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Balneotherapy in Rheumatologic Conditions

Balneotherapy in Rheumatologic Conditions. Dr. Deniz EVCİK Kocatepe University,Dep. of PRM,Afyon-TURKEY. Balneotherapy consists of the use of natural thermal mineral water,The definitions of these water is based on the sum of the cations ( Na,K..etc) and the anions (Cl, SO4..etc)

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Balneotherapy in Rheumatologic Conditions

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  1. Balneotherapy in Rheumatologic Conditions Dr. Deniz EVCİK Kocatepe University,Dep. of PRM,Afyon-TURKEY

  2. Balneotherapy consists of the use of natural thermal mineral water,The definitions of these water is based on the sum of the cations ( Na,K..etc) and the anions (Cl, SO4..etc) • Afyon is a famous spa center with its hot springs.In our center the natural spring water flows at a temperature of 36-60Cº.

  3. Balneotherapy is useful in prevention and treatment of all aspects of rheumatologic conditions . • It is also an important part of rehabilitation, used in the treatment of impairments and disabilities.

  4. Musculoskeletal system diseases • Inflammatory arthritis (RA,AS,PsA…etc) • Osteoarthritis • Extraarticular soft tissue diseases (MPS,FMS) • Mechanical neck and back pain • Osteoporosis

  5. Rheumatologic conditions • Muscle relaxation and join relief • Joint mobilization, increase ROM, • Strengthening muscles • Advancement in motor control, • Improve well-being, quality of life

  6. Aquatic exercises in Fibromyalgia • A total of 53 patients diagnosed according to ACR criteria • They divided into two groups. • Group I (n=29) aquatic exercise program (swimming pool) • Group II (n=23) home-based exercise program Evcik D, Yigit İ, Pusak H , , Kavuncu V , Geçici Ö

  7. Grup I received pool based exercise program, • Grup II received an home-based exercise program • It consist of 10 min warming and 30 minutes aquatik program. • Home exercises included warming, stretching, strengthening o • Program three times a week, during five weeks.

  8. Assessment parameters • Pain (VAS) • Number of tender points • Beck depression scale (BDS) • Functional capacity (FİQ) • Assessments were done before and after 1,3 and 6 months of the therapy.

  9. Results • The mean age of group I was 43,8 and group II was 42.8 years. • There was an improvement in VAS, BDS, FIQ and NTP in group I (p<0.05) • In group II we observed an improvement in BDS,NTP and FIQ (p<0.05) except VAS.

  10. Effectiveness of Balneotherapy on MMP-3, NO, TIMP-1 in knee OA • A total of 22 (2M/20F) patients • Balneotherapy were applied 20 minutes once a day and five times per week, totally 10 session. • MMP-3, TIMP-1 and NO were measured four times ( before therapy, 5th day, at the end and after one week of the therapy ) Evcik D,Serteser M,Kavuncu V,Türel A

  11. Clinical parameters • Pain Visuel Analogue Scale, WOMAC pain scale, • Functional capacity WOMAC functional capacity index • Assessment were done before and after therapy

  12. No statistically significant differences in MMP-3 ,TIMP-1 and NO values between the measurements (p>0.05) • After therapy, pain (p<0.05) and functional capacity were statistically improved (p<0.001) • There was a correlation between TIMP-1 and WOMAC pain (r = 45) and WOMAC functional index (r = 46) (p<0.05).

  13. The efficacy of Balneotherapy and mud-pack therapy in patients with knee OA, • Eighty patients with knee OA • They randomised in to three groups. • Group I (n=25) received balneotherapy, • They had bathing in mineral water pools at 36 Cº Evcik D,Kavuncu V,Yeter A,Yiğit İ.

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

  15. Assessment parameters • Pain , (VAS,WOMAC) (0-4 likert scale) • Functional capacity (WOMAC functional and WOMAC global index) • Quality of life (Nottingham Health Pofile) self-administered questionnaire

  16. Physician’s global assessment (VAS) • Maximum distance that patient can walk without pain • Assessment was before and after three months.

  17. Results • Improvement in VAS and WOMAC pain scores in group I (p<0. 001), group II and III (p<0. 05). • The WOMACfunctional and global index improved in group I, group II and hot-pack group (p<0. 05).

  18. Quality of lifewere significantly improved in balneotherapy and mud-pack therapy groups (p<0. 05).No difference in hot-pack therapy. • The maximum distance was improved both in group I and II (p<0. 05) but not in group III. • Physician’s global assessment was found to be improved in all groups (p<0. 05).

  19. Effects on immune system? • Effects on articular cartilage degradation? ( protection? ) • Effects on inflammatory parameters? • Is it cost effective?

  20. Conclusion • Finally Balneotherapy has positive effects on rheumatologic diseases. • In order to be in scientific evidence, more trials are needed with a good methodologic quality (plasebo controlled, double blind). • These researches should include not only BT but also with other therapies (peloidotherapy, thalassotherapy,hydrotherapy)

  21. Balneotherapy should be considered as a part of aquatik rehabilitation. • Rather than a single therapy, combined therapy including physical therapy modalities, rehabilitation techniques (such as exercises) should be prefered in rheumatologic diseases.

  22. Thank you

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