Skip to main content
Log in

Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial

  • Original Paper
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate both the short-term and the long-term effectiveness of spa therapy in patients with primary hand osteoarthritis (OA). This was a prospective randomized, single blind controlled trial. Sixty outpatients with primary bilateral hand OA were included in the study and randomized to one of two groups. One group (n = 30) was treated with 12 daily local mud packs and generalized thermal baths with a sulfate-calcium-magnesium-fluorides mineral water added to usual treatment. The control group (n = 30) continued regular outpatient care routine (exercise, NSAIDs and/or analgesics). Each patient was examined at baseline, after 2 weeks, and after 3, 6, 9 and 12 months. Primary outcome measures were global spontaneous hand pain on a visual analogue scale (VAS) and the functional index for hand osteoarthritis (FIHOA) score; secondary outcomes were health assessment questionnaire (HAQ), duration of morning stiffness, medical outcomes study 36-item short form (SF-36) and symptomatic drugs consumption. Our results demonstrated that the efficacy of spa therapy was significant in all the assessed parameters, both at the end of therapy and after 3 months; the values of FIHOA, HAQ and drugs consumption continued to be significantly better after 6 months in comparison with baseline. There were no significant modifications of the parameters throughout the follow-up in the control group. Differences between the two groups were significant for all parameters at the 15th day and at 3 months follow-up; regarding FIHOA, HAQ, and symptomatic drugs consumption, the difference between the two groups persisted and was significant at 6month follow-up. Tolerability of spa therapy seemed to be good. In conclusion, our results confirm that the beneficial effects of spa therapy in patients with hand OA last over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Altman RD (2010) Pharmacological therapies for osteoarthritis of the hand: a review of the evidence. Drugs Aging 27:729–745

    Article  Google Scholar 

  • Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Gray R et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610

    Article  CAS  Google Scholar 

  • Altman RD, Dreiser RL, Fisher CL, Chase WF, Dreher DS, Zacher J (2009) Diclofenac sodium gel in patients with primary hand osteoarthritis: a randomized, double-blind, placebo-controlled trial. J Rheumatol 36:1991–1999

    Article  Google Scholar 

  • Apolone G, Mosconi P (1998) The Italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036

    Article  CAS  Google Scholar 

  • Ardiç F, Őzgen M, Aybek H, Rota S, Cubukçu D, Gökgöz A (2007) Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int 27:441–446

    Article  Google Scholar 

  • Bellometti S, Galzigna L (1998) Serum levels of a prostaglandin and a leukotriene after termal mud pack therapy. J Investig Med 46:140–145

    CAS  Google Scholar 

  • Bellometti S, Galzigna L, Richelmi P, Gregotti C, Berté F (2002) Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Int J Tissue React 24:57–64

    CAS  Google Scholar 

  • Bellometti S, Richelmi P, Tassoni T, Bertè F (2005) Production of matrix metalloproteinases and their inhibitors in osteoarthritic patients undergoing mud bath therapy. Int J Clin Pharmacol Res 25:77–94

    CAS  Google Scholar 

  • Bellometti S, Cecchettin M, Galzigna L (1997) Mud-pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. Clin Chim Acta 268:101–106

    Article  CAS  Google Scholar 

  • 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

    Article  CAS  Google Scholar 

  • 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 terapies. Clin Biochem 43:973–978

    Article  CAS  Google Scholar 

  • Braga PC, Sambataro G, Dal Sasso M, Culici M, Alfieri M, Nappi G (2008) Antioxidant effect of sulphurous thermal water on human neutrophil bursts: chemiluminescence evaluation. Respiration 75:193–201

    Article  Google Scholar 

  • Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, Lines C, Riddell R, Morton D, Lanas A, Konstam MA, Baron JA, Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial investigators (2005) Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 352:1092–1102

    Article  CAS  Google Scholar 

  • Dahaghin S, Bierma-Zeinstra SM, Ginai AZ, Pols HA, Hazes JM, Koes BW (2005) Prevalence and pattern of radiographic hand osteoarthritis and associations with pain and disability (The Rotterdam study). Ann Rheum Dis 64:682–687

    Article  CAS  Google Scholar 

  • Dreiser RL, Maheu E, Guillou GB, Caspard H, Grouin JM (1995) Validation of an algofunctional index for osteoarthritis of the hand. Rev Rhum Engl Ed 62(6 Suppl 1):43S–53S

    CAS  Google Scholar 

  • Dreiser RL, Maheu E, Guillou GB (2000) Sensitivity to change of the functional index for hand osteoarthritis. Osteoarthr Cartil 8(Suppl A):S25–S28

    Article  Google Scholar 

  • Ekmekcioglu C, Strauss-Blasche G, Holzer F, Marktl W (2002) Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis. Forsch Komplementarmed Klass Naturheilkd 9:216–220

    Article  CAS  Google Scholar 

  • Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M (2010a) Short- and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil 89:125–132

    Article  Google Scholar 

  • Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M (2011) Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol 56:583–590

    Article  Google Scholar 

  • Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2010b) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31:1–8

    Article  Google Scholar 

  • Fioravanti A, Cantarini L, Bacarelli MR, de Lalla A, Ceccatelli L, Blardi P (2010c) Effects of Spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int 31:879–882

    Article  Google Scholar 

  • Forestier R, Desfour H, Tessier JM, Francon A, Foote AM, Genty C, Rolland C, Roques CF, Bosson JL (2010) Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 69:660–665

    Article  CAS  Google Scholar 

  • Fries JF, Spitz PW, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145

    Article  CAS  Google Scholar 

  • Gabay C, Medinger-Sadowski C, Gascon D, Kolo F, Finckh A (2011) Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center. Arthritis Rheum 63:3383–3391

    Article  CAS  Google Scholar 

  • Gandini F, Giannitti C, Fattore G, Giordano N, Galeazzi M, Fioravanti A (2012) Validation of an Italian version of the functional index for hand osteoarthritis (FIHOA). Mod Rheumatol 22:758–765

    Google Scholar 

  • Graber Duvernay B, Forestier R, Françon A (1997) Efficacy of the Berthollet technique at Aix les Bains spa on functional impairment in hand ostheoarthritis. A controlled therapeutic study. Rhumatologie 49:151–156

    Google Scholar 

  • Gutenbrunner C, Bender T, Cantista P, Karagulle Z (2010) A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol 54:495–507

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Huskisson EC, Berry H, Gishen P, Jubb RW, Whitehead J (1995) Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee. LINK Study Group. Longitudinal investigation of nonsteroidal antiinflammatory drugs in knee osteoarthritis. J Rheumatol 22:1941–1946

    CAS  Google Scholar 

  • Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C (2006) Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332:1302–1308

    Article  CAS  Google Scholar 

  • Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  Google Scholar 

  • Kovács C, Pecze M, Tihanyi A, 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

    Google Scholar 

  • Mahendira D, Towheed TE (2009) Systematic review of non-surgical therapies for osteoarthritis of the hand: an update. Osteoarthr Cartil 17:1263–1268

    Article  CAS  Google Scholar 

  • Nguyen M, Revel M, Dougados M (1997) Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomized controlled trial. Br J Rheumatol 36:77–81

    Article  CAS  Google Scholar 

  • Ofman JJ, MacLean CH, Straus WL, Morton SC, Berger ML, Roth EA, Shekelle P (2002) A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol 29:804–812

    CAS  Google Scholar 

  • Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM (1995) Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 38:1134–1141

    Article  CAS  Google Scholar 

  • Ranza R, Marchesoni A, Calori G, Bianchi G, Braga M, Canazza S, Canesi B, Fumagalli M, Mastaglio C, Mathieu A et al (1993) The Italian version of the functional disability index of the health assessment questionnaire. A reliable instrument for multicenter studies on rheumatoid arthritis. Clin Exp Rheumatol 11:123–128

    CAS  Google Scholar 

  • Shehata M, Schwarzmeier JD, Hilgarth M, Demirtas D, Richter D, Hubmann R, Boeck P, Leiner G, Falkenbach A (2006) Effect of combined spa-exercise therapy on circulating TGF-beta1 levels in patients with ankylosing spondylitis. Wien Klin Wochenschr 118:266–272

    Article  Google Scholar 

  • Shimodozono M, Matsumoto S, Ninomiya K, Miyata R, Ogata A, Etoh S, Watanabe S, Kawahira K (2012) Acute effects of a single warm-water bath on serum adiponectin and leptin levels in healthy men: a pilot study. Int J Biometeorol 56:933–939

    Article  Google Scholar 

  • Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  • Zhang Y, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369

    Article  Google Scholar 

  • Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT (2002) Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: the Framingham study. Am J Epidemiol 56:1021–1027

    Article  Google Scholar 

  • Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW et al (2007) EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:377–388

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonella Fioravanti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fioravanti, A., Tenti, S., Giannitti, C. et al. Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial. Int J Biometeorol 58, 79–86 (2014). https://doi.org/10.1007/s00484-012-0627-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-012-0627-6

Keywords

Navigation