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A randomized, controlled study of balneotherapy in patients with rheumatoid arthritis
Yurtkuran M, Yurtkuran MA, Dilek K, Gullulu M, Karakoc Y, Ozbek L, Bingol U
Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 1999 Jun;9(3):92-96
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Rheumatoid arthritis (RA) is a systemic disease with the most prominent symptom being chronic inflammation of synovial joints. Chronic synovitis often leads to an irreversible destruction of articular cartilage and subchondral bone (Steffen et al. 1995, van Leeuwen et al. 1993). T and B cells remain important in the development of RA. Recent data indicate that the involvement of T cells is more complex than recognizing an arthritogenic antigen in synovia (Goronzy et al. 1995). RA has nonspecific criteria for disease definition, unknown etiology, partially defined pathogenesis, fluctuating disease course, influences from psychological factors. As a result of these factors, the therapy of RA is empirical. The goals of management are to relieve patients from pain and other articular symptoms, and to improve mobility and function. Drug therapy, unfortunately must be given empirically. Single agents often fail to adequately control synovial inflammation and they may lead to serious side effects such as gastrointestinal, renal and hepatic toxicity. Cyclosporine A (CsA) has been the most extensively investigated of the immunomodulatory agents (Yocum 1997). But it has some serious side effects (Dougaudos 1988, Van Rijthoven 1986). Non-pharmacological therapy such as TENS, laser, heat, balneotherapy, peloetherapy has been used alternately (Behrend 1979, Kumar 1982, Heussler 1993, Danneskiold 1987, Sukenik 1990, Grigor'eva 1995, Dial 1985). Balneotherapy (BT) is one of the most ancient of all treatments for rheumatic diseases. The buoyancy is useful and the heat and diuretic effects may add to benefit (Dieppe 1994). Elkayam et al. (1991) showed that mineral bath could be beneficial in RA. Others concluded that mud packs and sulphur bath alone or in combination are safe and effective in reducing objective and subjective indices of RA activity (Sukenik et al. 1990). This study was aimed to determine whether BT might result in alterations in clinical and laboratory parameters of RA, and to determine whether these alterations might be comparable to drug therapy.

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