Elsevier

Joint Bone Spine

Volume 72, Issue 4, July 2005, Pages 303-308
Joint Bone Spine

Original article
Improvement of the clinical outcome in Ankylosing Spondylitis by balneotherapy

https://doi.org/10.1016/j.jbspin.2004.06.006Get rights and content

Abstract

Aims. – This study is designed to show the efficacy of balneotherapy and balneotherapy (BT) + nonsteroid antiinflammatory drug (NSAID) use in Ankylosing spondylitis (AS) patients.

Methods. – In this prospective study, BT, BT+ NSAID and NSAID therapy in 61 patients with AS were evaluated by ASAS core set. BT group (21 patients) was treated only with BT for 20 min, once a day, 5 days a week, over a period of 3 weeks. BT+NSAID group (20 patients) was treated with 1000 mg naproxen as well as BT. NSAID group (20 patients) was treated with 1000 mg naproxen. All of the participants did respiratory and postural exercises for 20 min a day and for the whole study period. Each patient was evaluated on admission (before treatment), at the end of the therapy and 6 months after the treatment.

Results. – At the end of the study, statistically significant improvement was observed in all the clinical parameters of the patients in BT (G1), BT+NSAID (G2) and NSAID (G3) groups. This significant symptomatic and clinical improvement was maintained even 6 months after the treatment. The changes from baseline to follow up were similar in G1 and G2 except duration of morning stiffness (DMS) and chest expansion (CE). Improvements in CE and DMS were better in G1 and G2, respectively. Improvements observed in G1 and G2 were superior to the improvements observed in G3 for the variables of morning pain, nocturnal pain, DMS, global well being of the patient, occiput-wall distance, CE, finger to floor distance and functional index. In Schober test, improvement observed in G1 was statistically superior to G3.

Conclusion. – We concluded that BT can be suggested as an effective symptomatic treatment modality in patients with AS. Furthermore, sufficient improvement in clinical parameters can be obtained by BT alone.

Introduction

Ankylosing spondylitis (AS) is defined as a chronic, systemic, inflammatory disorder that mainly affects the axial skeleton. Typical presentation is low back pain of insidious onset and morning stiffness that is improved with exercise. The main pathologic lesion is enthesitis mostly accompanied by paraarticular bone sclerosis (osteitis) and discitis. The inflammatory process erodes the skeletal fibrocartilage, hyalin cartilage, ligaments and paraarticular bone and leads to chondroosseous and fibrous ankylosis. The disease almost always involves the sacroiliac joints. Peripheric joints like hip and shoulders are involved as synovitis with a lesser ratio [1].

Nocturnal and morning pain and stiffness are the most prominent clinical features in AS accompanied by functional deterioration later on [1]. The therapeutic management of AS is based on the use of nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying drugs like sulphasalazine. Besides, symptomatic relief can be obtained by physical therapy regimens. NSAIDs are used to lessen the pain and the related symptoms. But they may cause some serious side effects [2]. Morris et al. [3] showed that NSAIDs can be as toxic as disease modifying drugs.

Balneotherapy (BT) has been used traditionally in the management of various rheumatic diseases since ancient times [4]. There are a few randomised controlled studies about this therapy regimen [5], [6], [7], [8], [9], [10]. Goldby and Scott [5] pointed out that most of the studies were carried out retrospectively and they involved some methodological errors.

Because balneotherapy (spring water) has been used frequently in Turkey because of its availability, we intended to evaluate the efficacy of balneotherapy on the patients with AS. We planned to make a randomised controlled study to investigate the clinical effects of balneotherapy on the patients with AS and to compare it with NSAIDs.

Section snippets

Design

This prospective study was carried out as single blinded and the evaluation was done before (a), after (b) and 2 months after (c) the treatment by three physicians. Two of them who did the physical examination and pain evaluation were blind to the study.

Participants

Sixty-one Ankylosing spondylitis patients (14 females, 47 males) selected from the outpatients of Atatürk Balneotherapy and Rehabilitation Center were enrolled in the present study. The diagnosis of AS was made according to the New York

Results

The groups were homogenous for demographic and clinical characteristics of the patients which were sex, age, duration of illness, severity of sacroiliitis, pain, duration of morning stiffness, ESR, global well being of the patient, occiput-wall distance, chest expansion, finger to floor distance and functional index. Lumbar flexibility measured by Schober test was better in NSAID group when compared with the other groups (Table 1). There was statistically significant improvement in all of the

Discussion

It is well known that physiotherapy including postural exercises is the most effective therapy regimen in the treatment of AS patients to prevent functional deterioration [2]. On the other hand, NSAIDs are used to control the pain and the morning stiffness as a therapeutic adjuvant to physiotherapy. As a matter of fact, the main difficulty in using NSAIDs are the serious gastrointestinal side effects including bleeding and perforation of an existing peptic ulcus [3].

Goldby and Scott [5]

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