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Effect of balneotherapy on Effect of balneotherapy on plasma cytokine levelsplasma cytokine levels
Dr. Gabriella Mészáros, Dr. György Nagy Ph.D.
Polyclinic of the Hospitaller Brothers of the St. John of God in BudapestSemmelweis University, I. Dept. of Rheumatology
•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
Chemical effects
Biological / molecular changesBiological / molecular changes
Physical-thermal effects
Mud Pack Therapy and Thermal Bath
Elkayam (1991)Sukenik (1992) Shlomi (2003)
Mud Pack Therapy and Thermal Bath in Rheumatoid Arthritis 1 .
....Cosh (1982) : spa treatment is recommended only in remission
......
......
Thermal bath, mud pack treatmentor
combination
..
Reducing objective and subjective parametersof activity and severity
Mud Pack Therapy and Thermal Bath in Rheumatoid Arthritis 2 .
Morning stiffness, hand grip strength, activities of dailyliving, patient self-assessment of disease severity,reduction in number of active joints, Ritchie index.
Bellometti (2000): se NO , se MPO , se GSH-peroxidase level -
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).
Degradationof articular cartilage
(Y Ersoy Ann Rheum Dis 2002)
-37 Rheumatoid arthritis patients- mud bath treatment (20’,45°C, daily) bath (20’, 38°C, daily)
Mud Pack Therapy and Thermal Bath inRheumatoid Arthritis 3 .
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)
Mud Pack Therapy and Thermal Bath in
Rheumatoid Arthritis 4 .
TNF-
IL-1
Mud-bath
Time/day
Time/day
Mud-bath
p<0,05 vs control
§p<0,01 vs control
control
control
/F. Cozzi et al. Clinical and Exp. Rheumatology 2004 /
Thermal effect Minerals
Muscle-tone
Joint mobility
Pain intensity
Neuroendocrine- system
-endorphine, ACTH,
cortisol
Skin microcirculation
IGF-1
Hydromechanical effect
Antiinflammatory effect
Reduction of objective and subjective indices
Change of some cytokines/
biochemical marker‘s levels
Zn ?Tissue compresses
(trace elements)
pl.:NO , MPO ,TNF-α , IL-1β (Bellometti 1997)PGE2 (Bellometti 1998)
Leukotriene B4
Trace elements?
(Bellometti 1998)
(Jezova 1985)(Bender T 1997-2005)
Mud Pack Therapy and Thermal Bath in Rheumatoid Arthritis 5.
OA patomechanismsOA patomechanisms
Mud Pack Therapy and Thermal Bath in Osteoarthritis 1 .
Kelley’s Textbook of Rheumatology
Elkayam (1991)
Wigler (1995)
Mud Pack Therapy and Thermal Bath in Osteoarthritis 2 .
......
......
......
Bath and mud pack treatments on theknees
Index of severity, night pain, tenderness on palpationand pain on motion.
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 3 .
IGF-1IGF-1ng/ml
TNF-TNF-pg/ml
Before treatmentBefore treatment
After treatmentAfter treatment TNF-TNF-
IGF-1IGF-1
2020
8080
100100
6060
4040
120120
00
Bellometti Clinica Chimica Acta (1997)
p<0,01
Mud Pack Therapy and Thermal Bath inOsteoarthritis 4 .
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)
Kelley’s Textbook of Rheumatology
Mud packs treatment Mud packs treatment and thermal bathand thermal bath