The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial. Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response Therapy With Mud Compresses for Knee Osteoarthritis: Comparison of Natural Mud Preparations With Mineral-Depleted Mud The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study
 Mud-bath therapy and oral glucosamine sulfate in patients with knee osteoarthritis: a randomized, controlled, crossover study. Spa therapy for gonarthrosis: a prospective study Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis
OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel . R and omized into 2 groups , Group 1 received a combination of mineral baths and mud packs , and Group 2 had tap water baths only . Both groups had a significant but temporary improvement in Ritchie index . Group 1 showed a significant improvement in grip strength . No improvement was noticed in morning stiffness , 15 meter walk time and laboratory variables of disease activity in either group . Twelve patients with osteoarthritis ( OA ) received 2 weeks of treatment with mineral baths and mud packs . Statistically significant improvement for a period of 6 months was noticed in night pain , pain on passive motion , tenderness on palpation and in the index of severity of OA of the knee OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis . DESIGN This study was design ed as a prospect i ve , r and omized-controlled , and single-blinded clinical trial . Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were r and omly assigned into two groups and were treated with mature mud packs ( n 15 ) or hot packs ( n=12 ) . Patients were evaluated for pain [ based on the visual analog scale ( VAS ) ] , function ( WOMAC , 6 min walking distance ) , quality of life [ Short Form-36 ( SF-36 ) ] , and serum levels of tumor necrosis factor-alpha ( TNF-α ) , interleukin-6 ( IL-6 ) , and insulin-like growth factor-1 ( IGF-1 ) at baseline , post-treatment , and 3 and 6~months after treatment . RESULTS The mud pack group shows a significant improvement in VAS , pain , stifness , and physical function domains of WOMAC . The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack . For a 6 min walking distance  , mud pack shows significant improvement , and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment . Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment . Significant improvements are found for the social function , vitality/energy , physical role disability , and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment . A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline , and the difference is significant between groups 3 months after the treatment . CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis Several authors have demonstrated the pivotal role of proinflammatory cytokines in inducing progressive cartilage degradation and secondary inflammation of the synovial membrane in osteoarthritis ( OA ) . It has recently been established that tumor necrosis factor (TNF)-alpha plays a well-defined role in the pathophysiology of inflammatory joint diseases and that binding to circulating soluble TNF-alpha receptors can inactivate it . We investigated the influence of mud pack treatment , which is able to diminish TNF-alpha serum values , on specific TNF receptor ( sTNF-R ) levels . Thirty-six patients with OA were enrolled and r and omized into two groups . Group A underwent mud pack treatment and group B underwent thermal bath treatment .  A group of 20 healthy untreated subjects was used as a control . Blood sample s were collected at baseline and after treatment , and assays of sTNF-R55 and sTNF-R75 were performed in both groups . We found small changes in sTNF-Rs serum values but these were not statistically significant . sTNF-R55 serum values decreased by 0.4 % after the therapy in group A , while in group B the decrease was -17.7 % . sTNF-R75 was reduced by -21.17 % in group A and by -10.6 % in group B. In conclusion , through its thermic and ant/inflammatory activity mud pack treatment shows complex interaction with the most common factors of inflammatory and cartilage degradation . Our results suggest that the thermic component of this natural treatment is mainly involved in modulating inflammatory reaction and cartilage damage through binding of the circulating TNF , which controls the activation of the cells responsible for the production of proinflammatory cytokines BACKGROUND Balneotherapy is one of the most commonly used non-pharmacological approaches for osteoarthritis ( OA ) . Recent data indicate that some biomarkers could be useful to predict OA progression and to assess therapeutic response . OBJECTIVES To evaluate the effects of mud-bath therapy on serum biomarkers in patients with knee OA . METHODS The study group comprised 103 patients with primary symptomatic bilateral knee OA who were r and omly assigned to receive a  cycle of mud-bath therapy over a period of 2 weeks or to continue their st and ard therapy alone . Clinical and biochemical parameters were assessed at baseline and after 2 weeks . Clinical assessment s included global pain score on a visual analogue scale ( VAS ) and the Western Ontario and McMaster Universities Index ( WOMAC ) subscores for knee OA . Cartilage oligomeric matrix protein ( COMP ) , C-terminal cross-linked telopeptide type II collagen ( CTX-II ) , myeloperoxidase ( MPO ) and high sensitivity C-reactive protein ( hsCRP ) serum levels were assessed by ELISA . RESULTS At the end of mud-bath therapy we observed a statistically significant improvement in VAS and WOMAC subscores . Serum levels of COMP , MPO and hsCRP did not show any significant modification in either group , while a significant increase ( P < 0.001 ) in CTX-II serum levels was observed in the mud-bath group after the treatment . CONCLUSIONS A cycle of mud-bath therapy added to the usual treatment had a beneficial effect on pain and function in patients with knee OA . The evaluation of serum biomarkers showed a significant increase of CTX-II only , perhaps due to an increase of cartilage turnover induced by thermal stress OBJECTIVE To analyze the effects of mud therapy on perceived pain , Health Related Quality of Life ( HRQL ) and drug use in patients diagnosed with knee osteoarthritis . MATERIAL AND METHODS A prospect i ve , controlled clinical trial . The sample ( n=147 ) was divided into an experimental group ( EG ) of 61 subjects ( 69.13 ± 5,60 years ) who received 11 consecutive sessions of peloids in the knee/s affected by the process described and a control group ( CG ) of 60 subjects ( 73.08 ± 8,90 years ) who continued routine drug treatment . The sample was assessed before and after intervention using the SF-36 , Visual Analogue Scale and changes in drug use , setting a significance level of P ≤ .05 . RESULTS After the intervention , there were statistically significant differences ( P<.05 ) in all parameters analyzed between EG and CG , reduced drug use in the EG versus no change in the CG . The general health , bodily pain and perceived pain are those that show major changes between the two groups . CONCLUSIONS Mud therapy in patients diagnosed with knee osteoarthritis attains immediate effects on perceived pain and HRQOL , reducing the consumption of specific drugs . Studies are needed to evaluate the scientific evidence from the effects of such intervention The purpose of the present investigation was to evaluate whether an anti-inflammatory effect together with an improvement of the regulation of the interaction between the inflammatory and stress responses underlies the clinical benefits of pelotherapy in osteoarthritis ( OA ) patients . This study evaluated the effects of a 10-day cycle of pelotherapy at the spa centre ‘ El Raposo ’ ( Spain ) in a group of 21 OA patients diagnosed with primary knee OA . Clinical assessment s included pain intensity using a visual analog scale ; pain , stiffness and physical function using the Western Ontario and McMaster Universities Arthritis Index ; and health-related quality of life using the EuroQol-5D question naire . Serum inflammatory cytokine levels ( IL-1β , TNF-α , IL-8 , IL-6 , IL-10 and TGF-β ) were evaluated using the Bio-Plex ® Luminex ® system . Circulating neuroendocrine-stress biomarkers , such as cortisol and extracellular 72 kDa heat shock protein ( eHsp72 ) , were measured by ELISA . After the cycle of mud therapy , OA patients improved the knee flexion angle and OA-related pain , stiffness and physical function , and they reported a better health-related quality of life . Serum concentrations of IL-1β , TNF-α , IL-8 , IL-6 and TGF-β , as well as eHsp72 , were markedly decreased . Besides , systemic levels of cortisol increased significantly . These results confirm that the clinical benefits of mud therapy may well be mediated , at least in part , by its systemic anti-inflammatory effects and neuroendocrine-immune regulation in OA patients . Thus , mud therapy could be an effective alternative treatment in the management of OA Mud pack therapy is an alternative mode of treatment for rheumatic diseases . It is based on the application of heated mud packs to the entire body or to specific areas , such as over joints . The aim of the current study was to evaluate the efficacy of treatment with mud compresses at patients ’ homes for osteoarthritis of the knee . Fifty-eight patients with osteoarthritis of the knee were enrolled in a prospect i ve , double-blinded , controlled study . Forty patients were treated with natural mineral-rich mud compresses and 18 patients were treated with mineral-depleted mud compresses . Mud compresses were applied 5 times each week during 3 weeks for a total of 15 treatments . Patients were assessed at baseline , at completion of the 3-week treatment period , and twice after the conclusion of the treatment period — after 1 month and after 3 months . The main outcome measures were the Lequesne Index of severity of knee osteoarthritis , patient self- assessment of pain , and severity of knee pain on a visual analog scale . A reduction of 20 % or more in the pain scores was considered clinical ly significant . In the group treated with natural mud compresses , a significant reduction in knee pain was observed at all assessment s. Similarly , improvement in the Lequesne Index was seen at the end of therapy and a month after treatment . In the control group , given mineral-depleted mud compresses , no significant change in knee pain was seen at any assessment . Improvement in the Lequesne Index was seen 1 and 3 months after completion of the therapy , but not at the end of therapy . Seventy-two percent of the patients in the treatment group had an improvement of > 20 % in self- assessment of knee pain , compared with 33 % in the control group ( p = 0.005).The data suggest that treatment with mud compresses , but only in their natural form , temporarily relieves pain in patients with osteoarthritis of the knees . We believe that treatment with mud compresses might augment conventional medical therapy in these patients The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased OBJECTIVES To evaluate the efficacy and safety of combined treatment of mud-bath therapy and glucosamine crystalline sulfate ( GlcN-S ) in patients with knee osteoarthritis ( OA ) . METHODS This study was a r and omised , controlled , crossover investigation . Patients were r and omly assigned ( 1:1 ) by the investigators to two groups , named group 1 and 2 . Group 1 included twenty-three patients receiving oral GlcN-S treatment from the beginning of the study  ( T0 ) to the end of the 3rd month of treatment ( T3 ) and a combined treatment of both mud-bath therapy and GlcN-S from T3 to the end of the study at six months ( T6 ) . Group 2 included twenty-two patients receiving a combined treatment of both mud-bath therapy and GlcN-S from T0 to T3 and that discontinued mud-bath therapy , receiving GlcN-S treatment alone , from T3 to T6 . Primary endpoints of the study consisted of evaluating OA severity and activity at baseline and at follow-up visits . RESULTS All 45 patients , eligible for the study , completed the period of the crossover . In group 1 , no significant difference was shown in the comparison from T0 to T3 , while from T3 to T6 most variables were significantly improved . In group 2 , instead , the comparison between T0 and T3 showed a significant difference in different parameters . When comparing T3 and T6 , despite an improvement of all the variables , no significant difference was shown . CONCLUSIONS The association of GlcN-S and mud-bath therapy has a positive and safe role in improving pain , function and quality of life in knee OA patients The objective of this study was to evaluate the effect of spa therapy on clinical parameters of patients with gonarthrosis . Patients with gonarthrosis ( n=33 ) underwent a 2-week spa therapy using three treatment regimes and a 20-week follow-up as follows : group I ( n=11 ) had mineral water baths and hot native mineral mud packs , group II ( n=12 ) had mineral water baths and rinsed mineral-free mud packs and group III ( n=10 ) had tap water baths and mineral-free mud packs . The patients and the assessing rheumatologist were blinded to the difference in the treatment protocol s. A significant improvement in the index of severity of the knee ( ISK ) , as well as night pain scores , was achieved in group I. Improvement in physical findings and a reduction in pain ratings on a visual analogue scale ( VAS ) did not reach statistical significance . Analgesic consumption was significantly decreased in both groups I and III for up to 12 weeks . Global improvement assessed by patients and physician was observed in all three groups up to 16 weeks but persisted to the end of the follow-up period in group I only . Patients with gonarthrosis seemed to benefit from spa therapy under all three regimes . However , for two parameters ( night pain and ISK ) the combination of mineral water baths and mud packs ( group I ) appeared to be superior We have previously shown that thermal mud therapy is able to influence chondrocyte activity of osteoarthrosic patients by modulating the production of serum cytokines , such as interleukin 1 , and this was related to the presence of an anti-inflammatory principle in mature thermal mud . Mud therapy influences many biochemical processes of the body , independently of the thermic stimulation alone and the present paper documents specific increases of insulin growth factor 1 and decreases of tumor necrosis factor alpha in serum of osteoarthrosic patients after 12 days of mud pack application Mud-bath therapy plays a primary role in the treatment and prevention of  osteoarthritis  that has been recognised since antiquity . Numerous studies have demonstrated its clinical benefits and its effects on inflammatory mediators ( interleukins ) , the immune system , cenesthesic factors ( endorphins ) , and the diencephalic – pituitary – adrenal axis . This study was conducted to assess the efficacy of mud-bath therapy with mineral water from the Sillene Spring at Italy ’s Chianciano Spa in patients with osteoarthritis of the knee . Patients ( n = 61 ) were divided into two groups . Group A underwent three cycles of mud-based spa therapy over a year ’s time , whereas group B did not . Clinical conditions , visual analogue scale pain ratings , and Lequesne indexes of the two groups were compared . We also compared these same parameters in the patients of the two groups that were following the therapy with drugs and in the patients of the group A before and after spa treatment . The percentage of patients with no symptoms or mild symptoms was higher in group A than in group B. Within group A , this percentage was higher after treatment than before spa therapy . Even in the comparison between the patients of the two groups that were following the therapy with drug , the results was that in group A the percentage of patients with no symptoms or mild symptoms was higher than in group B. Statistical analyses based on various tests revealed that almost all these differences were highly significant . No adverse effects were observed in any of the patients in group A. In conclusion , the mud-bath therapy performed at Chianciano Spa with Sillene Spring water remarkably improved the clinical conditions of patients with knee arthritis and significantly reduces the frequency and severity of symptoms and the disability they cause
CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA .
OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA .