Abstract
To evaluate the additional effect and safety of peloidotherapy to usual care at short- and middle-term in patients with rheumatoid arthritis (RA). RA patients were recruited in the medical ecology and hydroclimatology department of Istanbul Medical Faculty and were randomized into two parallel groups. Peloidotherapy group was treated with heated mudpack (41–42 °C) on painful and active joints (5 days/week, during 2 weeks) + usual care. Control group received usual care alone. Randomization was performed by using a computer-generated table of random numbers and was blinded. The sequence was concealed until interventions were assigned. The investigator was blinded. The assessments were done before and after the intervention, 1 month and 3 months after the completion of treatment. The main criterion was the number of patients with low disease activity (DAS 28 ≤ 3.2) at the end of follow-up. Other judgment criteria were pain (VAS), patient’s global assessment (VAS), physician’s global assessment (VAS), Health Assessment Questionnaire (HAQ), Disease Activity Score (DAS 28), CRP, and ESR. Fifty-six patients were recruited and analyzed: 29 in peloidotherapy group and 27 in the control group between 11/2011 and 02/2012. At the third month, 9/29 patients were with low disease activity in peloidotherapy group and 4/27 in the control group (p = 0.15). There was a statistically significant improvement in favor of peloidotherapy group for HAQ during all follow-up period (0.25 vs 0.63, p = 0.007 at the end of the treatment, 0.29 vs 0.68 p = 0.007 at the 1st month and 0.30 vs 0.59, p = 0.040 at the 3rd month). Pain (35vs50, p = 0.028), patient’s global assessment (37vs53, p = 0.028), physician’s global assessment (33vs48, p = 0.030), and DAS28 (3.76vs4.58, p = 0.049) improved significantly more in peloidotherapy group at the 3rd month. There were no between group differences for ESR and CRP. There were no important adverse events. There is no significant improvement for the main criteria so we can’t conclude that peloidotherapy has additional effect over usual care. But most of the other judgment criteria improved more in the peloidotherapy group than in the control group and peloidotherapy was well tolerated. A trial with higher statistical power is necessary to if we want to reveal the effects on disease activity and confirm the short and middle term efficiency of this treatment modality on pain and quality of life.
Similar content being viewed by others
References
Başaran S, Güzel R, Sarpel T (2005) Yaşam kalitesi ve sağlık sonuçlarını değerlendirme ölçütleri. Romatizma Dergisi (turkish Journal of Rheumatology) 20(1):55–63
Bellometti S, Galzigna L (1998) Serum levels of a prostaglandin and a leukotriene after thermal mud pack therapy. J Investig Med 46(4):140–145
Bellometti S, Cecchettin M, Galzigna L (1997) Mud pack therapy in osteoarthrosis. Clin Chim Acta 268(1–2):101–106. https://doi.org/10.1016/s0009-8981(97)00171-x
Caporali R, Bellometti S, Rossi S, Bogliolo L, Klersy C, Montecucco C (2010) Safety of mud-bath applications in moderately active rheumatoid arthritis. J Musculoskelet Pain 18(1):81–87. https://doi.org/10.3109/10582450903495866
Codish S, Abu-Shakra M, Flusser D, Friger M, Sukenik S (2005) Mud compress therapy for the hands of patients with rheumatoid arthritis. Rheumatol Int 25(1):49–54. https://doi.org/10.1007/s00296-003-0402-4
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(6):763–766
Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R et al (1991) Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 18(12):1799–1803
Falagas ME, Zarkadoulia E, Rafailidis PI (2009) The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract 63(7):1068–1084. https://doi.org/10.1111/j.1742-1241.2009.02062.x
Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31(1):1–8. https://doi.org/10.1007/s00296-010-1628-6
Flusser D, Abu-Shakra M, Friger M, Codish S, Sukenik S (2002) Therapy with mud compresses for knee osteoarthritis: Comparison of natural mud preparations with mineral-depleted mud. J Clin Rheumatol 8(4):197–203. https://doi.org/10.1097/00124743-200208000-00003
Forestier R, André-Vert J, Guillez P, Coudeyre E, Lefevre-Colau M-M, Combe B et al (2009) Non drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelines. Joint Bone Spine 76(6):691–698. https://doi.org/10.1016/j.jbspin.2009.01.017
Forestier R, Erol-Forestier F-B, Francon A (2017) Current role for spa therapy in rheumatology. Joint Bone Spine 84(1):9–13. https://doi.org/10.1016/j.jbspin.2016.05.003
Gallagher EJ, Liebman M, Bijur PE (2001) Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 38(6):633–638. https://doi.org/10.1067/mem.2001.118863
Gutenbrunner C, Bender T, Cantista P, Karagülle Z (2010) A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol 54(5):495–507. https://doi.org/10.1007/s00484-010-0321-5
Hurkmans EJ, Jones A, Li LC, Vliet Vlieland TPM (2011) Quality appraisal of clinical practice guidelines on the use of physiotherapy in rheumatoid arthritis: a systematic review. Rheumatology (oxford) 50(10):1879–1888. https://doi.org/10.1093/rheumatology/ker195
Huskisson EC (1974) Measurement of pain. Lancet 304(7889):1127–1131. https://doi.org/10.1016/s0140-6736(74)90884-8
Lee DM, Weinblatt ME (2001) Rheumatoid arthritis. Lancet 358(9285):903–911. https://doi.org/10.1016/S0140-6736(01)06075-5
Million R, Hall W, Nilsen KH, Baker RD, Jayson MIV (1982) Assessment of the progress of the back-pain patient. Spine (Phila Pa 1976) 7(3):204–212
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(5):559–565. https://doi.org/10.1089/acm.2008.0003
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis: Modified disease activity score. Arthritis Rheum 38(1):44–48. https://doi.org/10.1002/art.1780380107
Scott DL, Wolfe F, Huizinga TWJ (2010) Rheumatoid arthritis. Lancet 376(9746):1094–1108. https://doi.org/10.1016/S0140-6736(10)60826-4
Senerdem N, Gül A, Koniçe M, Aral O, Ocal L, Inanç M et al (1999) The use of two different Health Assessment Questionnaires in Turkish rheumatoid arthritis population and assessment of the associations with disability. Clin Rheumatol 18(1):33–37. https://doi.org/10.1007/s100670050048
Skogh T, Gustafsson D, Kjellberg M, Husberg M (2003) Twenty eight joint count disease activity score in recent onset rheumatoid arthritis using C reactive protein instead of erythrocyte sedimentation rate. Ann Rheum Dis 62(7):681–682. https://doi.org/10.1136/ard.62.7.681
Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman S, Horowitz J (1990) Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area. Ann Rheum Dis 49(2):99–102. https://doi.org/10.1136/ard.49.2.99
Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A (1992) Mud pack therapy in rheumatoid arthritis. Clin Rheumatol 11(2):243–247. https://doi.org/10.1007/BF02207966
van der Heijde DM, van’t Hof M, van Riel PL, van de Putte LB (1993) Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol 20(3):579–581
Verhagen, AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie R, de Vet HC (2015) Balneotherapy (or spa therapy) for rheumatoid arthritis. Cochrane Database Syst Rev(4):CD000518. https://doi.org/10.1002/14651858.cd000518.pub2
Wasserman AM (2011) Diagnosis and management of rheumatoid arthritis. Am Fam Physician 84(11):1245–1252
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Güneri, F.D., Forestier, F.B.E., Forestier, R.J. et al. Peloidotherapy in rheumatoid arthritis: a pilot randomized clinical trial. Int J Biometeorol 65, 2171–2180 (2021). https://doi.org/10.1007/s00484-021-02181-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00484-021-02181-2