Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients

Abstract

The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome (FMS) and to determine if balneotherapy influences serum levels of inflammation markers, IL-1, PGE2 and LTB4. 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study. Their ages ranged between 33 and 55 years. FMS patients were randomly assigned in two groups as, group 1 (n = 12) and group 2 (n = 12). Group 1 received 20-min bathing, once in a day for five days per week. Patients participated in the study for 3 weeks (total of 15 sessions) in Denizli. Group 2 did not receive balneotherapy. FMS patients were evaluated by tenderness measurements (tender point count and algometry), Visual Analogue Scale, Beck's Depression Index, Fibromyalgia Impact Questionnaire. Ten healthy women recruited group three as the controls. Serum PGE2, LTB4 and IL1-alpha levels were measured in all three groups. The biochemical measurements and clinical assessments were performed before and at the end of general period of therapy. Statistically significant alterations in algometric score, Visual Analogue score, Beck's Depression Index and PGE2 levels (P < 0.001), numbers of tender points (P < 0.01) and Fibromyalgia Impact Questionnaire score (P < 0.05) were found after the balneotherapy between group 1 and 2. Mean PGE2 level of FMS patients were higher compared to healthy control group (P < 0.0001) and decreased after the treatment period, only in group 1 (P < 0.05). As in the group 2 and 3, detectable IL-1 and LTB4 measurements were insufficient, statistical analysis was performed, only in group 1. After balneotherapy IL-1 and LTB4 significantly decreased in group 1 (P < 0.05). In conclusion, balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms, and possibly influencing the inflammatory mediators.

Balneoterapijos Efektyvumas Ir Perspektyvos

“…Nustatytas poveikis hormonams (didėja prieširdžių natruretinio peptido, mažėja renino aktyvumas, mažėja aldosterono gamyba, mažėja anti-diuretinio hormono, didėja dopamino, keičiasi AKTH, kortizolio kiekiai, didėja ß-endorfino, augimo hormono, norepinefrino, prolaktino), lipidams (padidėja didelio tankio lipoproteinų), citokinams (TNF-α,IL-1α IL-1β,IL-6, IFN-γ , IL-2, IL-4, EGF, TGF-β1), prostaglandinams (PGE 2, LTB 4, PGF 2 α), ląstelių populiacijoms (Langerhanso, T-ir B-, CD4+, CD4-, CD8+, CD8 ląstelėms), C-reaktyviam baltymui, haptoglobulinui, medžiagai P, matrikso metaloproteazėms (MMP-1, MMP-2, mažėja MMP-3, didėja MMP-8, MMP-9), poveikis oksidacinei/antioksidacinei sistemai (sumažinama reaktyvaus deguonies (ROS) ir azoto (RNS) atmainų, katalazės, superoksido dismutazės, gliutationo peroksidazės aktyvumas, sumažėja glikolizuoto hemoglobino, β-2-mikroglobulino, azoto oksido, galimai stimuliuojama opioidų sekrecija, modifikuojami SERT (serotonimo transporteriai) receptoriai, gerėja afinitetas SERT. Nustatyta, kad spa terapija didina į insuliną panašaus augimo faktoriaus-1 (IGF1), kuris stimuliuoja kremzlės metabolizmą, ir transformuojančio augimo faktoriaus-β (TGF-β) kiekius [20][21][22][23][24][25][26][27]31]. Šių citokinų, chemokinų, uždegimo/ oksidacijos biomarkerių kaitos pasekoje pastebimas teigiamas poveikis reumatologinėms ligoms, depresijai, psoriazei, lėtiniam/alerginiam rinosinusitui, kraujospūdžiui, lėtinei obstrukcinei plaučių ligai ir kitiems susirgimams [3].…”

“…M. Vitale, remdamasis "PubMed" duomenimis, pastebėjo, kad daugiausia balneoterapijos poveikio tyrimų 2000-2013 metais skirta uždegi-mui ir odai, mažiausiai -nervų sistemai ir ląstelių apoptozei [3]. Naujausi gydymo balneologinėmis procedūromis tyrimai patvirtina statistiškai reikšmingą pagerėjimą sergant: a) ankilozuojančiu spondilitu [49,50]; b) fibromialgija [26,51]; c) osteoartritu [52][53][54][55][56]; d) reumatoidiniu artritu [24,25]; e) psoriaze [57,69]; f ) venų varikoze [58][59][60]; g) esant apatinės nugaros dalies skausmams [61][62][63]. Falagas ir kt.…”

New evidence on mechanisms of action of spa therapy in rheumatic diseases

“…Recent studies have shown a reduction of circulating levels of Prostaglandin E2 (PGE2) and Leukotriene B4 (LTB4), important mediators of inflammation and pain, in patients suffering from OA or fibromyalgia who undergo mud-packs or balneotherapy (Ardiç et al, 2007;Bellometti and Galzigna, 1998) (Table 1).…”

Fibromyalgia Syndrome and Spa Therapy

“…Ardiç et al (Ardiç et al, 2007) investigated the clinical effects of balneotherapy in the treatment of FS, considering serum levels of certain inflammatory markers. One group of patients (n22) bathed 20 min per day for five days per week for three consecutive weeks and the other group (n22) (control) continued with pharmacological treatment.…”