Balneotherapy in Rheumatologic Conditions

Dr. Deniz EVCİKKocatepe University,Dep. of PRM,Afyon-

TURKEY

Balneotherapy consists of the use of natural Balneotherapy consists of the use of natural thermal mineral water,The definitions of thermal mineral water,The definitions of these water is based on the sum of the these water is based on the sum of the cations ( Na,K..etc) and the anions (Cl, cations ( Na,K..etc) and the anions (Cl, SO4..etc) SO4..etc)

Afyon is a famous Afyon is a famous spa center spa center with its hot with its hot springs.In our center the natural spring water springs.In our center the natural spring water flows at a temperature of 36-60Cº.flows at a temperature of 36-60Cº.

BalneoBalneotherapy therapy is useful in is useful in preventionprevention and and treatment treatment of of all aspects of rheumatologic all aspects of rheumatologic conditions .conditions .

It is also an important part of It is also an important part of rehabilitation, used in the rehabilitation, used in the treatment oftreatment of impairments impairments and and disabilities.disabilities.

Musculoskeletal system Musculoskeletal system diseasesdiseases

Inflammatory arthritis (RA,AS,PsA…Inflammatory arthritis (RA,AS,PsA…etc)etc)

OsteoarthritisOsteoarthritis

Extraarticular soft tissue diseases Extraarticular soft tissue diseases (MPS,FMS)(MPS,FMS)

Mechanical neck and back painMechanical neck and back pain

OsteoporosisOsteoporosis

Rheumatologic conditionsRheumatologic conditions

Muscle relaxation and join reliefMuscle relaxation and join relief

JJoint mobilizationoint mobilization, increase ROM, , increase ROM,

SStrengthening musclestrengthening muscles

AAdvancement dvancement in in motor control, motor control,

Improve well-being, quality of lifeImprove well-being, quality of life

Aquatic exercises in Aquatic exercises in FibromyalgiaFibromyalgia

A A total of 53 patients diagnosed according to total of 53 patients diagnosed according to ACR criteriaACR criteriaThey divided into two groups.They divided into two groups.Group I (n=29) aquatic exercise program Group I (n=29) aquatic exercise program (swimming pool)(swimming pool)Group II (n=23) home-based exercise Group II (n=23) home-based exercise programprogram

Evcik D, Yigit İ, Pusak H , , Kavuncu V , Geçici ÖEvcik D, Yigit İ, Pusak H , , Kavuncu V , Geçici Ö

Grup I received pool based exercise program, Grup I received pool based exercise program,

Grup II received an home-based exercise Grup II received an home-based exercise programprogram

It consist of 10 min warming and 30 minutes It consist of 10 min warming and 30 minutes aquatik program.aquatik program.

Home exercises included warming, stretching, Home exercises included warming, stretching, strengthening ostrengthening o

Program three times a week, during five weeks.Program three times a week, during five weeks.

Assessment parametersAssessment parameters

Pain (VAS)Pain (VAS)

Number of tender pointsNumber of tender points

Beck depression scale (BDS)Beck depression scale (BDS)

Functional capacity (FİQ)Functional capacity (FİQ)

Assessments were done before and after 1,3 Assessments were done before and after 1,3 and 6 months of the therapy. and 6 months of the therapy.

ResultsResults

The mean age of group I was 43,8 and The mean age of group I was 43,8 and group II was 42.8 years.group II was 42.8 years.

There was an improvement in VAS, There was an improvement in VAS, BDS, FIQ and NTP in group I (p<0.05)BDS, FIQ and NTP in group I (p<0.05)

In group II we observed an In group II we observed an improvement in BDS,NTP and FIQ improvement in BDS,NTP and FIQ (p<0.05) except VAS.(p<0.05) except VAS.

Effectiveness of Balneotherapy on Effectiveness of Balneotherapy on MMP-3, NO, TIMP-1 in knee OA MMP-3, NO, TIMP-1 in knee OA

A total of 22 (2M/20F) patients A total of 22 (2M/20F) patients

Balneotherapy were applied 20 minutes Balneotherapy were applied 20 minutes once a day and five times per week, totally 10 once a day and five times per week, totally 10 session.session.

MMP-3, TIMP-1 and NO were measured four MMP-3, TIMP-1 and NO were measured four times ( before therapy, 5th day, at the end times ( before therapy, 5th day, at the end and after one week of the therapy ) and after one week of the therapy )

Evcik D,Serteser M,Kavuncu V,Türel A Evcik D,Serteser M,Kavuncu V,Türel A

Clinical parametersClinical parameters

Pain Pain

Visuel Analogue Scale, Visuel Analogue Scale, WOMAC pain scale, WOMAC pain scale,

Functional capacity Functional capacity

WOMAC functional capacity WOMAC functional capacity indexindex

Assessment were done Assessment were done before and after therapybefore and after therapy

No statistically significant differences in No statistically significant differences in MMP-3 ,TIMP-1 and NO values between the MMP-3 ,TIMP-1 and NO values between the measurements (p>0.05)measurements (p>0.05)

After therapy, pain (p<0.05) and functional After therapy, pain (p<0.05) and functional capacity were statistically improved (p<0.001)capacity were statistically improved (p<0.001)

There was a correlation between TIMP-1 and There was a correlation between TIMP-1 and WOMAC pain (r = 45) and WOMAC WOMAC pain (r = 45) and WOMAC functional index (r = 46) (p<0.05). functional index (r = 46) (p<0.05).

The efficacy of Balneotherapy and The efficacy of Balneotherapy and mud-pack therapy in patients with mud-pack therapy in patients with

knee OA,knee OA,

Eighty patients with knee OA Eighty patients with knee OA

They randomised in to three groups. They randomised in to three groups.

Group I (n=25) received balneotherapy, Group I (n=25) received balneotherapy,

They had bathing in mineral water They had bathing in mineral water pools at 36 Cºpools at 36 Cº

Evcik D,Kavuncu V,Yeter A,Yiğit İ. Evcik D,Kavuncu V,Yeter A,Yiğit İ.

Group II (n=29) received mud-pack therapy Group II (n=29) received mud-pack therapy Group III (n=26) had hot-pack application Group III (n=26) had hot-pack application Mud-packs and hot-packs were heated to Mud-packs and hot-packs were heated to 42 Cº and applied over knees for 20 42 Cº and applied over knees for 20 minutesminutes Therapy once a day and five times per week Therapy once a day and five times per week (10 session)(10 session)

Assessment parametersAssessment parameters

Pain , (VAS,WOMAC) (0-4 likert scale)Pain , (VAS,WOMAC) (0-4 likert scale)

Functional capacity (WOMAC functional and Functional capacity (WOMAC functional and WOMAC global index) WOMAC global index)

Quality of life (Nottingham Health Pofile) Quality of life (Nottingham Health Pofile) self-administered questionnaireself-administered questionnaire

Physician’s global Physician’s global assessment (VAS)assessment (VAS)

Maximum distance that Maximum distance that patient can walk without patient can walk without pain pain

Assessment was before and Assessment was before and after three months.after three months.

ResultsResults

IImprovement in VAS and WOMAC pain mprovement in VAS and WOMAC pain scores in group I (p<0. 001), group II and III scores in group I (p<0. 001), group II and III (p<0. 05). (p<0. 05).

The WOMACThe WOMAC functional and global index functional and global index improved improved in group I, group II and hot-pack in group I, group II and hot-pack group (p<0. 05). group (p<0. 05).

Quality of lifeQuality of life were significantly improved in were significantly improved in balneotherapy and mud-pack therapy groups balneotherapy and mud-pack therapy groups (p<0. 05).(p<0. 05). No difference in hot-pack therapy.No difference in hot-pack therapy.

The maximum distance was improved both in The maximum distance was improved both in group I and II (p<0. 05) but not in group III. group I and II (p<0. 05) but not in group III.

PPhysician’s global assessment was found to hysician’s global assessment was found to be improved in all groups (p<0. 05). be improved in all groups (p<0. 05).

Effects on immune system?Effects on immune system?

Effects on articular cartilage Effects on articular cartilage degradation?degradation?

( protection? )( protection? )

Effects on inflammatory Effects on inflammatory parameters?parameters?

Is it cost effective?Is it cost effective?

ConclusionConclusion

Finally Balneotherapy has positive effects Finally Balneotherapy has positive effects on rheumatologic diseases. on rheumatologic diseases.

In order to be in scientific evidence, more In order to be in scientific evidence, more trials are needed with a good methodologic trials are needed with a good methodologic quality (plasebo controlled, double blind).quality (plasebo controlled, double blind).

These researches should include not only These researches should include not only BT but also with other therapies BT but also with other therapies (peloidotherapy, (peloidotherapy, thalassotherapy,hydrotherapy)thalassotherapy,hydrotherapy)

Balneotherapy should be considered as a Balneotherapy should be considered as a part of aquatik rehabilitation.part of aquatik rehabilitation.

Rather than a single therapy, combined Rather than a single therapy, combined therapy including physical therapy therapy including physical therapy modalities, rehabilitation techniques (such modalities, rehabilitation techniques (such as exercises) should be prefered in as exercises) should be prefered in rheumatologic diseases. rheumatologic diseases.

Thank youThank you