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Spa therapy: can be a valid option for treating knee osteoarthritis?

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Abstract

Osteoarthritis (OA) continues to be one of the leading causes of ‘years lived with disability’ worldwide. Symptomatic knee OA is highly prevalent among people aged 50 years and over and is destined to become an ever more important healthcare problem. Current management of knee OA includes non-pharmacological and pharmacological treatments. Spa therapy is one of the most commonly used non-pharmacological approaches for OA in many European countries, as well as in Japan and Israel. Despite its long history and popularity, spa treatment is still the subject of debate and its role in modern medicine continues to be unclear. The objective of this review is to summarize the currently available information on clinical effects and mechanisms of action of spa therapy in knee OA. Various randomized controlled clinical trials (RCTs) were conducted to assess the efficacy and tolerability of balneotherapy and mud-pack therapy in patients with knee OA. Data from these clinical trials support a beneficial effect of spa therapy on pain, function and quality of life in knee OA that lasts over time, until 6–9 months after the treatment. The mechanisms by which immersion in mineral or thermal water or the application of mud alleviate suffering in OA are not fully understood. The net benefit is probably the result of a combination of factors, among which the mechanical, thermal and chemical effects are most prominent. In conclusion, spa therapy seems to have a role in the treatment of knee OA. Additional RCTs and further studies of mechanisms of action with high methodological quality are necessary to prove the effects of spa therapy.

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References

  • Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049

    Article  CAS  Google Scholar 

  • Apolone G, Mosconi P (1998) The Italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036

    Article  CAS  Google Scholar 

  • Ardiç F, Ozgen M, Aybek H, Rota S, Cubukçu D, Gökgöz A (2007) Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int 27:441–446

    Article  Google Scholar 

  • Bálint GP, Buchanan WW, Adám A, Ratkó I, Poór L, Bálint PV, Somos E, Tefner I, Bender T (2007) The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis—a double blind study. Clin Rheumatol 26:890–894

    Article  Google Scholar 

  • Bellamy N, Goldsmith CH, Buchanan WW, Campbell J, Duku E (1991) Prior score availability: observations using the WOMAC osteoarthritis index. Br J Rheumatol 30:150–151

    Article  CAS  Google Scholar 

  • Bellometti S, Galzigna L (1998) Serum levels of a prostaglandin and a leukotriene after thermal mud pack therapy. J Investig Med 46:140–145

    CAS  Google Scholar 

  • Bellometti S, Cecchettin M, Galzigna L (1997) Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. Clin Chim Acta 268:101–106

    Article  CAS  Google Scholar 

  • Bellometti S, Galzigna L, Richelmi P, Gregotti C, Bertè F (2002) Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Int J Tissue React 24:57–64

    CAS  Google Scholar 

  • Bellometti S, Richelmi P, Tassoni T, Bertè F (2005) Production of matrix metalloproteinases and their inhibitors in osteoarthritic patients undergoing mud bath therapy. Int J Clin Pharmacol Res 25:77–94

    CAS  Google Scholar 

  • Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224

    Article  Google Scholar 

  • Bender T, Bariska J, Vàghy R, Gomez R, Kovàcs I (2007) Effect of balneotherapy on the antioxidant system—a controlled pilot study. Arch Med Res 38:86–89

    Article  CAS  Google Scholar 

  • Braga PC, Sambataro G, Dal Sasso M, Culici M, Alfieri M, Nappi G (2008) Antioxidant effect of sulphurous thermal water on human neutrophil bursts: chemiluminescence evaluation. Respiration 75:193–201

    Article  Google Scholar 

  • Britschka ZMN, Teodoro WR, Velosa APP, de Mello SB (2007) The effect of Brazilian black mud treatment in chronic experimental arthritis. Rheumatol Int 28:39–45

    Article  Google Scholar 

  • Burguera EF, Anero AV, Falide RM, Blanco FJ (2012) The effect of hydrogen sulfide donors on inflammatory mediators in human articular osteoarthritic chondrocytes. Arthritis Rheum 64(Suppl 10):S6

    Google Scholar 

  • Busija L, Bridgett L, Williams SR, Osborne RH, Buchbinder R, March L, Fransen M (2010) Osteoarthritis. Best Pract Res Clin Rheumatol 24:757–768. doi:10.1016/j.berh.2010.11.001

    Article  Google Scholar 

  • Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A (2007) Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial. Rheumatol Int 27:523–529

    Article  Google Scholar 

  • Cecchettin M, Bellometti S, Lalli A, Galzigna L (1995) Serum interleukin 1 changes in arthrosic patients after mud-packs treatment. Phys Rheab Kur Med 5:92–93

    Article  Google Scholar 

  • Cozzi F, Lazzarin P, Todesco S, Cima L (1995) Hypothalamic-pituitary-adrenal axis dysregulation in healthy subjects undergoing mud-bath applications. Arthritis Rheum 38:724–726

    Article  CAS  Google Scholar 

  • Cozzi F, Carrara M, Sfriso P, Todesco S, Cima L (2004) Anti-inflammatory effect of mud-bath applications on adjuvant arthritis in rats. Clin Exp Rheumatol 22:763–766

    CAS  Google Scholar 

  • Eckmekcioglu C, Strauss-Blasche G, Holzer F, Marktl W (2002) Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis. Forsch Komplementarmed Klass Naturheilkd 9:216–220

    Article  Google Scholar 

  • Espejo-Antúnez L, Cardero-Durán MA, Garrido-Ardila EM, Torres-Piles S, Caro-Puértolas B (2013) Clinical effectiveness of mud pack therapy in knee osteoarthritis. Rheumatology (Oxford) 52:659–668. doi:10.1093/rheumatology/kes322

    Article  Google Scholar 

  • EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  • Evcik D, Kavuncu V, Yeter A, Yigit I (2007) The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Joint Bone Spine 74:60–65

    Article  Google Scholar 

  • Fautrel B, Hilliquin P, Rozenberg S, Allaert FA, Coste P, Leclerc A, Rossignol M (2005) Impact of osteoarthritis: results of a nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine 72:235–240

    Article  Google Scholar 

  • Fioravanti A, Valenti M, Altobelli E, Di Orio F, Nappi G, Crisanti A, Cantarini L, Marcolongo R (2003) Clinical efficacy and cost-effectiveness evidence of spa therapy in osteoarthritis. The results of “Naiade” Italian Project. Panminerva Med 45:211–217

    CAS  Google Scholar 

  • Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M (2010) Short- and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil 89:125–132. doi:10.1097/PHM.0b013e3181c1eb81

    Article  Google Scholar 

  • Fioravanti A, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P (2011a) Effects of spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int 31:879–882. doi:10.1007/s00296-010-1401-x

    Article  Google Scholar 

  • Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011b) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31:1–8. doi:10.1007/s00296-010-1628-6

    Article  Google Scholar 

  • Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M (2012) Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol 56:583–590. doi:10.1007/s00484-011-0447-0

    Article  Google Scholar 

  • Fioravanti A, Lamboglia A, Pascarelli NA, Cheleschi S, Manica P, Galeazzi M, Collodel G (2013) Thermal water of Vetriolo, Trentino, inhibits the negative effect of interleukin 1β on nitric oxide production and apoptosis in human osteoarthritic chondrocytes. J Biol Regul Homeost Agents 27:891–902

    CAS  Google Scholar 

  • Forestier R, Françon A (2008) Crenobalneotherapy for limb osteoarthritis: systematic literature review and methodological analysis. Joint Bone Spine 75:138–148. doi:10.1016/j.jbspin.2007.06.009]

    Article  Google Scholar 

  • Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL (2010) Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 69:660–665. doi:10.1136/ard.2009.113209

    Article  CAS  Google Scholar 

  • Fox B, Schantz JT, Haigh R, Wood ME, Moore PK, Viner N, Spencer JP, Winyard PG, Whiteman M (2012) Inducible hydrogen sulfide synthesis in chondrocytes and mesenchymal progenitor cells: is H2S a novel cytoprotective mediator in the inflamed joint? J Cell Mol Med 16:896–910. doi:10.1111/j.1582-4934.2011.01357.x

    Article  CAS  Google Scholar 

  • Fraioli A, Serio A, Mennuni G, Ceccarelli F, Petraccia L, Fontana M, Grassi M, Valesini G (2011) A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis. Rheumatol Int 31:1333–1340. doi:10.1007/s00296-010-1475-5

    Article  Google Scholar 

  • Gomez R, Lago F, Gomez-Reino J, Dieguez C, Gualillo O (2009) Adipokines in the skeleton: influence on cartilage function and joint degenerative diseases. J Mol Endocrinol 43:11–18. doi:10.1677/JME-08-0131

    Article  CAS  Google Scholar 

  • Grabski M, Wozakowska-Kaplon B, Kedziora J (2004) Hydrogen sulphide water balneum effect on erythrocyte superoxide dismutase activity in patients with rheumatoid arthritis-in vitro study. Przegl Lek 61:1405–1409

    Google Scholar 

  • Guidelli GM, Tenti S, De Nobili E, Fioravanti A (2012) Fibromyalgia syndrome and spa therapy: myth or reality? Clin Med Insights Arthritis Musculoskelet Disord 5:19–26. doi:10.4137/CMAMD.S8797

    Article  Google Scholar 

  • Harzy T, Ghani N, Akasbi N, Bono W, Nejjari C (2009) Short- and long-term therapeutic effects of thermal mineral waters in knee osteoarthritis: a systematic review of randomized controlled trials. Clin Rheumatol 28:501–507. doi:10.1007/s10067-009-1114-2

    Article  Google Scholar 

  • Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M (2003) Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62:1145–1155

    Article  CAS  Google Scholar 

  • Karagülle M, Karagülle MZ, Karagülle O, Dönmez A, Turan M (2007) A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis. A 24-week randomised, controlled pilot study. Clin Rheumatol 26:2063–2071

    Article  Google Scholar 

  • Kloesch B, Liszt M, Steiner G, Brӧll J (2012) Inhibitors of p38 and ERK1/2 MAPkinase and hydrogen sulphide block constitutive and IL-1β-induced IL-6 amd IL-8 expression in the human chondrocyte cell line C-28/I2. Rheumatol Int 32:729–736. doi:10.1007/s00296-010-1682-0

    Article  CAS  Google Scholar 

  • Kubota K, Kurabayashi H, Tamura K, Kawada E, Tamura J, Shirakura T (1992) A transient rise in plasma beta-endorphin after a traditional 47 degrees C hot-spring bath in Kusatsu-spa, Japan. Life Sci 51:1877–1880

    Article  CAS  Google Scholar 

  • Kücükdeveci AA, McKenna SP, Kutlay S, Gürsel Y, Whalley D, Arasil T (2000) The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 23:31–38

    Article  Google Scholar 

  • Kuczera M, Kokot F (1996) Effect of spa therapy on the endocrine system. I. Stress reaction hormones. Pol Arch Med Wewn 95:11–20

    CAS  Google Scholar 

  • Lago R, Gomez R, Otero M, Lago F, Gallego R, Dieguez C, Gomez-Reino JJ, Gualillo O (2008) A new player in cartilage homeostasis: adiponectin induces nitric oxide synthase type II and pro-inflammatory cytokines in chondrocytes. Osteoarthritis Cartil 16:1101–1109. doi:10.1016/j.joca.2007.12.008

    Article  CAS  Google Scholar 

  • Lequesne MG, Mery C, Samson M, Gerard P (1987) Indexes of severity for osteoarthritis of the hip and knee. Validation—value in comparison with other assessment tests. Scand J Rheumatol Suppl 65:85–89

    Article  CAS  Google Scholar 

  • Li L, Fox B, Keeble J, Salto-Tellez M, Winyard PG, Wood ME, Moore PK, Whiteman M (2013) The complex effects of the slow-releasing hydrogen sulfide donor GYY4137 in a model of acute joint inflammation and in human cartilage cells. J Cell Mol Med 17:365–376. doi:10.1111/jcmm.12016

    Article  CAS  Google Scholar 

  • Malemud CJ, Islam N, Haqqi TM (2003) Pathophysiological mechanisms in osteoarthritis lead to novel therapeutic strategies. Cells Tissues Organs 174:34–48

    Article  Google Scholar 

  • McDowell IW, Martini CJ, Waugh W (1978) A method for self-assessment of disability before and after hip replacement operation. Br Med J 2:857–859

    Article  CAS  Google Scholar 

  • Meenan RF, Gertman PM, Mason JH (1980) Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum 23:146–152

    Article  CAS  Google Scholar 

  • Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–979

    Article  CAS  Google Scholar 

  • Odabasi E, Turan M, Erdem H, Tekbas F (2008) Does mud pack treatment have any chemical effect? A randomized controlled clinical study. J Altern Complement Med 14:559–565. doi:10.1089/acm.2008.0003

    Article  Google Scholar 

  • Salaffi F, Cavalieri F, Nolli M, Ferraccioli G (1991) Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol 18:1581–1586

    CAS  Google Scholar 

  • Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L (2003) GOnorthrosis and Quality Of Life Assessment (GOQOLA). Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage 11:551–560

    Article  CAS  Google Scholar 

  • Sarsan A, Akkaya N, Ozgen M, Yildiz N, Atalay NS, Ardic F (2012) Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. J Back Musculoskelet Rehabil 25:193–199. doi:10.3233/BMR-2012-0327

    Google Scholar 

  • Sherman G, Zeller L, Avriel A, Friger M, Harari M, Sukenik S (2009) Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. Isr Med Assoc J 11:88–93

    Google Scholar 

  • Shimodozono M, Matsumoto S, Ninomiya K, Miyata R, Ogata A, Etoh S, Watanabe S, Kawahira K (2012) Acute effects of a single warm-water bath on serum adiponectin and leptin levels in healthy men: a pilot study. Int J Biometeorol 56:933–939. doi:10.1007/s00484-011-0502-x

    Article  Google Scholar 

  • Sukenik S, Flusser D, Abu-Shakra M (1999) The role of spa therapy in various rheumatic diseases. Rheum Dis Clin N Am 25:883–897

    Article  CAS  Google Scholar 

  • Tefner IK, Gaál R, Koroknai A, Ráthonyi A, Gáti T, Monduk P, Kiss E, Kovács C, Bálint G, Bender T (2013) The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study. Rheumatol Int 33:2569–2576. doi:10.1007/s00296-013-2776-2

    Article  Google Scholar 

  • Tishler M, Rosenberg O, Levy O, Elias I, Amit-Vazina M (2004) The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective? Eur J Intern Med 15:93–96

    Article  Google Scholar 

  • Trippel SB (1995) Growth factor actions on articular cartilage. J Rheumatol Suppl 43:129–132

    CAS  Google Scholar 

  • Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie RA, de Vet HC (2007) Balneotherapy for osteoarthritis. Cochrane Database Syst Rev 4, CD006864

    Google Scholar 

  • Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  • Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    Google Scholar 

  • Yurtkuran M, Yurtkuran M, Alp A, Nasircilar A, Bingöl U, Altan L, Sarpdere G (2006) Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int 27:19–27

    Article  Google Scholar 

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  1. Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Policlinico “Le Scotte”, University of Siena, Viale Bracci 1, 53100, Siena, Italy

    Sara Tenti, Sara Cheleschi, Mauro Galeazzi & Antonella Fioravanti

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  1. Sara Tenti
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Tenti, S., Cheleschi, S., Galeazzi, M. et al. Spa therapy: can be a valid option for treating knee osteoarthritis?. Int J Biometeorol 59, 1133–1143 (2015). https://doi.org/10.1007/s00484-014-0913-6

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