Rheumatology International

, Volume 33, Issue 1, pp 241–245 | Cite as

The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors

  • Luca Ciprian
  • Alessandro Lo Nigro
  • Michela Rizzo
  • Alessandra Gava
  • Roberta Ramonda
  • Leonardo Punzi
  • Franco Cozzi
Short Communication

Abstract

Despite advances in pharmacological therapy, physical treatment continues to be important in the management of ankylosing spondylitis (AS). The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors. Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were randomized and assessed by an investigator independent from the spa staff: 15 were prescribed 10 sessions of spa therapy (mud packs and thermal baths) and rehabilitation (exercises in a thermal pool) and the other 15 were considered controls. The patients in both groups had been receiving anti-TNF agents for at least three months. The outcome measures utilized were BASFI, BASDAI, BASMI, VAS for back pain and HAQ. The evaluations were performed in all patients at the entry to the study, at the end of the spa treatment, and after 3 and 6 months. Most of the evaluation indices were significantly improved at the end of the spa treatment, as well as at the 3 and 6 months follow-up assessments. No significant alterations in the evaluation indices were found in the control group. Combined spa therapy and rehabilitation caused a clear, long-term clinical improvement in AS patients being treated with TNF inhibitors. Thermal treatment was found to be well tolerated and none of the patients had disease relapse.

Keywords

Ankylosing spondylitis BASFI Mud-bath therapy Rehabilitation in thermal pool 

References

  1. 1.
    Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390PubMedCrossRefGoogle Scholar
  2. 2.
    Dagfinrud HJ, Kvien TK, Hagen KB (2005) The Cochrane review of physioterapy interventions for ankylosing spondylitis. J Rheumatol 32:1899–1906PubMedGoogle Scholar
  3. 3.
    Clegg DO, Reda DJ, Weisman MH, Blackburn WD, Cush JJ, Cannon GW et al (1996) Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 39:2004–2012PubMedCrossRefGoogle Scholar
  4. 4.
    Biasi D, Carletto A, Caramaschi P, Pacor ML, Maleknia T, Bambara LM (2009) Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clin Rheumatol 19:114–117CrossRefGoogle Scholar
  5. 5.
    Haibel H, Sieper J (2010) Editorial review: how early should ankylosing spondylitis be treated with a tumor necrosis factor-blocker? Curr Opin Rheumatol 22:388–392PubMedCrossRefGoogle Scholar
  6. 6.
    Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B et al (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452PubMedCrossRefGoogle Scholar
  7. 7.
    Dagfinrud H, Kvien TK, Hagen KB (2008) Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 1:CD002822PubMedGoogle Scholar
  8. 8.
    Van Tubergen A, Van der Linden S (2002) A brief history of spa therapy. Ann Rheum Dis 61:273–275PubMedCrossRefGoogle Scholar
  9. 9.
    Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al (2009) The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783PubMedCrossRefGoogle Scholar
  10. 10.
    Codish S, Dobrovinsky S, Abu Shakra M, Flusser D, Sukenik S (2005) Spa therapy for ankylosing spondylitis at the Dead Sea. Isr Med Assoc J 7:443–446PubMedGoogle Scholar
  11. 11.
    Yurtkuran M, Ay A, Karakoc Y (2005) Improvement of the clinical outcome in ankylosing spondylitis by balneotherapy. Joint Bone Spine 72:303–308PubMedCrossRefGoogle Scholar
  12. 12.
    Altan L, Bingol U, Aslan M, Yurtkuran M (2006) The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 35:283–289PubMedCrossRefGoogle Scholar
  13. 13.
    Elkayam O, Ophir J, Brener S, Paran D, Wigler I, Efron D et al (2000) Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis. Rheumatol Int 19:77–82PubMedCrossRefGoogle Scholar
  14. 14.
    Cozzi F, Podswiadek M, Cardinale G, Oliviero F, Dani L, Sfriso P et al (2007) Mud-bath treatment in spondylitis associated with inflammatory bowel disease—a pilot randomized clinical trial. Joint Bone Spine 74:436–439PubMedCrossRefGoogle Scholar
  15. 15.
    Dubey SG, Leeder J, Gaffney K (2008) Physical therapy in anti-TNF treated patients with ankylosing spondylitis. Rheumatology 47:1100–1101PubMedCrossRefGoogle Scholar
  16. 16.
    Van Tubergen A, Landewé R, van der Heijde D, Hidding A, Wolter N, Asscher M et al (2001) Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 45:430–438PubMedCrossRefGoogle Scholar
  17. 17.
    Colina M, Ciancio G, Garavini R, Conti M, Trotta F, Govoni M (2009) Combination treatment with etanercept and an intensive spa rehabilitation program in active ankylosing spondylitis. Int J Immunopathol Pharmacol 22:1125–1129PubMedGoogle Scholar
  18. 18.
    Giusti P, Cima L, Tinello A, Cozzi F, Targa L, Lazzarin P et al (1990) Stresshormone, freigesetzt durch Fangotherapie. ACTH- und Beta-Endorphin-Konzentrationen unter Wärmestress. Fortsch Med 108:601–604Google Scholar
  19. 19.
    Cozzi F, Lazzarin P, Todesco S, Cima L (1995) Hypothalamic-pituitary-adrenal axis dysregulation in healthy subjects undergoing mud-bath applications. Arthritis Rheum 38:724–725PubMedCrossRefGoogle Scholar
  20. 20.
    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 22:763–766PubMedGoogle Scholar
  21. 21.
    Britschka ZM, Teodoro WR, Velosa AP, de Mello SB (2007) The efficacy of Brazilian black mud treatment in chronic experimental arthritis. Rheumatol Int 28:39–45PubMedCrossRefGoogle Scholar
  22. 22.
    Schmidt KL (1991) Physical therapy and balneotherapy of arthritis. Ther Umsch 48:46–51PubMedGoogle Scholar
  23. 23.
    Kappel M, Gyhrs A, Galbo H, Pedersen BK (1997) The response on glucoregulatory hormones of in vivo whole body hyperthermia. Int J Hyperthermia 13:413–421PubMedCrossRefGoogle Scholar
  24. 24.
    Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224PubMedCrossRefGoogle Scholar
  25. 25.
    Reilly KA, Bird HA (2001) Prophylactic hydrotherapy. Rheumatology 40:4–6PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Luca Ciprian
    • 1
  • Alessandro Lo Nigro
    • 1
  • Michela Rizzo
    • 1
  • Alessandra Gava
    • 1
  • Roberta Ramonda
    • 1
  • Leonardo Punzi
    • 1
  • Franco Cozzi
    • 1
  1. 1.Rheumatology Unit, Department of Clinical and Experimental MedicineUniversity of PadovaPadovaItaly

Personalised recommendations