Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there?

Abstract

Spa therapy represents a popular treatment for many rheumatic diseases. The mechanisms by which immersion in mineral or thermal water or the application of mud alleviates suffering in rheumatic diseases are not fully understood. The net benefit is probably the result of a combination of factors, with mechanical, thermal and chemical effects among the most prominent ones. Buoyancy, immersion, resistance and temperature all play important roles. According to the gate theory, pain relief may be due to the pressure and temperature of the water on skin; hot stimuli may influence muscle tone and pain intensity, helping to reduce muscle spasm and to increase the pain threshold. Mud-bath therapy increases plasma β-endorphin levels and secretion of corticotrophin, cortisol, growth hormone and prolactin. It has recently been demonstrated that thermal mud-pack therapy induces a reduction in the circulating levels of prostaglandin E2 (PGE2), leukotriene B4 (LTB4), interleukin-1β (IL-1β) and tumour necrosis factor-α (TNF-α), important mediators of inflammation and pain. Spa therapy has been found to cause an increase in insulin-like growth factor-1 (IGF1), which stimulates cartilage metabolism, and transforming growth factor-β (TGF-β). There is also evidence of the positive action of mud-packs and thermal baths on the oxidant/antioxidant system, with a reduction in the release of reactive oxygen (ROS) and nitrogen (RNS) species. Overall, thermal stress has an immunosuppressive effect. Many other non-specific factors may also contribute to the beneficial effects observed after spa therapy in some rheumatic diseases, including effects on cardiovascular risk factors, and changes in the environment, pleasant surroundings and the absence of work duties.

Can Thermal Water Be an Alternative Treatment Method for Wound Healing?

“…The healing and disappear of ulcer can also show healing of wound (Fioravanti et al, 2011, El-Anwar et al, 2016. Although there was no statistically significant difference between groups in terms of ulcers in our findings, it appears that the ulcer has disappeared in the study group and in control group larger ulcers were numerically and proportionally more .…”

“…However, in order to meet the needs of many unknowns; studies on the availability of water, plant, hot spring and similar paramedical solutions besides medical treatment have been carried out as well as in the past. Especially, the efficiency of CO2 gas in hot springs has been investigated (Irie et al, 2005, Fabry R et al, 2013, Fioravanti et al, 2011. Irie and colleagues have argued that topical CO2 bath in rats increases angiogenesis and CO2 enriched-water bath therapy may exhibit angiogenic therapy associated with neovascularization, such as transplantation of bone marrow mononuclear cells and VEGF gene therapy (Irie et al, 2005).…”

“…The physiological and teratogenic effects of thermal CO2 therapy are used in central and eastern Europe (Fabry et al, 1995) and are used as adjunctive therapy in the treatment of many diseases.It is stated that therapies made with hot spring water are beneficial in Hypertension, vascular occlusion, various arterial blood flow disorders, microcirculatory disorders, delayed wound healing and certain cardiac diseases (Fabry et al, 1995 andSato et al, 2009). Thermal waters may be beneficial with mineral contents (Dandinoğlu et al, 2016), have effects on oxidant -antioxidant systems and may be immunosuppressive (Fioravanti et al, 2011). The water temperature and the CO2 gas in the skin increased vasodilatation and new vessel formation and increased the blood circulation and tissue perfusion in the areas where CO2 gas was applied (Irie et al, 2005).…”

The Balneotherapy Links With Seafarers Health in Randomized Clinical Trial

“…During the last decades a lot of attention was paid to the exploration of balneotherapy impact mechanisms, developed theoretical formulas and models the flow of minerals through the skin, carrying trials in vitro and in vivo for materials acsess roads and metabolism to determine their safety and efficacy (14)(15)(16). The combined effects of balneotherapy results in a beneficial impact which has been observed in rheumatic diseases, depression, psoriasis, chronic/allergic rhinosinusitis, blood pressure, chronic obstructive pulmonary disease (17).…”

Historia del descubrimiento y aprovechamiento de las fuentes termales en Costa Rica

“…La OMS es el organismo dependiente de la Organización de la Naciones Unidas que tiene a su cargo el estudio epidemiológico, planificaciones sanitarias y evaluaciones terapéuticas de grandes núcleos de población en todo el mundo, en especial de los países en desarrollo. El consejo ejecutivo de la OMS ha decidido establecer relaciones oficiales con la Federación y ha admitido oficialmente el tratamiento hidrotermomineral válido como tal y coadyuvante de múltiples afecciones (Rodríguez, 2000;Bender et al, 2005;Fernández-González et al, 2010Gutenbrunner et al, 2010;Oláh et al, 2010;Fioravanti et al, 2011, entre muchos otros).…”