Balneotherapy in medicine: A review Balneotherapy at the Dead Sea area for knee osteoarthritis. Effectiveness of Balneotherapy in Chronic Low Back Pain – a Randomized Single-Blind Controlled Follow-up Study Effect of balneotherapy on the antioxidant system--a controlled pilot study. Balneotherapy for rheumatoid arthritis at the Dead Sea. Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis Balneotherapy for fibromyalgia at the Dead Sea Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands: a randomized controlled single-blind follow-up study The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study Balneotherapy at the Dead Sea area for patients with psoriatic arthritis and concomitant fibromyalgia. The role of trace elements in psoriatic patients undergoing balneotherapy with Dead Sea bath salt. Effects of sulfur bath on hip osteoarthritis: a randomized, controlled, single-blind, follow-up trial: a pilot study Does balneotherapy with low radon concentration in water influence the endocrine system? A controlled non-randomized pilot study Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study Spa therapy for ankylosing spondylltis at the Dead Sea. The effect of balneotherapy on patients with ankylosing spondylitis Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial The efficacy of alum-containing ferrous thermal water in the management of chronic inflammatory gynaecological disorders--a randomized controlled study. The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels The Effect of Balneotherapy at the Dead Sea on the Quality of Life of Patients with Fibromyalgia Syndrome Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Controlled trial of balneotherapy in treatment of low back pain. Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis.
Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments BACKGROUND Balneotherapy at the Dead Sea area has been applied in various inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis . The efficacy of balneotherapy at the Dead Sea area for the treatment of degenerative rheumatic diseases has not yet been formally evaluated . OBJECTIVE To evaluate the efficacy of balneotherapy at the Dead Sea area in patients suffering from osteoarthritis of the knees . METHODS Forty patients were r and omly allocated into four groups of 10 patients . Group I was treated by bathing in a sulphur pool , group 2 by bathing in the Dead Sea , group 3 by a combination of sulphur pool and bathing in the Dead Sea , and group 4 served as the control group receiving no balneotherapy . The duration of balneotherapy was 2 weeks . RESULTS Significant improvement as measured by the Lequesne index of severity of osteoarthritis was observed in all three treatment groups , but not in the control group . This improvement lasted up to 3 months of follow-up in patients in all three treatment groups . CONCLUSION Balneotherapy at the Dead Sea area has a beneficial effect on patients with osteoarthritis of the knees , an effect that lastas at least 3 months Objective : Balneotherapy , a domain of medical science , focuses on utilizing the beneficial effects of medicinal waters . Low back pain is among the most prevalent musculoskeletal disorders affecting a large proportion of the population during their lifetime . Although small in number , all controlled studies published on this subject have demonstrated the benefits of balneotherapy . This present study was undertaken to compare the effects of hydrotherapy with mineral water vs. tap water on low back pain . Patients and Methods : A single-blind clinical study was carried out to appraise the therapeutic efficacy of reduced sulphurous water on 60 patients with low back pain . 30 subjects took baths in reduced sulphurous mineral water  , whereas the other 30 patients used modified tap water of matching odor . Parameters determined at baseline , after balneo-/hydrotherapy , and at the end of the 3-month follow-up period included the results of the Visual Analogue Scale ( VAS ) score , the modified Oswestry index , mobility of the spine , antalgic posture , tenderness of the paravertebral muscles on palpation , the dose requirements for analgesics , and the efficacy assessed by the investigators and by the patients . Results : Bathing in mineral water result ed in a statistically significant improvement . This was reflected by the VAS ( p < 0.01 ) and manifested by the mitigation of muscle spasm ( p < 0.01 ) , the alleviation of local tenderness ( p < 0.01 ) , the enhanced flexion-extension and rotation of the spine ( p < 0.01 ) as well as by the improvement of the Schober ’s index ( p < 0.01 ) . All these beneficial changes persisted as long as 3 months after the completion of balneotherapy . By contrast , hydrotherapy with tap water result ed only in the temporary improvement of just a single parameter : the VAS score improved significantly ( p < 0.01 ) . Conclusions : Balneotherapy in itself can alleviate  low back pain . As demonstrated by this study , the analgesic efficacy and improvement of mobility accomplished by the use of mineral water is significantly superior to that afforded by hydrotherapy with tap water . Our results clearly establish the beneficial effects of mineral water . Moreover , it is a valuable adjunct to other forms of physical treatment as well as to pharmacotherapy BACKGROUND Balneotherapy is among the most widely used modalities of physical therapy in countries rich in mineral waters . This trial was intended to ascertain whether balneotherapy ( i.e. , therapeutic bath in mineral water ) has any influence on the antioxidant system and whether there are any differences compared to bathing in tap water . METHODS The ten subjects in Group I bathed in alkaline thermal water , Group II  used alkaline , chlorine-containing mineral water , whereas Group III  bathed in tap water .  Catalase , superoxide dismutase , malondialdehyde protein and glutathione peroxidase levels were measured at baseline and after concluding the course of balneotherapy . RESULTS Balneotherapy with either of the two mineral waters reduced the activity of all four enzymes studied . Using tap water , however , had no influence on either catalase or superoxide dismutase activity after one session or glutathione peroxidase levels after a course of ten balneotherapy treatments . CONCLUSIONS Thermal water may have a beneficial effect on the formation of free radicals . The therapeutic efficacy of mineral vs. tap water is different , although bathing in hot water itself reduces enzyme activity Thirty-six patients with active rheumatoid arthritis were treated for 12 days at the Ein Gedi Spa . The patients were allocated r and omly to four study groups . Group 1 ( n = 9 ) was treated with daily baths in the Dead Sea , group 2 ( n = 9 ) was treated with daily sulphur baths , group 3 ( n = 10 ) was treated with a combination of daily Dead Sea bathing and sulphur baths , and group 4 ( n = 8) served as a control group . All patients were assessed by a rheumatologist who was blinded to the treatment modalities and group allocation . Clinical parameters assessed included : duration of morning stiffness , 15 m walk time , grip strength , activities of daily living , patient 's assessment of disease severity , number of active joints , and the Ritchie articular index . Statistically significant improvement lasting up to 3 months was observed only in the three treatment groups Abstract The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis ( PsA ) . A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks . Patients were r and omly allocated into two groups : group 1 ( 23 patients ) and group 2 ( 19 patients ) . Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea . Group 1 was also treated with mud packs and sulfur baths . Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival , at the end of treatment , and at weeks 8 , 16 , and 28 from the start of treatment . The clinical indices assessed were morning stiffness , right and left h and grip , number of tender joints , number of swollen joints , Schober test , distance from finger to floor when bending forward , patient 's self- assessment of disease severity , inflammatory neck and back pain and psoriasis area and severity index ( PASI ) score . Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI , morning stiffness , patient self- assessment , right and left grip , Schober test and distance from finger to floor when bending forward . For variables such as tender and swollen joints , and inflammatory neck and back pain , improvement over time was statistically significant in group 1 . Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain Abstract . The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia ( FM ) at the Dead Sea . Forty-eight patients with FM were r and omly assigned to a treatment group receiving sulfur baths and a control group .  All participants stayed for 10 days at a Dead Sea spa .  Physical functioning , FM-related symptoms , and tenderness measurements ( point count and dolorimetry ) were assessed at four time points : prior to arrival at the Dead Sea , after 10 days of treatment , and 1 and 3 months after leaving the spa . Physical functioning and tenderness moderately improved in both groups . With the exception of tenderness threshold , the improvement was especially notable in the treatment group and it persisted even after 3 months . Relief in the severity of FM-related symptoms ( pain , fatigue , stiffness , and anxiety ) and reduced frequency of symptoms ( headache , sleep problems , and subjective joint swelling ) were reported in both groups but lasted longer in the treatment group . In conclusion , treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM . Future studies should address the outcome and possible mechanisms of this treatment in FM patients Objective : To evaluate the effectiveness of thermal mineral water compared with magnetotherapy without balneotherapy as control , in the treatment of h and osteoarthritis . Design : R and omized controlled single-blind follow-up study . Setting : Rheumatology specialist clinic of Gunaras Health Spa . Subjects : Patients between 50 and 70 years of age with h and osteoarthritis , r and omly assigned into three groups . Interventions : The subjects in the first two groups bathed in thermal mineral water of two different temperatures ( 36 ° C and 38 ° C ) for three weeks five times a week for 20 minutes a day and received magnetotherapy to their h and s three times weekly . The third group received only magnetotherapy . Outcome measures : Visual analogue scale scores , h and grip strength , pinchgrip strength , the number of swollen and tender joints of the h and , the duration of morning joint stiffness , Health Assessment Question naire , and Short Form-36 question naire . The study parameters were administered at baseline , immediately after treatment and after 13 weeks . Results : The study included 63 patients . Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the thermal water groups versus the control group . The 38 ° C thermal water treatment significantly improved the pinch strength of the right h and ( 0.6 ( 95 % confidence interval ( CI ) 0.2 to 1.1 ) vs. 0.03 ( 95 % CI −0.3 to 0.4 ) , P < 0.05 ) and the Health Assessment Question naire parameters ( −0.4 ( 95 % CI −0.6 to −0.2 ) vs. −0.1 ( 95 % CI −0.2 to 0.1 ) , P < 0.01 ) even in the long term . Conclusions : Balneotherapy combined with magnetotherapy  improved the pain and function as well as the quality of life in patients with h and osteoarthritis The aim of the study was to demonstrate the effectiveness of sulphurous water in patients with osteoarthritis of the h and . Forty-seven patients with osteoarthritis of the h and were enrolled into the double-blind , r and omized , controlled study , satisfying ACR criteria . One group of the patients ( n = 24 ) received balneotherapy , bathing in sulphurous thermal water for 20 min per occasion , 15 times in all during a period of 3 weeks . The control group ( n = 21 ) had a bath exclusively in warm tap water . Assessment s were carried out in both groups on four occasions : at the beginning and at the end of the treatment , and 3 and 6 months after the beginning of the treatment . The parameters studied were the following : pain in the h and , morning stiffness in the joints , grip strength of both h and s , and Health Assessment Question naire Disability Index ( HAQ ) and AUSCAN H and Osteoarthritis Index and EuroQol quality of life question naire . At the end of treatment , the improvement was more pronounced in the patient group treated with the sulphurous water . After 3 months , significant improvement could be detected in all parameters , except the morning stiffness and EQ5D . After 6 months , the values of pain , HAQ and AUSCAN continued to be significantly better in comparison with the baseline values . The improvement in quality of life was significant only at the end of the treatment , 6 months later not any longer . The difference between the two groups was significant after 3 months in point of pain and EQVAS .  Balneotherapy and within this the sulphurous spa water alone may be effective for the attenuation of pain in patients with h and osteoarthrosis BACKGROUND Balneotherapy has been successfully used to treat various rheumatic diseases , but has only recently been evaluated for the treatment of fibromyalgia . Since no effective treatment exists for this common rheumatic disease , complementary methods of treatment have been attempted . OBJECTIVES To assess the effectiveness of balneotherapy at the Dead Sea area in the treatment of patients suffering from both fibromyalgia and psoriatic arthritis . METHODS Twenty-eight patients with psoriatic arthritis and fibromyalgia were treated with various modalities of balneotherapy at the Dead Sea area . Clinical indices assessed were duration of morning stiffness , number of active joints , a point count of 18 fibrositic tender points , and determination of the threshold of tenderness in nine fibrositic and in four control points using a dolorimeter . RESULTS The number of active joints was reduced from 18.4 + /- 10.9 to 9 + /- 8.2 ( P < 0.001 ) . The number of tender points was reduced from 12.6 + /- 2 to 7.1 + /- 5 in men ( P < 0.003 ) and from 13.1 + /- 2 to 7.5 + /- 3.7 in women ( P < 0.001 ) . A significant improvement was found in dolorimetric threshold readings after the treatment period in women ( P < 0.001 ) . No correlation was observed between the reduction in the number of active joints and the reduction in the number of tender points in the same patients ( r = 0.2 ) . CONCLUSIONS Balneotherapy at the Dead Sea area appears to produce a statistically significant substantial improvement in the number of active joints and tender points in both male and female patients with fibromyalgia and psoriatic arthritis . Further research is needed to eluci date the distinction between the benefits of staying at the Dead Sea area without balneotherapy and the effects of balneotherapy in the study population BACKGROUND A beneficial effect was observed in patients with psoriasis vulgaris following balneotherapy with Dead Sea bath salt . OBJECTIVES To evaluate the possible role of trace elements in the effectiveness of balneotherapy . METHODS Serum levels of 11 trace elements were analyzed in 23 patients with psoriasis vulgaris who participated in a double-blind controlled study of balneotherapy with either Dead Sea bath salt ( 12 patients ) or common salt ( 11 patients ) . Thirteen healthy volunteers served as controls . RESULTS The mean pre-treatment serum levels of boron , cadmium , lithium and rubidium were significantly lower in patients compared to controls , whereas the mean pre-treatment serum level of manganese was significantly higher in patients compared to controls . Balneotherapy with Dead Sea bath salt result ed in a significant decrease ( P = 0.0051 ) in the mean serum level of manganese from 0.10 + /- 0.05 mol/L to 0.05 + /- 0.02 mumol/L. The mean reduction in the serum level of manganese differed significantly ( P = 0.002 ) between responders ( % Psoriasis Area and Severity Index score reduction > or = 25 ) and non-responders ( % PASI score reduction < 25 ) . Following balneotherapy with Dead Sea bath salt the mean serum level of lithium  decreased in responders by 0.01 + /- 0.02 mumol/L , whereas its level in non-responders increased by 0.03 + /- 0.03 mumol/L. ( P = 0.015 ) . CONCLUSIONS Manganese and lithium may play a role in the effectiveness of balneotherapy with Dead Sea bath salt for psoriasis The effects of balneotherapy were evaluated in patients with osteoarthritis of the hip . This r and omized , controlled , investigator-blinded study enrolled out patients with hip osteoarthritis according to ACR criteria . In addition to home exercise therapy , one patient group received balneotherapy for 3 weeks on 15 occasions . The mineral water used in this study is one of the mineral waters with the highest sulfide ion content ( 13.2 mg/L ) in Hungary . The control group received exercise therapy alone . The WOMAC Likert 3.1 index and the EQ-5D quality of life self-administered question naire were completed three times during the study : prior to first treatment , at the end of the 3-week treatment course , and 12 weeks later . The main endpoint was achievement of Minimal Clinical ly Important Improvement ( MCII ) at 12 weeks , defined as ≥7.9 points in a normalized WOMAC function score . The intention to treat analysis included 20 controls and 21 balneotherapy patients . At 12 weeks , 17 ( 81 % ) balneotherapy group patients had Minimal Clinical ly Important Improvement and 6 ( 30 % ) of controls ( p = 0.001 ) . Comparing the results of the two groups at the end of treatment , there was a significant difference in the WOMAC stiffness score only , whereas after 12 weeks , the WOMAC pain , stiffness , function , and total scores also showed a significant difference in favor of the balneotherapy group . The difference between the two groups was significant after 12 weeks in point of EQVAS score , too . The results of our study suggest that the combination of balneotherapy and exercise therapy  achieves more sustained improvement of joint function and decreases in pain than exercise therapy alone Radon bath is a well-established modality of balneotherapy for the management of degenerative musculoskeletal disorders . The present study was conducted to ascertain whether baths of relatively low ( 80 Bq/l ) radon concentration have any influence on the functioning of the endocrine system . In the study , a non-r and omized pilot study , 27 patients with degenerative musculoskeletal disorders received 30-min radon baths ( of 31–32 ° C temperature and 80 Bq/l average radon concentration ) daily , for 15 days . Twenty-five patients with matching pathologies were subjected to balneotherapy according to the same protocol , using thermal water with negligible radon content ( 6 Bq/l ) . Serum thyroid stimulating hormone , prolactin , cortisol , adrenocorticotropic hormone , and dehydroepi and rosterone levels were measured before and after a balneotherapy course of 15 sessions . Comparison of the accumulated data using the Wilcoxon test did not reveal any significant difference between pre- and post-treatment values or between the two patient groups . It is noted that while the beneficial effects of balneotherapy with radon-containing water on degenerative disorders is widely known , only few data have been published in the literature on its effect on endocrine functions . The present study failed to demonstrate any substantial effect of thermal water with relatively low radon content on the functioning of the endocrine system BACKGROUND Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people . The treatment of osteoarthritis includes non-pharmacological , pharmacological , and surgical therapies . Silver level evidence has been found concerning balneotherapy in osteoarthritis . AIM OF THE STUDY The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain , knee function , and quality of life in patients with knee osteoarthritis , compared to the control group . STUDY DESIGN r and omized , controlled , single-blind , follow-up study . SETTING Spa Hévíz and St. And rew Hospital for Rheumatic Diseases POPULATION This study included 77 out patients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria . METHODS Patients were r and omized into two groups . In group I ( n = 38 ) , subjects bathed in Lake Hévíz and in group II ( N.=39 ) , patients were treated in a pool full of tap water . Water temperature was 34 ° C for both groups . Participants underwent 30-minute therapy sessions , five times a week for three weeks . Outcome measures were pain visual analogue scale scores , active flexion degree , knee circumference , stair-climb time , Western Ontario and McMaster Universities osteoarthritis index ( WOMAC ) , and EuroQoL Group 5-Dimension Self-Report Question naire score ( EQ-5D ) . Study parameters were recorded at baseline , immediately after treatment , and after 15 weeks . RESULTS Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores ( P<0.01 ) , active flexion degree ( P<0.01 ) , physical function components of WOMAC ( P<0.05 ) , and EQ-5D scores ( P<0.05 ) even after 15 weeks . CONCLUSIONS Balneotherapy  improved pain , function as well as the quality of life in patients with knee osteoarthritis . CLINICAL REHABILITATION IMPACT Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis Oxidative stress has been shown to play a contributory role in the pathogenesis of rheumatoid arthritis ( RA ) . Recent studies have provided evidence for antioxidant properties of spa therapy . The purpose of this study is to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy . In this investigator-blind r and omized controlled trial , we r and omly assigned 50 patients in a 1:1 ratio to spa therapy plus st and ard drug treatment ( spa group ) or st and ard drug treatment alone ( control group ) . Spa group followed a 2-week course of spa therapy regimen consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36–37 ° C for 20 min every day except Sunday . All clinical and biochemical parameters were assessed at baseline and after spa therapy ( 2 weeks ) . The clinical parameters were pain intensity , patient global assessment , physician global assessment , Health Assessment Question naire disability index ( HAQ-DI ) , Disease Activity Score for 28-joints based on erythrocyte sedimentation rate ( DAS28–4[ESR ] ) . Oxidative status parameters were malondialdehyde ( MDA ) , nonenzymatic superoxide radical scavenger activity ( NSSA ) , antioxidant potential ( AOP ) , and superoxide dismutase ( SOD ) . The NSSA levels were increased significantly in the spa group ( p = 0.003 ) but not in the control group ( p = 0.509 ) ; and there was a trend in favor of spa therapy for improvements in NSSA levels compared to control ( p = 0.091 ) . Significant clinical improvement was found in the spa group compared to the control in terms of patient global assessment ( p = 0.011 ) , physician global assessment ( p = 0.043 ) , function ( HAQ-DI ) ( p = 0.037 ) , disease activity ( DAS28–4[ESR ] ) ( 0.044 ) and swollen joint count ( 0.009 ) , and a trend toward improvement in pain scores  ( 0.057 ) . Spa therapy with saline balneotherapy  exerts antioxidant effect in patients with RA as reflected by the increase in NSSA levels after spa therapy ; whether this antioxidant effect contributes to the clinical improvements observed remains to be verified BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment Effect of thermal water with high mineral content on clinical parameters and quality of life of patients with chronic low back pain was studied . In this r and omized controlled , single-blind , follow-up study , 60 patients with chronic low back pain were r and omized into two groups . The treatment group received balneotherapy with thermal-mineral water , and the control group bathed in tap water . Changes of the followings were evaluated : visual analogue scale ( VAS ) for pain , range of motion for the lumbar spine , Oswestry index , EuroQol-5D and Short Form-36 question naires . In the treatment group , the mobility of the lumbar spine , the Oswestry index , the VAS scores and the EuroQoL-5D index improved significantly . SF-36 items improved significantly in the treated group compared with baseline except for two parameters . Our study demonstrated the beneficial effect of balneotherapy with thermal mineral versus tap water on clinical parameters , along with improvements in quality of life The aims of this study were to evaluate whether balneotherapy with mineral sulphate – bicarbonate – calcium water could determine substantial symptomatic improvement , and to detect any changes in the quality of life ( QoL ) of patients with symptomatic knee osteoarthritis ( OA ) . This was a prospect i ve r and omized , single blind controlled trial . Sixty out patients with primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : group I ( 30 patients ) was treated with a daily sulphate – bicarbonate – calcium mineral water bath ; group II ( 30 patients ) , the control group , continued their regular outpatient care routine . At baseline , after 15 days and after 12 weeks , patients were evaluated by Visual Analogue Scale ( VAS ) for spontaneous pain , Lequesne and Womac Index for gonarthrosis , SF-36 , Arthritis Impact Measurement Scale ( AIMS ) and symptomatic drugs consumption . We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption . The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up . Tolerability of balneotherapy  seemed to be good , with light and transitory side effects . Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time , with positive effects on the painful symptomatology , a significant improvement on functional capacities and QoL.  Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments We aim ed to evaluate the effectiveness of balneotherapy in  fibromyalgia management .  Fifty women with fibromyalgia under pharmacological treatment were r and omly assigned to either the balneotherapy ( 25 ) or the control ( 25 ) group . Four patients from the balneotherapy group and one patient from the control group left the study after r and omization . The patients in the balneotherapy group ( 21 ) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center . The patients in the control group ( 24 ) continued to have their medical treatment and routine daily life . An investigator who was blinded to the study arms assessed the patients . All patients were assessed four times ; at the beginning of the study , at the end of the 2nd week , the 1st month , and the 3rd month after balneotherapy . Outcome measures of the study were pain intensity , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , patient ’s global assessment , investigator ’s global assessment , SF-36 scores , and tender point count .  Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity , FIQ , Beck Depression Inventory , patient ’s global assessment , investigator ’s global assessment scores , and tender point count as compared to the control group . The superiority of balneotherapy lasted up to the end of the 3rd month , except for the Beck Depression Inventory score and the investigator ’s global assessment score . Significant improvements were observed in PF , GH , and MH subscales of SF-36 during the study period in the balneotherapy group ; however , no such improvement was observed in the control group . Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls . It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia BACKGROUND The efficacy of spa therapy in ankylosing spondylitis has not been investigated extensively . OBJECTIVE To study the efficacy of balneotherapy and climatic therapy ( climatotherapy ) at the Dead Sea area in patients with ankylosing spondylitis . METHODS In a single-blind r and omized controlled study , 28 patients suffering from ankylosing spondylitis were allocated into two groups of 14 patients each . The first group ( the combined treatment group ) received balneotherapy ( mud packs and sulfur pool ) and exposure to the unique climatic conditions of the Dead Sea . The second group ( the climatotherapy group ) used the fresh water pool and experienced the same climatic conditions . The duration of treatment was 2 weeks and the follow-up period 3 months . RESULTS For both patient groups a significant improvement was found in the outcome measures : Bath AS Disease Activity Index ( P = 0.002 ) , VisuarAnalog Scale for pain ( P = 0.002 ) and VAS for spinal movement ( P = 0.011 ) . The variability was explained by the effect of time ( within group effect ) rather than the type of treatment ( between group effect ) . Quality of life , assessed by the SF-36 question naire , was very low prior to the study , but improved in terms of pain amelioration in the combined treatment group . CONCLUSIONS Climatotherapy at the Dead Sea area can improve the condition of patients suffering from long-st and ing ankylosing spondylitis Objective : To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis ( AS ) patients . Methods : A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study . The patients were r and omly assigned to two groups . In Group I ( n = 30 ) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks . All patients received instructions on the exercise programme , which they were requested to repeat once a day for 30 min during the study . The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months . In Group II the patients were given the same exercise protocol but did not receive balneotherapy . Patients were evaluated before the start of the study and at 3 weeks and 24 weeks . Evaluation parameters were daily and night pain , morning stiffness , the patient 's global evaluation and the physician 's global evaluation ( according to a scoring system of 1 to 5 ) , the Bath Ankylosing Spondilitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Dougados Functional Index ( DFI ) , tragus – wall distance , chest expansion , modified Shober test ( MST ) , fingertip – fibula head distance , and Nottingham Health Profile ( NHP ) . Results : Evaluations were completed in 54 patients in the two groups . Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI , NHP total , pain , physical activity , tiredness and sleep score , patient 's global evaluation and the physician 's global evaluation at 3 weeks , but only for the parameters of patient 's global evaluation and MST at 24 weeks . Conclusion : Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period . However , in the light of our medium‐term evaluation results , we suggest that further research is needed to assess the role of balneotherapy applied for longer duration s in AS patients The efficacy of balneotherapy in fibromyalgia syndrome ( FS ) has been well demonstrated , while controlled studies using mud packs are lacking . We performed a r and omized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients , who are poor responders to pharmacological therapy . Eighty patients with primary FS , according to ACR criteria , were r and omly allocated to two groups : 40 were su bmi tted to a cycle of 12 mud packs and thermal baths  , and 40 were considered as controls .  At baseline , after thermal treatment and after 16 weeks , patients were evaluated by FIQ , tender points count , VAS for “ minor ” symptoms , AIMS 1 and HAQ . Control patients were assessed at the same time periods . A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed . Mud packs were well tolerated and no drop-outs were recorded . Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS OBJECTIVES Treatment of gynaecological disorders is a frequent , but only barely substantiated application of balneotherapy . This study investigated potential differences between the clinical symptoms , pelvic blood flow and specific laboratory parameters of patients undergoing balneotherapy with two different types of immersion : alum-containing and tap water . STUDY DESIGN The study population comprised 40 patients ( mean age : 39.4 years ) , r and omized into two groups . All subjects took 20 min baths in 38 degrees C water every other day , for 10 occasions altogether . Study parameters were : pain relief , reduction in tissue growth , hormone levels , psychic status , and pelvic blood flow . RESULTS Thermal water improved the clinical parameters of both groups significantly . In comparison with tap water , treatment with alum-containing water accomplished significantly greater progress , as reflected by the relief of pain elicited by h and ling the uterus and improvement of psychic status . Laboratory parameters ( FSH , LH , prolactin , oestradiol and beta-endorphin serum levels ) and the Doppler index did not change in either group . CONCLUSIONS As demonstrated by our results , 3-week balneotherapy is a potentially useful adjunct for the management of chronic pelvic inflammatory disease , but further , long-term studies are notwithst and ing necessary An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades . In the present study , 42 ambulatory patients ( 23 males and 19 females , mean age 59.5 years ) with degenerative musculoskeletal disease were r and omised into one of two groups — bathing in tap water or in mineral water at the same temperature— and subjected to 30-min balneotherapy sessions on 15 occasions . Study parameters comprised serum levels of sensitised C-reactive protein ( CRP ) , plasma lipids , heat shock protein ( HSP-60 ) and total antioxidant status ( TAS ) . In both groups , CRP levels followed a decreasing tendency , which still persisted 3 months later . At 3 months after balneotherapy , serum cholesterol levels were still decreasing in patients who had used medicinal water , but exhibited a trend towards an increase in the control group . Triglyceride levels followed a decreasing trend in both patient groups . TAS showed a declining tendency in both groups . No changes of HSP-60 levels were observed in either group . Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period Abstract : Fibromyalgia ( FS ) is an idiopathic chronic pain syndrome defined by widespread non-articular musculoskeletal pain and generalised tender points . As there is no effective treatment , patients with this condition have impaired quality of life ( QoL ) . The aim of this study was to assess the possible effect of balneotherapy at the Dead Sea area on the QoL of patients with FS . Forty-eight subjects participated in the study ; half of them received balneotherapy , and half did not . Their QoL ( using SF-36 ) , psychological well-being and FS-related symptoms were assessed prior to arrival at the spa hotel in the Dead Sea area , at the end of the 10-day stay , and 1 and 3 months later . A significant improvement was reported on most subscales of the SF-36 and on most symptoms . The improvement in physical aspects of QoL lasted usually 3 months , but on psychological measures the improvement was shorter . Subjects in the balneotherapy group reported higher and longer-lasting improvement than subjects in the control group . In conclusion , staying at the Dead Sea spa , in addition to balneotherapy , can transiently improve the QoL of patients with FS . Other studies with longer follow-up are needed to support our findings BACKGROUND Osteoarthritis is a degenerative disease associated with pain , reduced range of motion , and impaired function . Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases . AIM To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of  knee osteoarthritis  . DESIGN A r and omized , assessor-blind , controlled trial . SETTING A spa resort . POPULATION One hundred and forty patients of both genders , mean age of 64.8±8.9 years , with knee osteoarthritis and chronic knee pain . METHODS Patients were r and omized into three groups : the sulfurous water ( SW ) group ( N.=47 ) , non-sulfurous water ( NSW ) group ( N.=50 ) , or control group ( N.=43 ) who received no treatment . Patients were not blinded to treatment allocation . Treatment groups received 30 individual thermal baths ( three 20-minute baths a week for 10 weeks ) at 37 - 39 ° C . The outcome measures were pain ( visual analog scale , VAS ) , physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC ; Lequesne Algofunctional Index , LAFI ; Stanford Health Assessment Question naire , HAQ ) , and use of pain medication . Patients were assessed before treatment ( T1 ) , at treatment endpoint ( T2 ) , and two months post-intervention ( T3 ) . Intra- and intergroup comparisons were performed at a significance level of 0.05 ( P<0.05 ) . RESULTS A significant decrease in VAS pain scores ( pain during movement , at rest , and at night ) and use of pain medication , and improvement in WOMAC , LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups ( P<0.001 ) , and between controls and both treatment groups at T2 and T3 ( P<0.001 ) . No significant differences in these variables were observed between treatment groups at T2 , but patients in the SW group reported less pain and better functional status than those in the NSW group at T3 , showing a lasting effect of sulfurous water baths . CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis ; however , sulfurous baths yielded longer-lasting effects than non-sulfurous water baths . CLINICAL REHABILITATION IMPACT Baths in thermal waters , especially those in sulfurous waters , are effective in reducing pain and improving physical function in patients with knee osteoarthritis Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group BACKGROUND Balneotherapy , traditionally administered during a continuous stay at the Dead Sea area , has been shown to be effective for patients suffering from knee osteoarthritis . OBJECTIVES To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis . METHODS Forty-four patients with knee osteoarthritis were included in a prospect i ve r and omized single-blind controlled study . The patients were divided into two groups : a treatment group ( n=24 ) , which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35 - 36 degrees C , and a control group ( n=20 ) treated in a Jacuzzi filled with tap water heated to 35 - 36 degrees C. Participants were assessed by the Lequesne index of osteoarthritis severity , the WOMAC index , the SF-36 quality of health question naire , VAS scales for pain ( completed by patients and physicians ) , and physical examination . RESULTS A statistically significant improvement , lasting up to 6 months , was observed in the treatment group for most of the clinical parameters . In the control group the only improvements were in the SF-36 bodily pain scale at 6 months , the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period . Although the patients in the control group had milder disease , the difference between the two groups was not statistically significant . CONCLUSIONS Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis
We found no statistically significant differences in pain on the McGill Question naire or in physical disability ( very low level of evidence ) between balneotherapy and the other interventions .
Overall evidence is insufficient to show that balneotherapy is more effective than no treatment , that one type of bath is more effective than another or that one type of bath is more effective than mudpacks , exercise or relaxation therapy
BACKGROUND No cure for rheumatoid arthritis ( RA ) is known at present , so treatment often focuses on management of symptoms such as pain , stiffness and mobility .
Treatment options include pharmacological interventions , physical therapy treatments and balneotherapy .
Balneotherapy is defined as bathing in natural mineral or thermal waters ( e.g. mineral baths , sulphur baths , Dead Sea baths ) , using mudpacks or doing both .
Despite its popularity , reported scientific evidence for the effectiveness or efficacy of balneotherapy is sparse .
This review , which evaluates the effects of balneotherapy in patients with RA , is an up date of a Cochrane review first published in 2003 and up date d in 2008 .
OBJECTIVES To perform a systematic review on the benefits and harms of balneotherapy in patients with RA in terms of pain , improvement , disability , tender joints , swollen joints and adverse events .