Study on the effect of balneotherapy on rheumatoid arthritis

Oxidative stress plays a contributing role in the development of rheumatoid arthritis (RA). Recent studies have provided evidence of the antioxidant properties of spa baths. The aim of this study conducted by Mine Karagülle et al. was to investigate whether spa treatment with salt bath therapy has an impact on oxidative/antioxidant status in patients with RA and to evaluate the clinical effects of spa therapy.

In this randomized controlled trial with no knowledge of the treatment group, 50 patients were assigned in a 1:1 ratio to spa therapy plus standard medication (spa group) or standard medication only (control group). The healing therapy group followed a 2-week spa program consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36-37 °C for 20 minutes daily (except Sundays). All clinical and biochemical parameters were assessed at baseline and after the spa treatment (2 weeks). Clinical parameters included pain intensity, patient's global assessment, physician's global assessment, Health Assessment Questionnaire Disability Index (HAQ-DI), Disease Activity Score for 28 joints based on erythrocyte sedimentation rate (DAS28-4[ESR]). Oxidative status parameters included malondialdehyde (MDA), non-enzymatic superoxide radical scavenging activity (NSSA), antioxidant potential (AOP) and superoxide dismutase (SOD).

NSSA levels increased significantly in the healing therapy group, but not in the control group; and there was a trend in favor of the healing therapy in improving NSSA levels compared to the control group. Significant clinical improvement was found in the healing therapy group compared with the control group in terms of patient global assessment, physician global assessment, function (HAQ-DI), disease activity (DAS28-4[ESR]), and joint swelling, with a trend toward improvement in pain scores.

Spa therapy with salt baths shows an antioxidant effect in patients with RA, which is reflected in the increase in NSSA scores after spa treatment; whether this antioxidant effect contributes to the clinical improvements remains to be verified.