Rheumatology International

, Volume 27, Issue 6, pp 523–529 | Cite as

Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial

  • Luca Cantarini
  • Graziana Leo
  • Chiara Giannitti
  • Gabriele Cevenini
  • Pietro Barberini
  • Antonella Fioravanti
Original Article


Spa therapy and short wave therapy are two of the most commonly used non-pharmacological approaches for osteoarthritis. The aim of this study was to assess their efficacy in comparison to conventional therapy in patients with osteoarthritis of the knee in a single blind, randomized, controlled trial. Seventy-four outpatients were enrolled; 30 patients were treated with a combination of daily local mud packs and arsenical ferruginous mineral bath water from the thermal resort of Levico Terme (Trento, Italy) for 3 weeks; 24 patients were treated with short wave therapy for the same period and 20 patients continued regular, routine ambulatory care. Patients were assessed at baseline, upon completion of the 3-week treatment period, and 12 weeks later. Spa therapy and short wave therapy both demonstrated effective symptomatic treatment in osteoarthritis of the knee at the end of the treatment, but only the spa therapy was shown to have efficacy persistent over time. Our study demonstrated the superiority of arsenical ferruginous spa therapy compared to short wave therapy in the treatment of osteoarthritis of the knee, probably in relationship to the specific effects of the minerals in this water.


Knee osteoarthritis Randomized clinical trial Arsenical ferruginous waters Spa therapy Short wave therapy 


  1. 1.
    Lawrence RC, Helmick CG, Arnett FC, et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in US. Arthritis Rheum 41:778–799PubMedCrossRefGoogle Scholar
  2. 2.
    Garcia Rodriguez LA, Hernandez-Diaz S (2001) The risk of upper gastrointestinal complications associated with non-steroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combination of these agents. Arthritis Res 3:98–101PubMedCrossRefGoogle Scholar
  3. 3.
    Perlman AI, Eisenberg DM, Panush RS (1999) Talking with patients about alternative and complementary medicine. Rheum Dis Clin North Am 25:815–822PubMedCrossRefGoogle Scholar
  4. 4.
    Szucs L, Ratko I, Lesko T, Szoor I, Genti G, Balint G (1989) Double-blind trial on the effectiveness of the Puspokladany thermal water on arthrosis of the knee joints. J R Soc Health 109:7–9PubMedGoogle Scholar
  5. 5.
    Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman S, Horowitz J (1990) Sulphur baths and mud pack treatment for rheumatoid arthritis at the dead sea area. Ann Rheum Dis 49:99–102PubMedCrossRefGoogle Scholar
  6. 6.
    Wigler I, Elkayam O, Paran D, Yaron M (1995) Spa therapy for gonarthrosis: a prospective study. Rheumatol Int 15:65–68PubMedCrossRefGoogle Scholar
  7. 7.
    Nguyen M, Revel M, Dougados M (1997) Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomized controlled trial. Br J Rheumatol 36:77–81PubMedCrossRefGoogle Scholar
  8. 8.
    Neumann L, Sukenik S, Bolotin A et al (2001) The effect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin Rheumatol 20:15–19PubMedCrossRefGoogle Scholar
  9. 9.
    vanTubergen A, Landewe R, van der Heijde D et al (2001) Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 45:430–438CrossRefGoogle Scholar
  10. 10.
    Flusser D, Abu-Shakra M, Friger M (2002) Therapy with mud compresses for knee osteoarthritis: comparison of natural mud preparation with mineral depleted mud. J Clin Rheumatol 8:197–203PubMedCrossRefGoogle Scholar
  11. 11.
    Kovacs I, Bender T (2002) The therapeutic effects of Cserkeszolo thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study. Rheumatol Int 21:218–221PubMedCrossRefGoogle Scholar
  12. 12.
    Sukenik S, Flusser D, Abu-Shakra M (1999) The role of spa therapy in various rheumatic diseases. Rheum Dis Clin North Am 25:883–897PubMedCrossRefGoogle Scholar
  13. 13.
    Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Knipschild PG. Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database Syst Rev 2: CD000518Google Scholar
  14. 14.
    Moffet JA, Richardson PH, Frost H, Osborn A (1996) A placebo controlled double blind trial to evaluate the effectiveness of pulsed short wave therapy for osteoarthritic hip and knee pain. Pain 67:121–127CrossRefGoogle Scholar
  15. 15.
    Shields N, Gormley J, O’Hare N (2002) Short wave diathermy: current clinical and safety practices. Physiother Res Int 7:191–202PubMedCrossRefGoogle Scholar
  16. 16.
    Altman R, Asch E, Bloch D, 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 29:1039–1049PubMedCrossRefGoogle Scholar
  17. 17.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedGoogle Scholar
  18. 18.
    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]:85–89Google Scholar
  19. 19.
    Meenan RF, Gertman PM, Mason JH (1980) Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum 23:146–152PubMedCrossRefGoogle Scholar
  20. 20.
    Salaffi F, Cavalieri F, Nolli M, Ferraccioli G (1991) Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with the radiographic score. J Rheumatol 18:1581–1586PubMedGoogle Scholar
  21. 21.
    Dougados M, Nguyen M, Listrat V, Amor B (1989) Score d’ équivalence des AINS (abstract 1134). Rev Rhum Mal Osteoartic 56:251Google Scholar
  22. 22.
    Guillemin F, Virion JM, Escudier P, De Talance N, Weryha G (2001) Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Joint Bone Spine 68:499–503PubMedCrossRefGoogle Scholar
  23. 23.
    Fioravanti A, Bisogno S, Nerucci F, Cicero MR, Locunsolo S, Marcolongo R (2000) Evaluation of the efficacy and tolerance of radioactive fangotherapy in gonarthrosis. Comparative study versus short wave therapy. Minerva Med 91:291–298PubMedGoogle Scholar
  24. 24.
    Cozzi F, Lazzarin P, Todesco S, Cima L (1995) Hypothalamic-pituitary-adrenal axis dysregulation in healthy subjects undergoing mud-bath applications. Arthritis Rheum 38:724–726PubMedCrossRefGoogle Scholar
  25. 25.
    Bellometti S, Galzigna L (1998) Serum levels of a prostaglandin and a leukotriene after thermal mud pack therapy. J Investig Med 46:140–145PubMedGoogle Scholar
  26. 26.
    Bellometti S, Cecchettin M, Galzigna L (1997) Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. Clin Chim Acta 268:101–106PubMedCrossRefGoogle Scholar
  27. 27.
    Bellometti S, Galzigna L, Richelmi P, Gregotti C, Berté F (2002) Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Int J Tissue React 24:57–64PubMedGoogle Scholar
  28. 28.
    Bellometti S, Richelmi P, Tassoni T, Berté F (2005) Production of matrix metalloproteinases and their inhibitors in osteoarthritic patients undergoing mud bath therapy. Int J Clin Pharmacol Res 25:77–94PubMedGoogle Scholar
  29. 29.
    Bellometti S, Cecchettin M, Lalli A, Galzigna L (1996) Mud pack treatment increases serum antioxidant defenses in osteoarthrosic patients. Biomed Pharmacother 50:37PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Luca Cantarini
    • 1
  • Graziana Leo
    • 1
  • Chiara Giannitti
    • 1
  • Gabriele Cevenini
    • 2
  • Pietro Barberini
    • 3
  • Antonella Fioravanti
    • 1
  1. 1.Rheumatology Unit, Department of Clinical Medicine and Immunological SciencesUniversity of SienaSienaItaly
  2. 2.Department of Surgery and BioengineeringUniversity of SienaSienaItaly
  3. 3.Clinical BioengineeringAzienda Ospedaliera SeneseSienaItaly

Personalised recommendations