[Effects of serial mud baths on inflammatory rheumatic and degenerative diseases]. / Wirkeffekte serieller Heiltorfbäder bei entzündlich-rheumatischen und degenerativen Erkrankungen.

BACKGROUND: Mud baths have been used for a long time for the treatment of musculoskeletal diseases. In addition to a reduction of pain and improved function, serially applied mud baths lead to a reduction in the inflammatory processes, which often underlie degenerative and inflammatory rheumatic diseases. OBJECTIVE: This study investigated the effects of serial mud baths on parameters of functional health, on pain perception and at the molecular level in patients with inflammatory rheumatic diseases, e.g. rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and degenerative alterations, e.g. gonarthritis and/or coxarthritis. MATERIAL AND METHODS: A total of 41 patients with inflammatory rheumatic (33 RA and 8 AS) and 40 patients with degenerative diseases were subdived into 2 groups by computer-assisted randomization. In each group a subgroup received 9 serial mud baths within 21 days in addition to a multimodal physical rehabilitative complex treatment (intervention groups). In the other subgroups only the physical rehabilitative treatment was carried out and no mud baths were administered (control group). The outcome parameters were assessment of the functional capacity and pain perception (HAQ, FFbH, VAS and WOMAC), diesease activity (DAS28 and BASDAI) as well as laboratory markers of inflammatory activity (CRP, BSG, IL-1 beta and IL-10) and the patient assessment. RESULTS: In the intervention groups after serial mud baths there was a significant improvement in the functional parameters (HAQ and FFbH, both p < 0.01) and a significant reduction in pain strength (VAS, p < 0.01) persisting for 3 months after the end of treatment. A significant reduction in disease activity (RA in DAS28 and AS in BASDAI) could be shown for the intervention groups as well as the control groups, whereby the effect strength was more pronounced in the intervention groups. In patients with gonarthritis and/or coxarthritis a significant improvement in functional limitations (WOMAC, p < 0.01) was only found in the intervention groups. A significant improvement in the proinflammatory cytokine IL-1 beta (p < 0.01) was only found in the intervention groups with a simultaneous increase in the anti-inflammatory cytokine IL-10 (p < 0.01). The CRP and BSG remained within the normal range and showed no significant changes even after serial mud baths. CONCLUSION: Mud baths applied within the framework of a physical rehabilitative complex treatment brought about an improvement of parameters of functional health for both inflammatory rheumatic and degenerative diseases. Effects at the molecular level were induced, which are possibly accompanied by osteoprotective and chondroprotective effects.