International Journal of Biometeorology

, Volume 61, Issue 12, pp 2159–2173 | Cite as

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

  • Carla Morer
  • Christian-François Roques
  • Alain Françon
  • Romain Forestier
  • Francisco MaraverEmail author
Review Paper


The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: “spa therapy” “balneotherapy” “mud” “peloid” “mud pack Therapy” in combination with “randomized controlled trial” “double blind trial.” We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group (“non-mineral”). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or “non-mineral” mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study’s methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients’ population are needed to establish the role of minerals and other chemical compounds in spa therapy.


Spa therapy Balneotherapy Peloid therapy Mud therapy Double blind trial Review 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. Abu-Shakra M, Mayer A, Friger M, Harari M (2014) Dead Sea mud packs for chronic low back pain. Isr Med Assoc J 16:574–577Google Scholar
  2. 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. doi: 10.1002/art.1780290816 CrossRefGoogle Scholar
  3. Bacle I, Meges S, Lauze C, Macleod P, Dupuy P (1999) Sensory analysis of four medical spa spring waters containing various mineral concentrations. Int J Dermatol 38:784–786. doi: 10.1046/j.1365-4362.1999.00789.x CrossRefGoogle Scholar
  4. 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. doi: 10.1007/s10067-006-0420-1 CrossRefGoogle Scholar
  5. Balogh Z, Ordögh J, Gász A, Német L, Bender T (2005) Effectiveness of balneotherapy in chronic low back pain -- a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd 12:196–201. doi: 10.1159/000086305 Google Scholar
  6. Bazzichi L, Da Valle Y, Rossi A, Giacomelli C, Sernissi F, Giannaccini G, Betti L, Ciregia F, Giusti L, Scarpellini P, Dell'Osso L, Marazziti D, Bombardieri S, Lucacchini A (2013) A multidisciplinary approach to study the effects of balneotherapy and mud-bath therapy treatments on fibromyalgia. Clin Exp Rheumatol 31:S111–S120Google Scholar
  7. Beer AM, Junginger HE, Lukanov J, Sagorchev P (2003) Evaluation of the permeation of peat substances through human skin in vitro. Int J Pharm 253:169–175. doi: 10.1016/S0378-5173(02)00706-8 CrossRefGoogle Scholar
  8. 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. doi: 10.1007/s00296-004-0487-4 CrossRefGoogle Scholar
  9. 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 38:86–89. doi: 10.1016/j.arcmed.2006.08.007 CrossRefGoogle Scholar
  10. 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 therapies. Clin Biochem 43:973–978. doi: 10.1016/j.clinbiochem.2010.05.004 CrossRefGoogle Scholar
  11. Borroni G, Brazzelli V, Fornara L, Rosso R, Paulli M, Tinelli C, Ciocca O (2013) Clinical, pathological and immunohistochemical effects of arsenical-ferruginous spa waters on mild-to-moderate psoriatic lesions: a randomized placebo-controlled study. Int J Immunopathol Pharmacol 26:495–501. doi: 10.1177/039463201302600223 CrossRefGoogle Scholar
  12. Boutron I, Moher D, Tugwell P, Giraudeau B, Poiraudeau S, Nizard R, Ravaud P (2005) A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) was developed using consensus. J Clin Epidemiol 58:1233–1240. doi: 10.1016/j.jclinepi.2005.05.004 CrossRefGoogle Scholar
  13. Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF (2016) Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med 52:422–430Google Scholar
  14. Burguera EF, Vela-Anero A, Magalhães J, Meijide-Faílde R, Blanco FJ (2014) Effect of hydrogen sulfide sources on inflammation and catabolic markers on interleukin 1β-stimulated human articular chondrocytes. Osteoarthr Cartil 22:1026–1035. doi: 10.1016/j.joca.2014.04.031 CrossRefGoogle Scholar
  15. Burguera EF, Meijide-Failde R, Blanco FJ (2016) Hydrogen sulfide and inflammatory joint diseases. Curr Drug Targets. doi: 10.2174/1389450117666160829112824
  16. Chen CQ, Xin H, Zhu YZ (2007) Hydrogen sulfide: third gaseous transmitter, but with great pharmacological potential. Acta Pharmacol Sin 28:1709–1716. doi: 10.1111/j.1745-7254.2007.00629.x CrossRefGoogle Scholar
  17. Ciani O, Pascarelli NA, Giannitti C, Galeazzi M, Meregaglia M, Fattore G, Fioravanti A (2017) Mud-bath therapy in addition to usual care in bilateral knee osteoarthritis: economic evaluation alongside a randomized controlled trial. Arthritis Care Res (Hoboken) 69:966–972. doi: 10.1002/acr.23116 CrossRefGoogle Scholar
  18. Ciprian L, Lo Nigro A, Rizzo M, Gava A, Ramonda R, Punzi L, Cozzi F (2013) The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 33:241–245. doi: 10.1007/s00296-011-2147-9 CrossRefGoogle Scholar
  19. 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 25:49–54. doi: 10.1007/s00296-003-0402-4 CrossRefGoogle Scholar
  20. Costantino M, Filippelli A, Quenau P, Nicolas JP, Coiro V (2012) Sulphur mineral water and SPA therapy in osteoarthritis. Therapie 67:43–48. doi: 10.2515/therapie/2012002 CrossRefGoogle Scholar
  21. Cozzi F, Raffeiner B, Beltrame V, Ciprian L, Coran A, Botsios C, Perissinotto E, Grisan E, Ramonda R, Oliviero F, Stramare R, Punzi L (2015) Effects of mud-bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound (CEUS). Joint Bone Spine 82:104–108. doi: 10.1016/j.jbspin.2014.11.002 CrossRefGoogle Scholar
  22. Derek T, Cooke V, Kelly BP, Harrison L, Mohamed G, Khan B (1999) Radiographic grading for knee osteoarthritis. A revised scheme that relates to alignment and deformity. J Rheumatol 26:641–644Google Scholar
  23. Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R, Fishel B, Yaron M (1991) Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 18:1799–1803Google Scholar
  24. Espejo-Antúnez L, Cardero-Durán MA, Garrido-Ardila EM, Torres-Piles S, Caro-Puértolas B (2013a) Clinical effectiveness of mud pack therapy in knee osteoarthritis. Rheumatology (Oxford) 52:659–668. doi: 10.1093/rheumatology/kes322 CrossRefGoogle Scholar
  25. Espejo-Antúnez L, Caro Puértolas B, Ibáñez Burgos B, Porto Payán JM, Torres Piles ST (2013b) Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Reumatol Clin 9:156–160. doi: 10.1016/j.reuma.2012.09.005 CrossRefGoogle Scholar
  26. 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. doi: 10.1016/j.jbspin.2006.03.009 CrossRefGoogle Scholar
  27. Falagas ME, Zarkadoulia E, Rafailidis PI (2009) The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract 63:1068–1084. doi: 10.1111/j.1742-1241.2009.02062.x CrossRefGoogle Scholar
  28. Fazaa A, Souabni L, Ben Abdelghani K, Kassab S, Chekili S, Zouari B, Hajri R, Laatar A, Zakraoui L (2014) Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial. Ann Phys Rehabil Med 57:561–569. doi: 10.1016/ CrossRefGoogle Scholar
  29. 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 31:1–8. doi: 10.1007/s00296-010-1628-6 CrossRefGoogle Scholar
  30. 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 CrossRefGoogle Scholar
  31. Fioravanti A, Tenti S, Giannitti C et al (2014) Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial. Int J Biometeorol 58:79–86. doi: 10.1007/s00484-012-0627-6 CrossRefGoogle Scholar
  32. Fioravanti A, Bacaro G, Giannitti C, Tenti S, Cheleschi S, Gui Delli GM, Pascarelli NA, Galeazzi M (2015a) One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial. Int J Biometeorol 59:1333–1343. doi: 10.1007/s00484-014-0943-0 CrossRefGoogle Scholar
  33. Fioravanti A, Giannitti C, Cheleschi S, Simpatico A, Pascarelli NA, Galeazzi M (2015b) Circulating levels of adiponectin, resistin, and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis. Int J Biometeorol 59:1691–1700. doi: 10.1007/s00484-015-0977-y CrossRefGoogle Scholar
  34. Fioravanti A, Karagülle M, Bender T, Karagülle MZ (2017) Balneotherapy in osteoarthritis: facts, fiction and gaps in knowledge. Eur J Integr Med 9:148–150. doi: 10.1016/j.eujim.2017.01.001 CrossRefGoogle Scholar
  35. 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 8:197–203. doi: 10.1097/01.RHU.0000022542.38402.A9 CrossRefGoogle Scholar
  36. 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 CrossRefGoogle Scholar
  37. Forestier R, Erol Forestier FB, Francon A (2016) Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med 59:216–226. doi: 10.1016/ CrossRefGoogle Scholar
  38. Fortunati NA, Fioravanti A, Seri G, Cinelli S, Tenti S (2016) May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action. Int J Biometeorol 60:1–8. doi: 10.1007/s00484-015-1030-x CrossRefGoogle Scholar
  39. Fraioli A, Grassi M, Mennuni G, Geraci A, Petraccia L, Fontana M, Conte S, Serio A (2013) Clinical researches on the efficacy of spa therapy in fibromyalgia. A systematic review. Ann Ist Super Sanita 49:219–229. doi: 10.4415/ANN_13_02_13 Google Scholar
  40. Franke A, Reiner L, Pratzel HG, Franke T, Resch KL (2000) Long-term efficacy of radon spa therapy in rheumatoid arthritis--a randomized, sham-controlled study and follow-up. Rheumatology (Oxford) 39:894–902CrossRefGoogle Scholar
  41. Franke A, Reiner L, Resch KL (2007) Long-term benefit of radon spa therapy in the rehabilitation of rheumatoid arthritis: a randomised, double-blinded trial. Rheumatol Int 27:703–713. doi: 10.1007/s00296-006-0293-2 CrossRefGoogle Scholar
  42. Franke A, Franke T (2013) Long-term benefits of radon spa therapy in rheumatic diseases: results of the randomised, multi-centre IMuRa trial. Rheumatol Int 33:2839–2850. doi: 10.1007/s00296-013-2819-8 CrossRefGoogle Scholar
  43. Gomes C, Carretero MI, Pozo M, Maraver F, Cantista P, Armijo F, Legido JL, Teixeira F, Rautureau M, Delgado R (2013) Peloids and pelotherapy: historical evolution, classification and glossary. Appl Clay Sci 75–76:28–38. doi: 10.1016/j.clay.2013.02.008 CrossRefGoogle Scholar
  44. Gomes CS (2017) Healing and edible clays: a review of basic concepts, benefits and risks. Environ Geochem Health. doi: 10.1007/s10653-016-9903-4
  45. Gremeaux V, Benaïm C, Poiraudeau S, Hérisson C, Dupeyron A, Coudeyre E (2013) Evaluation of the benefits of low back pain patients' education workshops during spa therapy. Joint Bone Spine 80:82–87. doi: 10.1016/j.jbspin.2011.12.014 CrossRefGoogle Scholar
  46. Güngen G, Ardic F, Fındıkoğlu G, Rota S (2012) The effect of mud pack therapy on serum YKL-40 and hsCRP levels in patients with knee osteoarthritis. Rheumatol Int 32:1235–1244. doi: 10.1007/s00296-010-1727-4 CrossRefGoogle Scholar
  47. Gungen GO, Ardic F, Findikoglu G, Rota S (2016) Effect of mud compress therapy on cartilage destruction detected by CTX-II in patients with knee osteoarthritis. J Back Musculoskelet Rehabil 29:429–438. doi: 10.3233/BMR-150629 CrossRefGoogle Scholar
  48. 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 54:495–507. doi: 10.1007/s00484-010-0321-5 CrossRefGoogle Scholar
  49. Halevy S, Giryes H, Friger M, Grossman N, Karpas Z, Sarov B, Sukenik S (2001) The role of trace elements in psoriatic patients undergoing balneotherapy with Dead Sea bath salt. Isr Med Assoc J 3:828–832Google Scholar
  50. Hon KL, Tsang YC, Lee VW, Pong NH, Ha G, Lee ST, Chow CM, Leung TF (2016) Efficacy of sodium hypochlorite (bleach) baths to reduce Staphylococcus Aureus colonization in childhood onset moderate-to-severe eczema: a randomized, placebo-controlled cross-over trial. J Dermatolog Treat 27:156–162. doi: 10.3109/09546634.2015.1067669 CrossRefGoogle Scholar
  51. Horváth K, Kulisch Á, Németh A, Bender T (2012) Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands: a randomized controlled single-blind follow-up study. Clin Rehabil 26:431–441. doi: 10.1177/0269215511425961 CrossRefGoogle Scholar
  52. Kardeş S, Karagülle M, Karagülle MZ (2017) Comment on: clinical efficacy of mudpack therapy in treating knee osteoarthritis: a meta-analysis of randomized controlled studies. Am J Phys Med Rehabil 96:e9–e10. doi: 10.1097/PHM.0000000000000551 CrossRefGoogle Scholar
  53. Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T (2010) Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol 20:2–12. doi: 10.2188/jea.JE20090030 CrossRefGoogle Scholar
  54. Karagülle M, Kardeş S, Karagülle O, Dişçi R, Avcı A, Durak İ, Karagülle MZ (2017) Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial. Int J Biometeorol 61:169–180. doi: 10.1007/s00484-016-1201-4 CrossRefGoogle Scholar
  55. Kovács I, Bender T (2002) The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study. Rheumatol Int 21:218–221. doi: 10.1007/s00296-001-0167-6 CrossRefGoogle Scholar
  56. Kovács C, Pecze M, Tihanyi Á, Kovács L, Balogh S, Bender T (2012) The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study. Clin Rheumatol 31:1437–1442. doi: 10.1007/s10067-012-2026-0 CrossRefGoogle Scholar
  57. Kovács C, Bozsik Á, Pecze M, Borbély I, Fogarasi A, Kovács L, Tefner IK, Bender T (2016) Effects of sulfur bath on hip osteoarthritis: a randomized, controlled, single-blind, follow-up trial: a pilot study. Int J Biometeorol 60:1675–1680. doi: 10.1007/s00484-016-1158-3 CrossRefGoogle Scholar
  58. Kulisch A, Bender T, Németh A, Szekeres L (2009) Effect of thermal water and adjunctive electrotherapy on chronic low back pain: a double-blind, randomized, follow-up study. J Rehabil Med 41:73–79. doi: 10.2340/16501977-0291 CrossRefGoogle Scholar
  59. Kulisch Á, Benkö Á, Bergmann A, Gyarmati N, Horváth H, Kránicz Á, Mándó ZS, Matán Á, Németh A, Szakál E, Szántó D, Szekeres L, Bender T (2014) Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. Eur J Phys Rehabil Med 50:373–381Google Scholar
  60. Leibetseder V, Strauss-Blasche G, Holzer F, Marktl W, Ekmekcioglu C (2004) Improving homocysteine levels through balneotherapy: effects of sulphur baths. Clin Chim Acta 343:105–111. doi: 10.1016/j.cccn.2003.12.024 CrossRefGoogle Scholar
  61. Liu H, Zeng C, Gao SG, Yang T, Luo W, Li YS, Xiong YL, Sun JP, Lei GH (2013) The effect of mud therapy on pain relief in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials. J Int Med Res 41:1418–1425. doi: 10.1177/0300060513488509 CrossRefGoogle Scholar
  62. Mahboob N, Sousan K, Shirzad A, Amir G, Mohammad V, Reza M, Mansour VA, Hadi V (2009) The efficacy of a topical gel prepared using Lake Urmia mud in patients with knee osteoarthritis. J Altern Complement Med 15:1239–1242. doi: 10.1089/acm.2009.0304 CrossRefGoogle Scholar
  63. Matsumoto H, Hagino H, Hayashi K, Ideno Y, Wada T, Ogata T, Akai M, Seichi A, Iwaya T (2017) The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol. doi: 10.1007/s10067-017-3592-y
  64. Metin Ökmen B, Kasapoğlu Aksoy M, Güneş A, Eröksüz R, Altan L (2017) Effectiveness of PELOID therapy in carpal tunnel syndrome: a randomized controlled single blind study. Int J Biometeorol. doi: 10.1007/s00484-017-1317-1
  65. Naumann J, Sadaghiani C (2014) Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials. Arthritis Res Ther 16:R141. doi: 10.1186/ar4603 CrossRefGoogle Scholar
  66. 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 CrossRefGoogle Scholar
  67. Ottaviano G, Marioni G, Staffieri C, Giacomelli L, Marchese-Ragona R, Bertolin A, Staffieri A (2011) Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study. Am J Otolaryngol 32:235–239. doi: 10.1016/j.amjoto.2010.02.004 CrossRefGoogle Scholar
  68. Ottaviano G, Marioni G, Giacomelli L, La Torre FB, Staffieri C, Marchese-Ragona R, Staffieri A (2012) Smoking and chronic rhinitis: effects of nasal irrigations with sulfurous-arsenical-ferruginous thermal water: A prospective,randomized, double-blind study. Am J Otolaryngol 33:657–662. doi: 10.1016/j.amjoto.2012.03.002 CrossRefGoogle Scholar
  69. Özkuk K, Gürdal H, Karagülle M, Barut Y, Eröksüz R, Karagülle MZ (2016) Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine? Int J Biometeorol. doi: 10.1007/s00484-016-1250-8
  70. Pascarelli NA, Cheleschi S, Bacaro G, Guidelli GM, Galeazzi M, Fioravanti A (2016) Effect of mud-bath therapy on serum biomarkers in patients with knee osteoarthritis: results from a randomized controlled trial. Isr Med Assoc J 18:232–237Google Scholar
  71. Pittler MH, Karagülle MZ, Karagülle M, Ernst E (2006) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford) 45:880–884. doi: 10.1093/rheumatology/kel018 CrossRefGoogle Scholar
  72. Santos I, Cantista P, Vasconcelos C (2016) Balneotherapy in rheumatoid arthritis-a systematic review. Int J Biometeorol 60:1287–1301. doi: 10.1007/s00484-015-1108-5 CrossRefGoogle Scholar
  73. 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 CrossRefGoogle Scholar
  74. 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 Commun 17:501–512. doi: 10.1016/0031-6989(85)90123-7 CrossRefGoogle Scholar
  75. 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 11:88–93Google Scholar
  76. Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A (1992) Mud pack therapy in rheumatoid arthritis. Clin Rheumatol 11:243–247. doi: 10.1007/BF02207966 CrossRefGoogle Scholar
  77. Staffieri A, Marino F, Staffieri C, Giacomelli L, D'Alessandro E, Maria Ferraro S, Fedrazzoni U, Marioni G (2008) The effects of sulfurous-arsenical-ferruginous thermal water nasal irrigation in wound healing after functional endoscopic sinus surgery for chronic rhinosinusitis: a prospective randomized study. Am J Otolaryngol 29:223–229. doi: 10.1016/j.amjoto.2007.07.002 CrossRefGoogle Scholar
  78. Svenson KL, Hällgren R, Johansson E, Lindh U (1985) Reduced zinc in peripheral blood cells from patients with inflammatory connective tissue diseases. Inflammation 9:189–199. doi: 10.1007/BF00917591 CrossRefGoogle Scholar
  79. 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 109:7–9CrossRefGoogle Scholar
  80. Tefner IK, Németh A, Lászlófi A, Kis T, Gyetvai G, Bender T (2012) The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study. Rheumatol Int 32:3163–3169. doi: 10.1007/s00296-011-2145-y CrossRefGoogle Scholar
  81. 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 CrossRefGoogle Scholar
  82. Tenti S, Cheleschi S, Galeazzi M, Fioravanti A (2015) Spa therapy: can be a valid option for treating knee osteoarthritis? Int J Biometeorol 59:1133–1143. doi: 10.1007/s00484-014-0913-6 CrossRefGoogle Scholar
  83. Verhagen AP, Cardoso JR, Bierma-Zeinstra SM (2012) Aquatic exercise & balneotherapy in musculoskeletal conditions. Best Prac Res Clin Rheumatol 26:335–343. doi: 10.1016/j.berh.2012.05.008 CrossRefGoogle Scholar
  84. 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. doi: 10.1002/14651858.CD000518 Google Scholar
  85. Waller B, Munukka M, Multanen J, Rantalainen T, Pöyhönen T, Nieminen MT, Kiviranta I, Kautiainen H, Selänne H, Dekker J, Sipilä S, Kujala UM, Häkkinen A, Heinonen A (2013) Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial. BMC Musculoskelet Disord 14:82. doi: 10.1186/1471-2474-14-82 CrossRefGoogle Scholar
  86. Wigler I, Elkayam O, Paran D, Yaron M (1995) Spa therapy for gonarthrosis: a prospective study. Rheumatol Int 15:65–68. doi: 10.1007/BF00262710 CrossRefGoogle Scholar
  87. Winklmayr M, Kluge C, Winklmayr W, Küchenhoff H, Steiner M, Ritter M, Hartl A (2015) Radon balneotherapy and physical activity for osteoporosis prevention: a randomized, placebo-controlled intervention study. Radiat Environ Biophys 54:123–136. doi: 10.1007/s00411-014-0568-z CrossRefGoogle Scholar
  88. Wong SM, Ng TG, Baba R (2013) Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. J Dermatol 40:874–880. doi: 10.1111/1346-8138.12265 CrossRefGoogle Scholar
  89. Xiang J, Wu D, Li J (2016) Clinical efficacy of mudpack therapy in treating knee osteoarthritis: a meta-analysis of randomized controlled studies. Am J Phys Med Rehabil 95:121–131. doi: 10.1097/PHM.0000000000000354 CrossRefGoogle Scholar
  90. Yázigi F, Espanha M, Vieira F, Messier SP, Monteiro C, Veloso AP (2013) The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals. BMC Musculoskelet Disord 14:320. doi: 10.1186/1471-2474-14-320 CrossRefGoogle Scholar
  91. 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. doi: 10.1007/s00296-006-0158-8 CrossRefGoogle Scholar
  92. Zámbó L, Dékány M, Bender T (2008) The efficacy of alum-containing ferrous thermal water in the management of chronic inflammatory gynaecological disorders - a randomized controlled study. Eur J Obstet Gynecol Reprod Biol 140:252–257. doi: 10.1016/j.ejogrb.2008.03.015 CrossRefGoogle Scholar

Copyright information

© ISB 2017

Authors and Affiliations

  1. 1.Department of Physical Medicine and Rehabilitation. Medical Hydrology, Faculty of MedicineUniversidad Complutense de MadridMadridSpain
  2. 2.Institut Català de la Salut, EAP 8B Porta, Centro Atención Primaria Rio de JaneiroUTAC MuntanyaBarcelonaSpain
  3. 3.Université Paul SabatierToulouseFrance
  4. 4.Aix-les-Bains Rheumatologic and Thermal Research CenterAix-les-BainsFrance
  5. 5.Professional School of Medical Hydrology, Faculty of MedicineUniversidad Complutense de MadridMadridSpain

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