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Effect of balneotherapy on plasma cytokine levels. Dr. Gabriella Mészáros, Dr. György Nagy Ph.D. Polyclinic of the Hospitaller Brothers of the St. John of God in Budapest Semmelweis University, I. Dept. of Rheumatology. Mud Pack Therapy and Thermal Bath. Chronic low back pain

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Effect of balneotherapy on plasma cytokine levels

Effect of balneotherapy on plasma cytokine levels

Dr. Gabriella Mészáros, Dr. György Nagy Ph.D.

Polyclinic of the Hospitaller Brothers of the St. John of God in Budapest

Semmelweis University, I. Dept. of Rheumatology


Mud Pack Therapy and Thermal Bath

  • Chronic low back pain

  • Osteoarthritis

  • Fibromyalgia

  • Rheumatoid arthritis

  • Spondylarthritis ankylopoetica

  • Arthropathia psoriatica


Mud Pack Therapy and Thermal Bath

Effect of mud-pack and thermal bath

treatment

Physical-thermal effects

Chemical effects

Biological / molecular changes


Mud Pack Therapy and Thermal Bath in

Rheumatoid Arthritis 1 .

.

.

.

.

  • Cosh (1982) : spa treatment is recommended only in remission

.

.

.

.

.

.

.

.

.

  • Elkayam(1991)

  • Sukenik (1992)

  • Shlomi(2003)

Thermal bath, mud pack treatment

or

combination

.

.

.

.

.

.


Mud Pack Therapy and Thermal Bath in

Rheumatoid Arthritis 2 .

Reducing objective and subjective parameters

of activity and severity

Morning stiffness, hand grip strength, activities of daily

living, patient self-assessment of disease severity,

reduction in number of active joints, Ritchie index.


Mud Pack Therapy and Thermal Bath in

Rheumatoid Arthritis 3 .

  • Bellometti (2000): se NO , se MPO , se GSH-peroxidase level -

-37 Rheumatoid arthritis patients- mud bath treatment (20’,45°C, daily)

 bath (20’, 38°C, daily)

Background: NO (nitric-oxid):

- produced by chondrocytes, fibroblasts, endothel cells affected by

pro-inflammatory cytokines (eg.:TNF-; IL-1);

- inhibits collagen and proteoglycan synthesis;

- activates MMP-s;

- induces apoptosis.

-se nitrate (>18,6 mol/l), nitrite (>1,7 mol/l) concentrations are higher in RA than

in healthy controls (p<0.01).

-in active RA the serum level of nitrate and nitrite are higher than

in remission (p<0.01).

Degradation

of articular

cartilage

(Y Ersoy Ann Rheum Dis 2002)


Mud Pack Therapy and Thermal Bath in

Rheumatoid Arthritis 4 .

  • Cozzi (2004): Lewis rat adjuvant-arthritis (subplantar FCA inj.)

    macrophage activation , pro-inflammatory cytokines 

    expansion of autoreactive T-and B-cells

    +

    mud (15 min; 40-42°C)- thermal bath (10 min, 37-38°C)


control

Mud-bath

TNF-

p<0,05 vs control

Time/day

control

Mud-bath

IL-1

§p<0,01 vs control

Time/day

/F. Cozzi et al. Clinical and Exp. Rheumatology 2004 /


Mud Pack Therapy and Thermal Bath in

Rheumatoid Arthritis 5.

Thermal effect

Minerals

(trace elements)

Muscle-tone

Joint mobility

Pain intensity

Neuroendocrine- system

-endorphine, ACTH,

cortisol

Antiinflammatory effect

Reduction of objective and subjective indices

Change of some cytokines/

biochemical marker‘s levels

(Jezova 1985)

(Bender T 1997-2005)

Skin microcirculation 

pl.:NO , MPO ,

IGF-1 

(Bellometti 1998)

TNF-α, IL-1β (Bellometti 1997)

PGE2 (Bellometti 1998)

Leukotriene B4 

Hydromechanical effect

Tissue compresses

Zn ?

Trace elements?


Mud Pack Therapy and Thermal Bath in Osteoarthritis 1 .

OA patomechanisms

Kelley’s Textbook of Rheumatology


Mud Pack Therapy and Thermal Bath in

Osteoarthritis 2 .

.

.

.

.

.

.

  • Elkayam (1991)

  • Wigler (1995)

.

.

.

.

.

.

Bath and mud pack treatments on the

knees

.

.

.

.

.

.

Index of severity, night pain, tenderness on palpation

and pain on motion.


Mud Pack Therapy and Thermal Bath inOsteoarthritis 3 .

  • Bellometti(1997):

    -22 osteoarthritis patients a total of 12 mud pack treatments (20’,40°C, daily)+bath (10-12’,37-38°C, total of 12 days, daily)

     22 control group of patient - bath (10-12’,37-38°C, daily, total of 12)

    -se IGF-1 and se TNF- level 30 min. before the first and

    2 hours after the last (12 th ) treatment;


Mud Pack Therapy and Thermal Bath inOsteoarthritis 4 .

TNF-

pg/ml

IGF-1

ng/ml

120

100

80

60

40

20

0

IGF-1

Before treatment

TNF-

After treatment

p<0,01

Bellometti Clinica Chimica Acta (1997)


Mud pack therapy and thermal bath in osteoarthrosis 5
Mud Pack Therapy and Thermal Bath inOsteoarthrosis 5 .

  • Bellometti(2005):MMP-3 , MMP 8,9 

  • 50 patients with osteoarthritis

  • I. group: mud bath therapy(20’,40° C,5 times)

  • II.group:mud bath therapy(20’,40°C,10 times)

  •  30 patients with osteoarthritis- control group

    -Values of MMP-1,-2,-3,-8,-9, TIMP-1,-2

se MMP-3 value  in the II.group  Control group (p<0,05)



Mud packs treatment

and thermal bath

Kelley’s Textbook of Rheumatology



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