system as physical abilities decline. Patients with this disease observed in several regions in Indonesia, including the results of research conducted Silvia (1985) which states that hyperuricemia and gout in Indonesia the percentage is very high, especially Java and South Sulawesi who live on the coast, with a daily habit people consume alcohol and sea fish . Meanwhile, according Darmawan (1998) in Central Java in 1989 among 4,683 people aged 15-45 years were examined, found 8% had high uric acid (7.5% of men and 0.5% of women).

Hyperuricemia and gout usually attacks the men, and obese men have a higher tendency of developing the disease. Percentage of hyperuricemia and gout disease in men is very high compared to women who appear after menopause. This is due to the female reproductive hormones secreted (estrogen and progesterone) that helped the disposal of waste from the body (Wibowo, 2004). According to Guyton (1996) reproductive hormone that helps process the disposal stimulate follicular development that can improve the speed of cell proliferation, inhibiting the activity of second messenger system cycle adenosine monophosphate (cAMP). cAMP according Soewolo (2000) is thought to activate the enzyme protein kinase that accelerate metabolic activity, such as purine and pyrimidine metabolism.

Triggers Gout

Foods that trigger the formation of uric acid exceeds normal levels can be classified as follows: 

First, the purine foods containing high (150-800 mg / 100 grams of food) is among the liver, kidneys, brain, heart, shrimp, mussels, clams, sardines, extracts meat (shredded, dried meat), tape, alcohol. 

Second, foods containing purines medium (50-150 mg / 100 grams of food) is the beef, scallops, dried beans, cauliflower, spinach, asparagus, green beans, mushrooms, cassava leaves, papaya leaves and kale.

Third, foods that contain purine lighter (0-50 mg / 100 grams of food) is cheese, milk and eggs (Wibowo, 2004). Hyperuricemia and gout usually attacks the men, and obese men have a higher tendency of developing the disease. The male percentage of hyperuricemia and gout disease is very high compared with emerging women after menopause. This is due to the female hormone estrogen secreted who helped removal of uric acid through the urine, while the man is not secreted hormone estrogen, so tend to have higher uric acid (Wibowo, 2004).

Prevention and Treatment and prevention of hyperuricemia existing accomplished by reducing levels of uric acid production or increase its excretion. Two types of drugs used for the treatment of hyperuricemia are medications urikosurik and inhibiting the enzyme xanthine oxidase. The drugs work urikosurik improve the cleanliness of the kidneys of uric acid by inhibiting the tubular reabsorption of uric acid in the kidney. Shortage of drugs is the need alkalinasi urikosurik urine is contraindicated in patients with renal dysfunction.

Now, only allopurinol is still allowed to be used to reduce the production of uric acid. Allopurinol is given when urikosurik drug failed to reduce blood uric acid levels to below 7 mg / dl or if the patient is intolerant to the drug urikosurik. However, allopurinol can cause side effects such as nephropathy and allergic reactions, so that the necessary medication hiperurisemik which have higher efficacy and safety (Schlesinger, 2002).


For the purpose of the treatment carried out include:

1. Prevention of Inflammatory Arthritis (SIS)

All types of NSAIDs (anti-inflammatory and analgesic) can be given at hyperuricemia attack, but the result will be different (Ganiswara, 1995). Until now kholkisin is still the drug of choice in the treatment of gouty arthritis attacks hyperuricemia to acute or prevention with lower doses (Rahardjo and Tan, 1991). Kholkisin is an alkaloid obtained from plants. This drug has been used as a cure gout in the sixth century by doctors in Saudi.Kholkisin are anti-inflammatory and analgesic that is specific for gout with a rapid effect is 0.5 to 2 hours after an acute attack. Power works diperkirakanm based barriers phagositosis of leukocytes to inflammatory cycle is decided (Ganiswara, 1995).

2. Countermeasures Hyperuricemia

Treatment committed against disease while hyperuricemia can be classified into two, namely the prevention of which can lower uric acid levels, known as urikosurik drugs that facilitate the excretion of uric acid by the kidney tubules and prevention by inhibition of xanthine oxidase or xanthine dehydrogenase (Tehupeiory, 1996).

urikosurik

Urikosurik working mechanism in the treatment of hyperuricemia is inhibiting the reabsorption of uric acid by the kidney tubules, so much uric acid expelled with urine. To prevent mengendapny uric acid in the urinary tract due to high concentrations in the urine, it is advisable to drink water often less than three liters per day (Raharjo and Tan, 1979).

Xanthine oxidase inhibitors

Drugs are often used as an inhibitor of xanthine oxidase, is allopurinol. The working mechanism of allopurinol by inhibiting the enzyme xanthine oxidase, the enzyme responsible for the overhaul of purine compounds (hypoxanthine and xanthine) into uric acid. The chemical structure very similar to allopurinol xanthine xanthine oxidase so enzin work on these substances, consequently reshuffle xanthine to uric acid also decreased (Raharjo and Tan, 1979).

Moringa, Natural Medicines Uric Acid In traditional medicine Indonesia, one of the natural ingredients that have not been widely used in the community is a plant moringa (Moringa oleiferaLamk.). Seeds and young leaves of Moringa is consumed as a vegetable, while the dried seeds are used as bioflokulan heavy metals. In addition, the roots and leaves are often used as a natural alternative that can reduce pain in the joints. Utilization of Moringa plant, especially the leaves and roots are often used as a natural alternative treatment of rheumatic and arthritic. Some areas are populated utilizing Moringa plant for the treatment of rheumatic was Minahasa, South Sulawesi and Makassar (Tugo, 2005).

According Raharjo and Tan (1979) in the moringa plants are suspected of active substances which can reduce rheumatic and arthritic. Among the active substances are suspected of useful alkaloids and flavonoids. Both these compounds are believed to effectively decrease pain due to rheumatism, and are anti-inflammatory and anti-analgesic. Ganiswara (1995) adds, moringa plant alkaloid content which can reduce pain due to rheumatic is kholkisin. Colchicine has anti-inflammatory and analgesic properties that are specific to gout with a rapid effect is 0.5 to 2 hours after an acute attack. Power works is estimated based upon inhibition of leukocyte phagositosis so that the cycle of inflammation is decided, as well as the stabilization of lysosomes increased. In addition, anti-mitotic kholkisin also helpless, inhibiting the process of cell division (mitosis).

In addition to colchicine, Flavonoids are also expected to decrease pain due to rheumatic joints, with physiological activity, namely the inhibition of protein by protein kinase phosporilasi in netrophil (part of leukocytes), which are activated by cAMP to stimulate metabolic activity.

According Tahupeiory (1996) flavonoid and alkaloid found in a plant capable of inhibiting the synthesis of uric acid and mendegradasikannya. Alkaloid contained in the plant moringa (M. oleifera Lamk.) Were able to inhibit the synthesis of uric acid and also have anti-inflammatory is kholkisin. Kholkisin inhibit the activity xanthin degrade xanthin oxidase and hypoxanthine to uric acid. It also kholkisin menuurut Guyton (1987) to break the cycle of inflammation by inhibiting leukocyte phagositosis which causes increased stabilization of lysosomes.

Among the active substances contained in the leaves of Moringa in addition to flavonoids and alkaloids, is allopurinol. According to Mayes (1992) allopurinol is a nucleic acid derivative which allegedly also able to inhibit the synthesis of uric acid. Giving allopurinol done when the drug is used to degrade uric acid deposits can no longer afford. However, the use of allopurinol cause side effects such nefropathi and allergies.

The mechanism of inhibition of allopurinol is used to maintain the body's synthesis of uric acid remains setabil. The use of allopurinol according Mansoer (2001) cause side effects such nefropathi and allergies.

In 2008, the Faculty of Medical Sciences at the University Putra Malaysia, published a study which aims to test whether the Moringa has antinociceptive activity and anti-inflammatory properties, as well as drugs used in modern medicine such as NSAIDs (non-steroidal anti-inflammatory drugs). enelitian found that Moringa leaves have antinociceptive agent activity and anti-inflammatory properties, even in high quantities. It also means that the true Kelor used in traditional Indian medicine as a treatment for Arthritis and Gout only.

The effects of Moringa that suppress COX-2 enzyme. This enzyme responsible for inflammation and pain. Usually the drugs used to suppress this enzyme are NSAIDs - such as Voltaren, Nksin, Adoil, Arcoxia, Kaspo etc. However, NSAIDs have harmful side effects such as the risk of stroke, kidney problems, blood vessel problems, stomach problems and more.

Moringa is a tree that has been used as food and medicine oabt experienced throughout history, which means that Moringa is much safer to use than NSAIDs with the same healing effectiveness and no side effects. This time by going back to natural medicine and herbal, Kelor offers exceptional solutions for a variety of medical conditions.

A study in Indonesia concluded that:

Moringa leaf extract (M. oleifera Lamk.) Influence on blood uric acid levels in mice (Mus musculus)Moringa leaf extract concentration (M. oleifera Lamk.) Effective influence on blood uric acid levels in mice hyperuricemia adala concentration of 7.5% to the value of 4.4 mg / dl. (Friday Hadisasono, 2007).
Compiled from various sources.