Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021; 31(01): 20-24
DOI: 10.1055/a-1217-0749
Original Article

Serial Mud Packs Induce Anti-inflammatory Effects in Knee Osteoarthritis – A Randomized, Prospective Clinical Study

Serielle Heiltorfpackungen induzieren entzündungshemmende Effekte bei Gonarthrose – eine randomisierte, prospektive klinische Studie
1   Kerckhoff-Klinik, Department of Rheumatology, Osteology and Physical Medicine, University Gießen, Bad Nauheim
,
Shaban Fetaj
2   Rheumatology, Weserland-Klinik Bad Seebruch, Vlotho
,
Markus Ehnert
1   Kerckhoff-Klinik, Department of Rheumatology, Osteology and Physical Medicine, University Gießen, Bad Nauheim
,
Philipp Klemm
1   Kerckhoff-Klinik, Department of Rheumatology, Osteology and Physical Medicine, University Gießen, Bad Nauheim
,
Gabriel Dischereit
1   Kerckhoff-Klinik, Department of Rheumatology, Osteology and Physical Medicine, University Gießen, Bad Nauheim
› Institutsangaben

Abstract

Background Mud bath and pack have been used to treat musculoskeletal disorders since ancient times. However, the actual mechanisms of action of mud therapy on the inflammatory processes are complex and still not clarified.

Methods Therefore, the clinical effects of serial mud packs in patients with knee osteoarthritis were investigated on the molecular level. A total of 52 patients were recruited from an in-patient rheumatology clinic. The participants were randomized in 2 groups: the intervention group (IG, n=26) underwent 9 mud packs in 21 days and a standardized multimodal physical therapy in an in-patient setting, whereas the control group (CG, n=26) only received the multimodal physical therapy. Primary outcome parameters were changes in the serum levels of interleukin(IL)-1ß and IL-10. Secondary outcome parameters were changes of the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Western Ontario and Mc Master Universities Arthritis (WOMAC) index and pain (visual analog scale - VAS).

Results The IG presented after the serial mud packs significantly decreased pro-inflammatory IL-1ß levels and significantly increased anti-inflammatory IL-10 levels, whereas the CG showed no changes of the 2 cytokines. CRP and ESR remained within in the normal range in both groups without significant changes. Furthermore, the IG presented a significant decrease of the WOMAC index and pain (VAS).

Conclusions The results suggest an additive anti-inflammatory effect of serial mud packs within a multimodal physical therapy concept in patients with knee osteoarthritis and could explain the beneficial clinical effects.

Zusammenfassung

Hintergrund Heiltorfbäder und -packungen werden seit der Antike zur Behandlung von muskuloskelettalen Erkrankungen eingesetzt. Die tatsächlichen Wirkmechanismen der Heiltorftherapie auf den Entzündungsprozess sind jedoch komplex und noch nicht geklärt.

Methoden Daher wurden die klinischen Wirkungen von seriellen Heiltorfpackungen bei Patienten mit Gonarthrose auf molekularer Ebene untersucht. Insgesamt wurden 52 Patienten aus einer rheumatologischen Klinik rekrutiert und in 2 Gruppen randomisiert: Die Interventionsgruppe (IG, n=26) erhielt stationär 9 Heiltorfpackungen in 21 Tagen und eine standardisierte multimodale physikalische Therapie, während die Kontrollgruppe (KG, n=26) nur die multimodale physikalische Therapie erhielt. Primäre Outcome-Parameter waren Änderungen der Serum-Zytokinwerte von Interleukin(IL)-1ß und -10. Die sekundären Outcome-Parameter waren Änderungen vom C-reaktiven Protein (CRP), der Blutsenkungsgeschwindigkeit (BSG), dem Western Ontario and McMaster Universities Arthritis (WOMAC) Index und der Schmerzen (VAS – visuelle Analogskala).

Ergebnisse Die IG zeigte nach den seriellen Heiltorfpackungen eine signifikante Verminderung der Serumspiegel vom pro-inflammatorischen IL-1ß und einen signifikanten Anstieg des anti-inflammatorischen IL-10, während die CG keine Veränderungen der beiden Zytokine zeigte. CRP und BSG waren in beiden Gruppen baseline und nach der Therapie im Normbereich gelegen. Nur die IG zeigte eine signifikante Verbesserung im WOMAC Index und eine signifikante Schmerzabnahme (VAS).

Schlussfolgerungen Die Resultate legen einen additiven entzündungshemmenden Effekt der seriellen Heiltorfpackungen innerhalb eines multimodalen physikalischen Therapiekonzepts bei Gonarthrose nahe und bieten eine Erklärungsmöglichkeit für die vorteilhaften klinischen Wirkeffekte.



Publikationsverlauf

Eingereicht: 05. Mai 2020

Angenommen: 09. Juli 2020

Artikel online veröffentlicht:
05. August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Kolasinski SL, Neogi T, Hochberg MC. et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res 2020; 72: 149-162
  • 2 Van Tubergen A, Van der Linden S. Brief history of spa therapy. Ann Rheum Dis 2002; 61: 273-275
  • 3 Constant F, Callin JF, Guillemin F. et al. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 1995; 22: 1315-1320
  • 4 Nguyen M, Revel M, Dougados M. Prolonged effects of 3 week therapy in spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomised controlled trial. Br J Rheumatol 1997; 36: 77-81
  • 5 Yurtkuran M, Yurtkuran M, Alp A. et al. Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int 2006; 27: 19-27
  • 6 Evcik D, Kavuncu V, Yeter A. et al. The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Joint Bone Spine 2007; 74: 60-65
  • 7 Forestier R, Desfour H, Tessier JM. et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicenter trial. Ann Rheum Dis 2010; 69: 660-665
  • 8 Dischereit G, Fetaj S, Goronzy J-E. et al. Effects of serial mud baths in osteoarthritis on parameters of functional health and cytokines – A controlled, randomised, prospective Trial. Akt Rheumatol 2017; 42: 129-136
  • 9 Dischereit G, Goronzy J-E, Müller-Ladner U. et al. Effects of serial mud baths on inflammatory rheumatic and degenerative diseases. Z Rheumatol 2019; 78: 143-154
  • 10 Sukenik S, Buskila D, Neumann L. et al. Sulphur bath and mud packs treatment for rheumatoid arthritis at the Dead Sea area. Ann Rheum Dis 1990; 49: 99-102
  • 11 Tishler M, Brostovski Y, Yaron M. Effect of spa therapy in Tiberias on patients with ankylosing spondylitis. Clin Rheumatol 1995; 14: 21-25
  • 12 Ardic F, Özgen M, Aybek H. et al. Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int 2007; 27: 441-446
  • 13 Bellometti S, Galzigna L. Serum levels of a prostaglandin and a leukotriene after termal mud pack therapy. J Investig Med 1998; 46: 140-145
  • 14 Bellometti S, Galzigna LO, Richelmi P. et al. Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Int J Tissue React 2002; 24: 57-64
  • 15 Bellometti S, Richelmi P, Tassoni T. et al. Production of matrix metalloproteinase and their inhibitors in osteoarthritic patients undergoing mud bath therapy. Int J Clin Pharmacol Res 2005; 25: 77-94
  • 16 Fioravanti A, Cantarini L, Bacarelli MR. et al. Effects of Spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Rheumatol Int 2010; 31: 879-882
  • 17 Shimodozono M, Matsumoto S, Ninomiya K. et al. Acute effects of a single warm-water bath on serum adiponectin and leptin levels in healthy men: a pilot study. Int J Biometeorol 2012; 56: 933-999
  • 18 Lange U, Goronzy J-E, Müller-Ladner U. et al. Anti-Inflammatory Effect of Serial Mud Baths in Rheumatoid Arthritis and Ankylosing Spondylitis. IOSR J Pharmacy and Biol Sci 2018; 2: 59-63
  • 19 Altman R, Asch E, Bloch D. et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29: 1029-1049
  • 20 Peat G, Thomas E, Duncan R. et al. Clinical classification criteria for knee osteoarthritis: performance in the general population and primary care. Ann Rheum Dis 2006; 65: 1363-1367
  • 21 Cozzi F, Raffeiner B, Beltrame V. et al. Effects of mud bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound. Joint Bone Spine 2015; 82: 104-108
  • 22 Cozzi F, Podswiadek M, Cardinale G. et al. Mud bath treatment in spondylitis associated with inflammatory bowel disease – a pilot randomized clinical trial. Joint Bone Spine 2007; 74: 436-439
  • 23 Ciprian L, Lo Nigro A, Ritto M. et al. The effects of Spa therapy and rehabilitation on patients with ankylosing spondylitis beeing treated with TNF inhibitors. Rheumatol Int 2013; 33: 241-245
  • 24 Tarner IH, Müller-Ladner U, Uhlemann C. et al. The effects of mild whole-body hyperthermia on systemic levels of TNF-α, IL-1ß, and IL-6 in patients with ankylosing spondylitis. Clin Rheumatol 2009; 28: 397-402
  • 25 Balogh Z, Ordogh J, Gasz A. et al. Effectiveness of balneotherapy in chronic low back pain – a randomised single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd 2005; 12: 196-201
  • 26 Cantarini L, Leo G, Giannitti C. et al. Therapeutic effect of SPA therapy and short wave therapy in knee-osteoarthritis: a randomized, single blind, controlled trial. Rheumatol 2007; 27: 523-529
  • 27 Fioravanti A, Perpignano G, Tirri G. et al. Effects of mud bath treatment on fibromyalgia patients: a randomized clinical trial. Rheumatol Int 2007; 27: 1157-1161