Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial

Abstract

This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36-37 °C for 20 min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2 weeks) and 3 and 6 months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p = 0.010) and with a trend in favor of spa group in patient global assessment (p = 0.058), function (p = 0.092), and disease activity (p = 0.098) at 3 months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p = 0.006) and patient (p = 0.020) and physician global (p = 0.011) assessments, and a trend toward improvements in pain (p = 0.069) and swollen joints (p = 0.070) at 6 months. A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects may last for 6 months.

Investigation of Lake Hévíz Mineral Water Balneotherapy and Hévíz Mud Treatment in Murine Osteoarthritis and Rheumatoid Arthritis Models

“…Nowadays, several human in vivo studies demonstrated the efficacy of BT [ 1 – 3 , 9 , 48 , 49 ]. Randomized controlled clinical trials investigated OA of the knee [ 50 , 51 ], hip [ 52 ], or shoulder [ 53 ].…”

“…The effective substances of the Hévíz mud were described previously [ 4 – 6 ]. BT is widely used to amplify the effects of drug treatments and recommended for a broad spectrum of diseases, such as arthritis, dermatitis, and fibromyalgia [ 7 – 9 ]. The efficacy of BT for osteoarthritis has been approved by several randomized clinical trials but beneficial actions of this treatment are often manifested in subjective improvements of the pain sensation and the quality of life [ 1 , 10 ].…”

Alterations of voluntary behavior in the course of disease progress and pharmacotherapy in mice with collagen-induced arthritis

“…4b, Additional file 5: Figure S5B). This change in temperature-comfort relationship is reminiscent of the preference of human patients with RA for warm baths (36–37 °C), which relieve pain and provide a basis for conventional spa therapy [32, 33]. It is thus speculated that the increased preference for a warm temperature observed in the CIA mice in this study might reflect the subjective “feeling” of animals that a warmer temperature can reduce nociceptive sensation.…”

A New and Validated, Randomised, Controlled Placebo Water Development Trial for Medicinal Water-based Research

“…Most of the balneotherapeutic studies abroad have never used a placebo control (15,16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), despite the fact that this would be one of the most important steps in proving the beneficial effects of medicinal waters. In Hungarian studies, it is more common to use a placebo control (4,7,(38)(39)(40).…”