Mud-bath therapy (MBT) has been used as a treatment for rheumatic diseases and musculoskeletal complaints in the Euganean Thermal Area (near Padova, Italy) since ancient time. There is no consensus about the use of MBT in patients with inflammatory rheumatic diseases, although experimental studies have suggested a beneficial effect of MBT on chronic articular inflammation. To evaluate the effects of MBT in patients affected by seronegative spondyloarthritis, very common chronic inflammatory rheumatic diseases, randomized controlled trials (RCT) performed in the Euganean Thermal Area have been reviewed. A significant improvement of spondylitis parameters was observed in enteropathic spondylitis, without bowel symptom exacerbation. A long-term amelioration of clinical evaluation indices was found in ankylosing spondylitis. A significant improvement of cutaneous lesions, arthritis activity, and patient’s functional ability was observed in psoriatic arthritis. MBT was usually well tolerated and adverse side effects were rarely reported. The review of the RCT suggests that MBT may exert additional beneficial effects in patients with seronegative spondyloarthritis treated with pharmacological therapy.
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Altan L, Bingol U, Aslan M, Yurtkuran M (2006) The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 35:283–289
Bağdatlı AO, Donmez A, Eröksüz R, Bahadır G, Turan M, Erdoğan N (2015) Does addition of ‘mud-pack and hot pool treatment’ to patient education make a difference in fibromyalgia patients? A randomized controlled single blind study. Int J Biometeorol 59:1905–1911
Bellometti S, Poletto M, Gregotti C, Richelmi P, Bertè F (2000) Mud bath therapy influences nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients. Int J Clin Pharmacol Res 20:69–80
Berczi I, Chalmers IM, Nagy E, Warrington RJ (1996) The immune effects of neuropeptides. Baillieres Clin Rheumatol 10:227–257
Britschka ZMN, Teodoro WR, Velosa APP, de Mello SBV (2007) The effect of Brazilian black mud treatment in chronic experimental arthritis. Rheumatol Int 28:39–45
Cima L, Giusti P, Tinello A, Cozzi F, Menozzi L, Todesco S (1992) Risposte neuroendocrine all'applicazione di fanghi di diversa maturazione del Bacino Termale Euganeo. Clin Term 45:77–81
Ciprian L, Lo Nigro A, Rizzo M, Gava A, Ramonda R, Punzi L, Cozzi F (2013) The effects of Spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 33:241–245
Cozzi F, Punzi L (2006) Il trattamento con la fango-balneoterapia delle artriti croniche. Reumatismo 58:123–126
Cozzi F, Todesco S (1992) Il Termalismo Euganeo verso il suo quarto millennio. Clin Ter 45:3–7
Cozzi F, Lazzarin P, Todesco S, Cima L (1995) Hypothalamic-pituitary-adrenal axis dysregulation in healthy subjects undergoing mud-bath applications. Arthritis Rheum 38:724–725
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 22:763–766
Cozzi F, Podswiadek M, Cardinale G, Oliviero F, Dani L, Sfriso P, Punzi L (2007) Mud-bath treatment in spondylitis associated with inflammatory bowel disease – a pilot randomised clinical trial. Joint Bone Spine 74:436–439
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
Dönmez A, Karagülle MZ, Tercan N, Dinler M, Işsever H, Karagülle M, Turan M (2005) Spa therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int 26:168–172
Elkayam O, Ophir J, Brener S, Paran D, Wigler I, Efron D, Even-Paz Y, Politi Y, Yaron M (2000) Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis. Rheumatol Int 19:77–82
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
Fioravanti A, Perpignano G, Tirri G, Cardinale G, Gianniti C, Lanza CE, Loi A, Tirri E, Sfriso P, Cozzi F (2007) Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial. Rheumatol Int 27:1157–1161
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
Fioravanti A, Tenti S, Giannitti C, Fortunati NA, Galeazzi M (2014) Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial. Int J Biometeorol 58:79–86
Fioravanti A, Bacaro G, Giannitti C, Tenti S, Cheleschi S, Gui Delli GM, Pascarelli NA, Galeazzi M (2015) 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
Fioravanti A, Manica P, Bortolotti R, Cevenini G, Tenti S, Paolazzi G (2018) Is balneotherapy effective for fibromyalgia? Results from a 6-month double-blind randomized clinical trial. Clin Rheumatol 37:2203–2212
Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL (2010) Spa therapy in the treatment of knee osteoarthritis: a large randomized multicentre trial. Ann Rheum Dis 69:660–665
Forestier R, Erol-Forestier FB, Francon A (2016) Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med 59:216–226
Forestier R, Erol-Forestier FB, Francon A (2017) Current role for spa therapy in rheumatology. Joint Bone Spine 84:9–13
Galzigna L, Moretto C, Lalli A (1996) Physical and biochemical changes of thermal mud after maturation. Biomed Pharmacother 50:306–308
Giusti P, Cima L, Tinello A, Cozzi F, Targa L, Lazzarin P, Todesco S (1990) Stresshormone, freigesetzt durch Fangotherapie. ACTH- und Beta-Endorphin-Konzentrationen unter Wärmestress. Fortschr Med 108:601–604
Holden W, Orchard T, Wordsworth P (2003) Enteropathic arthritis. Rheum Dis Clin N Am 29:513–530
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
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
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 22:363–388
Ozkurt S, Dönmez A, Zeki Karagülle M, Uzunoğlu E, Turan M, Erdoğan N (2011) Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study. Rheumatol Int 32:1949–1954
Schmitt SK (2017) Reactive arthritis. Infect Dis Clin N Am 31:265–277
Sieper J, Poddubnyy D (2017) Axial spondyloarthritis. Lancet 390:73–84
Sukenik S, Giryes H, Halevy S, Neumann L, Flusser D, Buskila D (1994) Treatment of psoriatic arthritis at the Dead Sea. J Rheumatol 21:1305–1309
Thiéfin G, Beaugerie L (2005) Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum. Joint Bone Spine 72:286–294
Tucker LJ, Coates LC, Helliwell PS (2019) Assessing disease activity in psoriatic arthritis: a literature review. Rheumatol Ther 6:23–32
van Tubergen A, Landewé R, van der Heijde D, Hidding A, Wolter N, Asscher M, Falkenbach A, Genth E, Thè HG, van der Linden S (2001) Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomised controlled trial. Arthritis Rheum 45:430–438
Yurtkuran M, Ay A, Karakoc Y (2005) Improvement of the clinical outcome in ankylosing spondylitis by balneotherapy. Joint Bone Spine 72:303–308
Zochling J, Smith E (2010) Seronegative spondyloarthritis. Best Pract Res Clin Rheumatol 24:747–756
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The authors declare that they have no conflict of interest.
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Cozzi, F., Galozzi, P., Ciprian, L. et al. Mud-bath treatment of seronegative spondyloarthritis: experience at the Euganean Thermal Area. Int J Biometeorol 64, 937–941 (2020). https://doi.org/10.1007/s00484-019-01761-7
- Mud-bath therapy
- Ankylosing spondylitis
- Enteropathic spondylitis
- Psoriatic arthritis