The objective of the study was to evaluate short- and long-term therapeutic effectiveness of natural thermal mineral waters in patients with knee osteoarthritis (OA). We performed a systematic review of randomized controlled trials (RCTs) testing efficacy of thermal mineral water for treating patients with knee OA. Trials were identified by systematic searches of PubMed, Cochrane Central Register of Controlled trials, and Amed. We used the MeSH terms balneotherapy, balneology, and mineral water in combination with knee and osteoarthritis. Literature screening and data extraction were performed in duplicate. Nine RCTs satisfied the inclusion criteria, all published as full journal articles. Trial duration ranged from 10 to 24 weeks (median 15.33 +/- 5.56 weeks). The final sample included 493 patients who provided data at the ends of the studies. All interventions that were used in these trials found out an improvement in pain and functional capacity, which were sustained until week 24. No serious adverse events were reported to be associated with thermal mineral waters treatment. This work provide the most current and comprehensive review of the existing evidence of short- and long-term therapeutic effects of thermal mineral waters in knee OA. Additional RCTs with similar intervention comparisons and outcome measures, bigger sample size, and longer follow-up are required to confirm these results and to assess the biological effect of thermal mineral waters in patients with knee OA.

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IntroductionSubacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare.Case presentationWe present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms.ConclusionPhysicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.

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