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Balneo-Spa Therapy in The Management of Rheumatoid Arthritis

Balneo-Spa Therapy in The Management of Rheumatoid Arthritis. Mine Karagülle,MD Istanbul University Istanbul Medical Faculty Medical Ecology and Hydroclimatology Department. Rheumatoid Arthritis (ACR 2002).

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Balneo-Spa Therapy in The Management of Rheumatoid Arthritis

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  1. Balneo-Spa Therapy in The Management of Rheumatoid Arthritis Mine Karagülle,MD Istanbul University Istanbul Medical Faculty Medical Ecology and Hydroclimatology Department

  2. Rheumatoid Arthritis (ACR 2002) • Rheumatoid arthritis(RA) is an autoimmune disorder of unknown characterized by symmetric erosive synovitis and in some cases, extraarticular involvement • RA affects 1% of the adult population

  3. Rheumatoid Arthritis (ACR 2002) • Most patients experience a chronic fluctuating course of disease that , despite therapy , may result in progresive joint destruction, deformity, disability, and even premature death. • RA results in more than 9 million physician visits and more than 250,000 hospitalizations per year in USA. • Disability from RA causes major economic loss and can have a profound impact on families

  4. Goals Prevent or control joint damage Preventloss of function Decrease pain Management Patient education Start DMARD(s) Consider NSAID Consider local or Low dose systemic dteroids PhysicalTherapy/ occupational therapy Management of RA (ACR 2002)

  5. Balneotherapy • Is a therapeutic and/or rehabilitative option in the management of rheumatoid arthritis? • Is balneotherapy an effective tool in the achievement of ultimate goals in managing RA? • Is balneotherapy effective in preventing joint demage, preventing loss of function and decreasing pain in RA?

  6. Balneotherapy • Balneotherapy and spa therapy for patients with arthritis is one of the oldest forms of therapy.

  7. Balneotherapy • One of the aims of balneotherapy is to soothe the pain, improve joint motion and as a consequence to relieve people suffering and make them well.

  8. Balneotherapy • Balneotherapy is the main component of Spa Therapy

  9. Spa Therapy Mud therapy Massage Hydrotherapy Balneotherapy Social& Physicological influences Climatic factors Climatherapy Exercise

  10. Studies on Balneotherapy for RA

  11. Studies on Balneo-Spa therapy for RA in Turkey

  12. Evidence Based Medicine Aproach

  13. Evidence Based Medicine Aproach

  14. “This review has shown the positive effects of balneotherapy on important outcomes for patients with RA. The reviewers concluded that balneotherapy can be used as an adjunct therapy. However, these conclusions are undermined by the poor methodological quality of the trials available and the potential harmful side effects for arthritic patients with associated medical conditions.”

  15. Verhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW. Balneotherapy for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. • What is the bottom line?There is "silver" level evidence that balneotherapy or bathing in warm water may improve symptoms of rheumatoid arthritis. But most studies are of poor quality and therefore it cannot be concluded that balneotherapy works. It is also not clear if the effect of balneotherapy depends on water temperature and the addition of minerals to the water.

  16. Implications for researchVerhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW. Balneotherapy for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. • Large, high quality research is needed, focusing on appropriate allocation concealment, blinding and an adequate data presentation and analysis. The design and reporting of future trials should be conforming the CONSORT-statement.

  17. Implications for researchVerhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW. Balneotherapy for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. • New research should use outcome measures relevant to the patients, and adequate and responsive to the treatment under study. Follow-up should be of sufficient length to assess long-term effects. • New research should provide full data on outcome measures, including the mean and standard deviation or 95% confidence interval.

  18. Implications for researchVerhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW. Balneotherapy for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. • Future research should examine the effect of balneotherapy not only in pragmatic trials comparing various interventions with each other, but also in more explanatory trials comparing the intervention with a no treatment control group. When possible, the beneficial effect of the 'spa-environment' should be considered as a confounder or effect modifier and accounted for in the design of the trial.

  19. Implications for researchVerhagen AP, Bierma-Zeinstra SMA, Cardoso JR, de Bie RA, Boers M, de Vet HCW. Balneotherapy for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. • We conclude that performing randomised studies with high methodological quality concerning the effectiveness of balneotherapy is both possible and necessary to provide strong evidence on the effects of balneotherapy.

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