International Journal of Biometeorology

, Volume 62, Issue 5, pp 833–842 | Cite as

How does spa treatment affect cardiovascular function and vascular endothelium in patients with generalized osteoarthritis? A pilot study through plasma asymmetric di-methyl arginine (ADMA) and L-arginine/ADMA ratio

  • Fatih Karaarslan
  • Kagan Ozkuk
  • Serap Seringec Karabulut
  • Seldag Bekpinar
  • Mufit Zeki Karagulle
  • Nergis ErdoganEmail author
Original Paper


The study aims to investigate the effect of spa treatment on vascular endothelium and clinical symptoms of generalized osteoarthritis. Forty generalized osteoarthritis (GOA) patients referred to a government spa hospital, and 40 GOA patients followed on university hospital locomotor system disease ambulatory clinics were included as study and control groups, respectively. Study group received spa treatment including thermal water baths, physical therapy modalities, and exercises. Control group was followed with home exercises for 15 days. Plasma ADMA, L-arginine, L-arginine/ADMA ratio, routine blood analyses, 6-min walking test, including fingertip O2 saturation, systolic/diastolic blood pressure, and pulse rate, were measured at the beginning and at the end of treatment. Groups were evaluated with VAS pain, patient, and physician global assessment; HAQ; and WOMAC at the beginning, at the end, and after 1 month of treatment. In study group, L-arginine and L-arginine/ADMA ratio showed statistically significant increase after treatment. Plasma ADMA levels did not change. There is no significant difference in intergroup comparison. Study group displayed statistically significant improvements in all clinical parameters. The study showed that spa treatment does not cause any harm to the vascular endothelium through ADMA. Significant increase in plasma L-arginine and L-arginine/ADMA ratio suggests that balneotherapy may play a preventive role on cardiovascular diseases. Balneotherapy provides meaningful improvements on clinical parameters of GOA.


Generalized osteoarthritis Balneotherapy Spa therapy ADMA Arginine L-arginine Cardiovascular disease Pain Osteoarthritis 



This study was supported by Istanbul University Scientific Research Unit Project No. 47566.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© ISB 2017

Authors and Affiliations

  • Fatih Karaarslan
    • 1
  • Kagan Ozkuk
    • 1
  • Serap Seringec Karabulut
    • 1
  • Seldag Bekpinar
    • 1
  • Mufit Zeki Karagulle
    • 1
  • Nergis Erdogan
    • 1
    Email author
  1. 1.İstanbul UniversityIstanbulTurkey

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