International Journal of Biometeorology

, Volume 56, Issue 4, pp 583–590 | Cite as

Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee

  • Antonella Fioravanti
  • Chiara Giannitti
  • Barbara Bellisai
  • Francesca Iacoponi
  • Mauro Galeazzi
Original Paper

Abstract

The aims of this study were to evaluate whether balneotherapy with mineral sulphate–bicarbonate–calcium water could determine substantial symptomatic improvement, and to detect any changes in the quality of life (QoL) of patients with symptomatic knee osteoarthritis (OA). This was a prospective randomized, single blind controlled trial. Sixty outpatients with primary bilateral knee OA, according to ACR criteria, were included in the study and randomized to one of two groups: group I (30 patients) was treated with a daily sulphate–bicarbonate–calcium mineral water bath; group II (30 patients), the control group, continued their regular outpatient care routine. At baseline, after 15 days and after 12 weeks, patients were evaluated by Visual Analogue Scale (VAS) for spontaneous pain, Lequesne and Womac Index for gonarthrosis, SF-36, Arthritis Impact Measurement Scale (AIMS) and symptomatic drugs consumption. We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period, whereas in the control group no significant differences were noted. This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption. The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up. Tolerability of balneotherapy seemed to be good, with light and transitory side effects. Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time, with positive effects on the painful symptomatology, a significant improvement on functional capacities and QoL. Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments.

Keywords

Balneotherapy Knee osteoarthritis Pain Function Quality of life 

References

  1. 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 29:1039–1049CrossRefGoogle Scholar
  2. Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036CrossRefGoogle Scholar
  3. Ardiç F, Őzgen 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 27:441–446CrossRefGoogle Scholar
  4. Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ 172:1039–1043CrossRefGoogle Scholar
  5. Bellamy N, Goldsmith CH, Buchanan WW, Campbell J, Duku E (1991) Prior score availability: observations using the WOMAC osteoarthritis index. Br J Rheumatol 30:150–151CrossRefGoogle Scholar
  6. Bellometti S, Galzigna L (1998) Serum levels of a prostaglandin and a leukotriene after termal mud pack therapy. J Investig Med 46:140–145Google Scholar
  7. Bellometti S, Cecchettin M, Galzigna L (1997) Mud-pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. Clin Chim Acta 268:101–106CrossRefGoogle Scholar
  8. 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 osteoarthrosic patients. Int J Tissue React 24:57–64Google Scholar
  9. 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 25:77–94Google Scholar
  10. Bender T, Bariska J, Vághy R, Gomez R, Kovács I (2007) Effect of balneotherapy on the antioxidant system – a controlled pilot study. Arch Med Res 38:86–89CrossRefGoogle Scholar
  11. Benedetti S, Canino C, Tonti G, Medda V, Calcaterra P, Nappi G, Salaffi F, Canestrari F (2010) Biomarkers of oxidation, inflammation and cartilage degradation in osteoarthritis patients undergoing sulfur-based spa terapies. Clin Biochem 43:973–978CrossRefGoogle Scholar
  12. Bjordal JM, Ljunggren AE, Klovning A, Slørdal L (2004) Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ 329:1317CrossRefGoogle Scholar
  13. 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 75:193–201CrossRefGoogle Scholar
  14. Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, Lines C, Riddell R, Morton D, Lanas A, Konstam MA, Baron JA, Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial investigators (2005) N Engl J Med 352:1092–1102CrossRefGoogle Scholar
  15. Cozzi F, Lazzarin P, Todesco S, Cima L (1995) Hypothalamic-pituitary-adrenal axis dysregulation in healthy subjects undergoing mud-bath applications. Arthritis Rheum 38:724–726CrossRefGoogle Scholar
  16. Ekmekcioglu 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 9:216–220CrossRefGoogle Scholar
  17. 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 74:60–65CrossRefGoogle Scholar
  18. Falagas ME, Zarkadoulia E, Rafailidis PI (2009) The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract 63:1068–1084CrossRefGoogle Scholar
  19. Fautrel B, Hilliquin P, Rozenberg S, Allaert FA, Coste P, Leclerc A, Rossignol M (2005) Impact of osteoarthritis: results of nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine 72:235–240CrossRefGoogle Scholar
  20. Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M (2010a) Short- and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil 89:125–132CrossRefGoogle Scholar
  21. Fioravanti A, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P (2010b) Effects of Spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int (in press)Google Scholar
  22. Fioravanti A,Cantarini L, Guidelli GM, Galeazzi M (2010c) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int (in press)Google Scholar
  23. Forestier R, Desfour H, Tessier JM, Francon 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 69:660–665CrossRefGoogle Scholar
  24. Gaál J, Varga J, Szekanecz Z, Kurkó J, Ficzere A, Bodolay E, Bender T (2008) Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Isr Med Assoc J 10:365–369Google Scholar
  25. Guccione AA, Felson DT, Anderson JJ (1990) Defining arthritis and measuring functional status in elders: methodological issues in the study of disease and physical disability. Am J Public Health 80:945–949CrossRefGoogle Scholar
  26. 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 28:501–507CrossRefGoogle Scholar
  27. Huskisson EC, Berry H, Gishen P, Jubb RW, Whitehead J (1995) Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee. LINK Study Group. Longitudinal investigation of nonsteroidal antiinflammatory drugs in knee osteoarthritis. J Rheumatol 22:1941–1946Google Scholar
  28. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al (2003) 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 62:1145–1155CrossRefGoogle Scholar
  29. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C (2006) Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332:1302–1308CrossRefGoogle Scholar
  30. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefGoogle Scholar
  31. Kuczera M, Kokot F (1996) Effect of spa therapy on the endocrine system. I. Stress reaction hormones. Pol Arch Med Wewn 95:11–20Google Scholar
  32. 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 65:85–89CrossRefGoogle Scholar
  33. Meenan RF, Gertman PM, Mason JH (1980) Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum 23:146–152CrossRefGoogle Scholar
  34. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–979CrossRefGoogle Scholar
  35. Neame R, Zhang W, Doherty M (2004) A historic issue of the Annals: three papers examine paracetamol in osteoarthritis. Ann Rheum Dis 63:897–900CrossRefGoogle Scholar
  36. 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 36:77–81CrossRefGoogle Scholar
  37. Ofman JJ, MacLean CH, Straus WL, Morton SC, Berger ML, Roth EA, Shekelle P (2002) A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol 29:804–812Google Scholar
  38. Peat G, McCarney R, Croft P (2001) Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 60:91–97CrossRefGoogle Scholar
  39. Pincus T, Wang X, Chung C, Sokka T, Koch GG (2005) Patient preference in a crossover clinical trial of patients with osteoarthritis of the knee or hip: face validity of self-report questionnaire ratings. J Rheumatol 32:533–539Google Scholar
  40. 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 18:1581–1586Google Scholar
  41. Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L, GOnorthrosis and Quality of Life Assessment (GOQOLA) (2003) Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage 11:551–560CrossRefGoogle Scholar
  42. Shani J, Barak S, Levi D, Ram M, Schachner ER, Schlesinger T, Robberecht H, Van Grieken R, Avrach WW (1985) Skin penetration of minerals in psoriatics and guinea pigs bathing in hypertonic salt solutions. Pharmacol Res 17:501–506Google Scholar
  43. Shehata M, Schwarzmeier JD, Hilgarth M, Demirtas D, Richter D, Hubmann R, Boeck P, Leiner G, Falkenbach A (2006) Effect of combined spa-exercise therapy on circulating TGF-beta1 levels in patients with ankylosing spondylitis. Wien Klin Wochenschr 118:266–272CrossRefGoogle Scholar
  44. Sukenik S, Flusser D, Abu-Shakra M (1999) The role of spa therapy in various rheumatic diseases. Rheum Dis Clin North Am 25:883–897CrossRefGoogle Scholar
  45. 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:CD006864Google Scholar
  46. Ware JE Jr, Sherbourne CD (1992) The MOS 36- item short- form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefGoogle Scholar
  47. Yilmaz B, Goktepe AS, Alaca R, Mohur H, Kayar AH (2004) Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Joint Bone Spine 71:563–566CrossRefGoogle Scholar
  48. Zhang Y, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369CrossRefGoogle Scholar
  49. Zhang W, Jones A, Doherty M (2004) Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Ann Rheum Dis 63:901–907CrossRefGoogle Scholar
  50. Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW et al (2007) EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:377–388CrossRefGoogle Scholar
  51. Zochling J, March L, Lapsley H, Cross M, Tribe K, Brooks P (2004) Use of complementary medicines for osteoarthritis - a prospective study. Ann Rheum Dis 63:549–554CrossRefGoogle Scholar

Copyright information

© ISB 2011

Authors and Affiliations

  • Antonella Fioravanti
    • 1
  • Chiara Giannitti
    • 1
  • Barbara Bellisai
    • 1
  • Francesca Iacoponi
    • 2
  • Mauro Galeazzi
    • 1
  1. 1.Rheumatology Unit, Department of Clinical Medicine and Immunological SciencesUniversity of SienaSienaItaly
  2. 2.Department of Biomedical SciencesUniversity of SienaSienaItaly

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