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A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis

A 24-week randomised, controlled pilot study

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Abstract

The objective of this study was to test if spa therapy can play a role in the management of severe knee osteoarthritis (OA). Twenty patients with radiologically and clinically severe knee OA were randomly assigned into spa and drug therapy groups. Spa group (n = 10) traveled to a spa town and stayed at a hotel for a 10-day spa therapy course. They followed a balneotherapy regimen including thermal pool baths at 37°C for 20 min two times daily. Drug therapy group (n = 10) stayed at home and followed their individually prescribed drug therapy (NSAIDs and paracetamol). Patients were assessed at baseline (week 0), after spa therapy at 2 weeks (week 2) and during follow-up period at 12 (week 12) and 24 (week 24) weeks by a blinded investigator. Patients assessed with Lequesne algofunctional index (LAFI), pain (visual analogue scale, VAS), patient’s and investigator’s global evaluation (VAS), ten-stairs stepping up and down time, 15 m walking time and three times squatting up and down time. Significant improvement in pain and LAFI scores were found at week 2, week 12 and week 24 in the spa therapy group compared to baseline. Comparing the two group differences, spa therapy was superior to drug therapy in pain reduction and in physician’s global assessment at all time points. This superiority was also found in LAFI scores and patients’ global assessments at week 12 and week 24. A 10-day course of spa therapy may be beneficial in short- and medium-term up to 24 weeks by reducing pain and improving functional status and overall well-being in patients with severe knee OA and may be considered as an effective therapeutic tool for such patients in countries like Turkey where it is widely available and (at least partly) reimbursed.

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References

  1. Lonner JH (2003) A 57-year-old man with osteoarthritis of the knee. JAMA 289:1016–1025

    Article  PubMed  Google Scholar 

  2. Peat G, McCarney R, Croft P (2001) Knee pain and osteoarthritis in older adults: a review of community burden and current use of health care. Ann Rheum Dis 60:91–97

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Murray CJL, Lopez AD (1997) The global burden of disease. World Health Organization, Geneva

    Google Scholar 

  4. Roddy E, Doherty M (2003) Guidelines for management of osteoarthritis published by the American College of Rheumatology and the European League Against Rheumatism: why are they so different? Rheum Dis Clin North Am 29:717–731

    Article  PubMed  Google Scholar 

  5. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al (2003) EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62:1145–1155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Karagülle MZ, Tütüncü ZN, Özer N (1995) Die traditionellen und empirischen Kurortbehandlungsverfahren in der Türkei. Phys Rehab Kur Med 5:106–108

    Article  Google Scholar 

  7. Karagülle MZ (2003) Balneotherapie und Kurorttherapie rheumatischer Erkrankungen in der Türkei. In: Karagülle MZ, Gutenbrunner C, Karagülle O (eds) Balneologie, Medizinische Klimatologie bei rheumatischen Erkrankungen. ISMH Verlag, Törpin, pp 7–27

    Google Scholar 

  8. Karagülle MZ, Karagülle M (2004) Balneotherapy and spa therapy of rheumatic diseases in Turkey: a systematic review. Forsch Komplementärmed Klass Naturheilkd 11:33–41

    PubMed  Google Scholar 

  9. Karagülle MZ (ed) (2002) Balneoloji ve Kaplıca Tıbbı, (Balneology and Health Resort Medicine). Nobel Tıp Kitabevi, Istanbul (Turkish)

    Google Scholar 

  10. Bender T, Karagülle MZ, Balint GP, Gutenbrunner C, Balint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224

    Article  PubMed  Google Scholar 

  11. Lange U, Muller-Ladner U, Schmidt KL (2006) Balneotherapy in rheumatic diseases—an overview of novel and known aspects. Rheumatol Int 26:497–499

    Article  CAS  PubMed  Google Scholar 

  12. Nasermoaddeli A, Kagamimori S (2005) Balneotherapy in medicine: a review. Environ Health Prev Med 10:171–179

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kamioka H, Nakamura Y, Yazaki T, Uebaba K, Mutoh Y, Okada S, Takahashi M (2006) Comprehensive health education combining hot spa bathing and lifestyle education in middle-aged and elderly women: one-year follow-up on randomized controlled trial of three- and six-month interventions. J Epidemiol 16:35–44

    Article  PubMed  Google Scholar 

  14. Sekine M, Nasermoaddeli A, Wang H, Kanayama H, Kagamimori S (2006) Spa resort use and health-related quality of life, sleep, sickness absence and hospital admission: the Japanese civil servants study. Complement Ther Med 14:133–143

    Article  PubMed  Google Scholar 

  15. Sukenik S (1996) Balneotherapy for rheumatic diseases at the Dead Sea area. Isr J Med Sci 32 Suppl:S16–S19

    CAS  PubMed  Google Scholar 

  16. Sukenik S, Flusser D, Abu-Shakra M (1999) The role of spa therapy in various rheumatic diseases. Rheum Dis Clin North Am 25:883–897

    Article  CAS  PubMed  Google Scholar 

  17. Moses SW, David M, Goldhammer E, Tal A, Sukenik S (2006) The Dead Sea, a unique natural health resort. Isr Med Assoc J 8:483–488

    PubMed  Google Scholar 

  18. van Tubergen A, Landewe R, van der Heijde D, Hidding A, Wolter N, Asscher M, Falkenbach A, Genth E, The HG, van der Linden S (2001) Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 45(5):430–438 (Oct)

    Article  PubMed  Google Scholar 

  19. Codish S, Dobrovinsky S, Abu Shakra M, Flusser D, Sukenik S (2005) Spa therapy for ankylosing spondylitis at the Dead Sea. Isr Med Assoc J 7(7):443–446 (Jul)

    PubMed  Google Scholar 

  20. Yurtkuran M, Ay A, Karakoc Y (2005) Improvement of the clinical outcome in ankylosing spondylitis by balneotherapy. Jt Bone Spine 72(4):303–308 (Jul)

    Article  Google Scholar 

  21. Altan L, Bingol U, Aslan M, Yurtkuran M (2006) The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 35(4):283–289 (Jul–Aug)

    Article  CAS  PubMed  Google Scholar 

  22. Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, de Bie RA, Boers M, de Vet HC (2003) Balneotherapy for rheumatoid arthritis. Cochrane Database Syst Rev (4):CD000518

    Google Scholar 

  23. Franke A, Reiner L, Pratzel HG, Franke T, Resch KL (2000) Long-term efficacy of radon spa therapy in rheumatoid arthritis—a randomized, sham-controlled study and follow-up. Rheumatology (Oxford) 39:894–902

    Article  CAS  Google Scholar 

  24. Dönmez A, Karagülle MZ, Tercan N, Dinler M, Işsever H, Karagülle M, Turan M (2005) SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int 26:168–172

    Article  PubMed  Google Scholar 

  25. Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E, Zakraoui L, Rasker JJ (2005) Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatology 44:539–546

    Article  CAS  PubMed  Google Scholar 

  26. Balogh Z, Ordogh J, Gasz A, Nemet L, Bender T (2005) Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd 12:196–201

    PubMed  Google Scholar 

  27. Pittler MH, Karagülle MZ, Karagülle M, Ernst E (2006) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology 45:880–884

    Article  CAS  PubMed  Google Scholar 

  28. Verhagen AP, de Vet HCM, de Bie RA, Kessels AGH, Boers M, Knipschild PG (2000) Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database Syst Rev (2):CD000518

    Google Scholar 

  29. Brosseau L, Macleay L, Robinson V, Casimiro L, Pelland L, Wells G, Tugwell P, Mcgowan J (2002) Efficacy of balneotherapy for osteoarthritis of the knee: a systematic review. Phys Ther Rev 7:209–222

    Article  Google Scholar 

  30. Dönmez A, Karagülle Z, Turan M (1995) Balneotherapie mit Akratoterme bei Gonartrose. Zeitschrift Naturamed 7:20–23

    Google Scholar 

  31. Odabaşı E, Karagulle MZ, Karagulle M, Turan M, Karagülle O (2002) Comparison of two traditional spa therapy regimens in patients with knee osteoarthritis. Phys Rehab Kur Med 12:337–341

    Article  Google Scholar 

  32. Altman RD, Blach DA, Bole GG, Brandt KD, Cooke DV, Greenwald RA (1999) Development of criteria for osteoarthritis. J Rheumatol 26:1959–1963

    Google Scholar 

  33. Kellgren JS, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lequesne MG (1997) The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 24:779–781

    CAS  PubMed  Google Scholar 

  35. The World Medical Association (1964) Declaration of Helsinki. BMJ 313:1448–1449 (1996)

    Google Scholar 

  36. İyi Klinik Uygulamalar Kılavuzu (Good Clinical Practice Guide) Sağlık Bakanlığı, İlaç ve Eczacılık Genel Müdürlüðü, no. 51748, 29 December 1995 (in Turkish)

  37. Lequesne MG, Maheu E (2003) Clinical and radiological evaluation of hip, knee and hand osteoarthritis. Aging Clin Exp Res 15:380–390

    Article  PubMed  Google Scholar 

  38. Brandt KD (2004) Non-surgical treatment of osteoarthritis: a half century of “advances”. Ann Rheum Dis 63:117–122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Szucs L, Ratko I, Lesko T, Szoor I, Genti G, Balint G (1989) Double-blind trial on the effectiveness of the Puspokladany thermal water on arthrosis of the knee-joints. J R Soc Health 109:7–9

    Article  CAS  PubMed  Google Scholar 

  40. Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R, Fishel B, Yaron M (1991) Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 18:1799–1803

    CAS  PubMed  Google Scholar 

  41. Forestier R (2000) Magnitude and duration of the effects of two spa therapy courses on knee and hip osteoarthritis: an open prospective study in 51 consecutive patients. Jt Bone Spine 67:296–304

    CAS  Google Scholar 

  42. Guillemin F, Virion JM, Escudier P, Talancé N, Weryha G (2001) Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Jt Bone Spine 68:499–503

    Article  CAS  Google Scholar 

  43. Wigler I, Elkayam O, Paran D, Yaron M (1995) Spa therapy for gonarthrosis: a prospective study. Rheumatol Int 15:65–68

    Article  CAS  PubMed  Google Scholar 

  44. Sukenik S, Flusser D, Codish S, Abu-Shakra M (1999) Balneotherapy at the Dead Sea area for knee osteoarthritis. Isr Med Assoc J 1:83–85

    CAS  PubMed  Google Scholar 

  45. Nguyen M, Revel M, Dougados M (1997) Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomised controlled trial. Br J Rheumatol 36:77–81

    Article  CAS  PubMed  Google Scholar 

  46. Kovacs I, Bender T (2002) The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of knee: a double blind, controlled, follow up study. Rheumatol Int 21:218–221

    Article  PubMed  Google Scholar 

  47. Tishler M, Rosenberga O, Levya O, Elias I (2004) The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective? Eur J Intern Med 15:93–96

    Article  PubMed  Google Scholar 

  48. Balint GP, Buchanan WW, Adam A, Ratko I, Poor L, Balint PV, Somos E, Tefner I, Bender T (2006) The effect of the thermal mineral water of Nagybaracska on patient with knee joint osteoarthritis, a double blind study. Clin Rheumatol (Nov 7, in press)

  49. Karagülle MZ (2000) Kaplıca tedavisinin etkinliği [Effectiveness of spa therapy]. Klinik Gelişim 7–8:258–261 (in Turkish)

    Google Scholar 

  50. van Tubergen A, van der Linden S (2002) A brief history of spa therapy. Ann Rheum Dis 61:273–275

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bender T, Balint PV, Balint GP (2002) A brief history of spa therapy. Ann Rheum Dis 61:949

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Gambichler T, Rapp S, Senger E, Altmeyer P, Hoffmann K (2001) Balneophototherapy of psoriasis: highly concentrated salt water versus tap water—a randomized, one-blind, right/left comparative study. Photodermatol Photoimmunol Photomed 17:22–25

    Article  CAS  PubMed  Google Scholar 

  53. Leaute-Labreze C, Saillour F, Chene G, Cazenave C, Luxey-Bellocq ML, Sanciaume C, Toussaint JF, Taieb A (2001) Saline spa water or combined water and UV-B for psoriasis vs conventional UV-B: lessons from the Salies de Bearn randomized study. Arch Dermatol 137:1035–1039

    CAS  PubMed  Google Scholar 

  54. Dawe RS, Yule S, Cameron H, Moseley H, Ibbotson SH, Ferguson J (2005) A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol 153:613–619

    Article  CAS  PubMed  Google Scholar 

  55. Tütüncü ZN, Karagülle MZ, Başak E, Aslan O (1993) Influence of NaCl baths on hind paw edema in the adjuvant arthritic rats. Türk Ekoloji ve Hidroklimatoloji Dergis 254–261. Proceedings of XI Congress of World Hydrothermal Organization. 13–18 May 1992, Istanbul

  56. Bothman O, Karagülle O, Candir F, Karagülle MZ, Gutenbrunner C (2003) Controlled study on the effect of brine baths on muscle tone and pain in patients with chronic low back pain. Phys Med Rehab Kuror 13:227

    Google Scholar 

  57. Bellometti S, Galzigna L, Richelmi P, Gregotti C, Berte F (2002) Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Int J Tissue React 24:57–64

    CAS  PubMed  Google Scholar 

  58. Tütüncü ZN, Turan M, Barut A, Yüzbaşıoğlu N, Karagülle MZ (1996) Changes in TNFα plasma levels in osteoartritic patients under balneotherapy with acratothermal water. Phys Rehab Kur Med 6:80–82

    Article  Google Scholar 

  59. Bellometti S, Cecchettin M, Galzigna L (1997) Mud pack therapy in osteoarthrosis; changes in serum levels of chondrocyte markers. Clin Chim Acta 268:101–106

    Article  CAS  PubMed  Google Scholar 

  60. Bellometti S, Richelmi P, Tassoni T, Berte F (2005) Production of matrix metalloproteinases and their inhibitors in osteoarthritic patients undergoing mud bath therapy. Int J Clin Pharmacol Res 25:77–94

    CAS  PubMed  Google Scholar 

  61. Yamaoka K, Mitsunobu F, Hanamoto K, Shibuya K, Mori S, Tanizaki Y, Sugita K (2004) Study on biologic effects of radon and thermal therapy on osteoarthritis. J Pain 5:20–25

    Article  CAS  PubMed  Google Scholar 

  62. Dieppe P, Lohmander S (2005) Pathogenesis and management of pain in osteoarthritis. Lancet 365:965–973

    Article  CAS  PubMed  Google Scholar 

  63. Hurley M, Walsh N (2001) Physical, functional and other non-pharmacological interventions for osteoarthritis. Best Pract Res Clin Rheumatol 15:569–581

    Article  CAS  PubMed  Google Scholar 

  64. Dougados M (2004) Monitoring osteoarthritis progression and therapy. Osteoarthr Cartil 12(Suppl A):S55–S60

    Article  PubMed  Google Scholar 

  65. Clegg DO, Reda DJ, Harris CL et al (2006) Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 354:795–808

    Article  CAS  PubMed  Google Scholar 

  66. Cherkin D (1998) Spa therapy: panacea or placebo? Med Care 36:1303–1305

    Article  CAS  PubMed  Google Scholar 

  67. Resch KL (2004) Placebo: nuisance or the equally important other side of the coin? Forsch Komplementarmed Klass Naturheilkd 11:140–142

    PubMed  Google Scholar 

  68. van Tubergen A, Hidding A (2002) Spa and exercise treatment in ankylosing spondylitis: fact or fancy? Best Pract Res Clin Rheumatol 16:653–666

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to Mr. Hasan Süzer for his open-minded support in conducting this study at Süzer Paradise Hotel and to the local spa physician Dr. Çoşkun Üremek for his help and cooperation during the spa therapy period. We thank Prof. Johannes Rasker for his comments and suggestions on the draft text.

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  1. Department of Medical Ecology and Hydroclimatology, Istanbul Medical Faculty, University of Istanbul, Millet cad. 126, 34093, Istanbul, Turkey

    Mine Karagülle, Müfit Zeki Karagülle, Oğuz Karagülle & Arif Dönmez

  2. Department of Medical Ecology and Hydroclimatology, Gülhane School of Medicine, Ankara, Turkey

    Mustafa Turan

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  1. Mine Karagülle
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  2. Müfit Zeki Karagülle
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Correspondence to Mine Karagülle.

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Karagülle, M., Karagülle, M.Z., Karagülle, O. et al. A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis. Clin Rheumatol 26, 2063–2071 (2007). https://doi.org/10.1007/s10067-007-0618-x

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