Mud-bath treatment of seronegative spondyloarthritis: experience at the Euganean Thermal Area

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  1. Altan L, Bingol U, Aslan M, Yurtkuran M (2006) The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 35:283–289

    CAS  Article  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    CAS  Google Scholar 

  4. Berczi I, Chalmers IM, Nagy E, Warrington RJ (1996) The immune effects of neuropeptides. Baillieres Clin Rheumatol 10:227–257

    CAS  Article  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Google Scholar 

  7. 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

    Article  Google Scholar 

  8. Cozzi F, Punzi L (2006) Il trattamento con la fango-balneoterapia delle artriti croniche. Reumatismo 58:123–126

    Google Scholar 

  9. Cozzi F, Todesco S (1992) Il Termalismo Euganeo verso il suo quarto millennio. Clin Ter 45:3–7

    Google Scholar 

  10. 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

    CAS  Article  Google Scholar 

  11. 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

    CAS  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. 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

    CAS  Article  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. 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

    CAS  Article  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. 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

    CAS  Article  Google Scholar 

  23. Forestier R, Erol-Forestier FB, Francon A (2016) Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med 59:216–226

    Article  Google Scholar 

  24. Forestier R, Erol-Forestier FB, Francon A (2017) Current role for spa therapy in rheumatology. Joint Bone Spine 84:9–13

    Article  Google Scholar 

  25. Galzigna L, Moretto C, Lalli A (1996) Physical and biochemical changes of thermal mud after maturation. Biomed Pharmacother 50:306–308

    CAS  Article  Google Scholar 

  26. 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

    CAS  Google Scholar 

  27. Holden W, Orchard T, Wordsworth P (2003) Enteropathic arthritis. Rheum Dis Clin N Am 29:513–530

    Article  Google Scholar 

  28. 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

    Article  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    CAS  Article  Google Scholar 

  31. 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

    Article  Google Scholar 

  32. Schmitt SK (2017) Reactive arthritis. Infect Dis Clin N Am 31:265–277

    Article  Google Scholar 

  33. Sieper J, Poddubnyy D (2017) Axial spondyloarthritis. Lancet 390:73–84

    Article  Google Scholar 

  34. 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

    CAS  Google Scholar 

  35. Thiéfin G, Beaugerie L (2005) Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum. Joint Bone Spine 72:286–294

    Article  Google Scholar 

  36. Tucker LJ, Coates LC, Helliwell PS (2019) Assessing disease activity in psoriatic arthritis: a literature review. Rheumatol Ther 6:23–32

    Article  Google Scholar 

  37. 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

    Article  Google Scholar 

  38. Yurtkuran M, Ay A, Karakoc Y (2005) Improvement of the clinical outcome in ankylosing spondylitis by balneotherapy. Joint Bone Spine 72:303–308

    Article  Google Scholar 

  39. Zochling J, Smith E (2010) Seronegative spondyloarthritis. Best Pract Res Clin Rheumatol 24:747–756

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Franco Cozzi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Mud-bath therapy
  • Ankylosing spondylitis
  • Enteropathic spondylitis
  • Psoriatic arthritis