Monday, April 13, 2015

Rheumatoid arthritis: is spa-therapy efficient?

Cochrane: We reviewed the evidence on the benefits and harms of balneotherapy (natural mineral waters, gases and mudpacks or spa therapy) in people with rheumatoid arthritis. Balneotherapy is defined as bathing in natural mineral or thermal waters (e.g. mineral baths, sulphur baths, Dead Sea baths), using mudpacks or doing both. The quality of the evidence is very low mainly because of the low number of participants in the studies and concerns about study designs.

This review shows that in people with rheumatoid arthritis:

• we are uncertain whether mudpacks (balneotherapy) improve pain, overall wellness and swollen joints compared with placebo (fake treatment) in patients with hand RA. Mudpacks may improve tender joints slightly compared with placebo, but information about physical ability and adverse events was not reported in the study.
• adding radon to carbon dioxide baths did not improve pain intensity at three months but may improve overall well-being and pain at six months compared with carbon dioxide baths without radon, but this may have happened by chance. Information about physical disability, tender and swollen joints and adverse events was not reported in the studies.
• we are uncertain whether balneotherapy (seated immersion) improves pain and physical function compared with hydrotherapy, exercise or relaxation. Improvement, tender joints, swollen joints and adverse events were not reported in the study.
• we are uncertain whether bathing in mineral baths (balneotherapy) improves pain and swollen joints compared with using a drug (Cyclosporin A). Mineral baths may improve overall wellness compared with Cyclosporin A, and Cyclosporin A may improve the number of tender joints compared with mineral baths. Physical disability and adverse events were not reported.
• we do not have precise information about side effects and complications of balneotherapy. This is particularly true for rare side effects. Side effects may include skin rash, infection and accidents, for example, slipping on wet surfaces near the bath area.

What is rheumatoid arthritis and what is balneotherapy?
When you have rheumatoid arthritis (RA), your immune system, which normally fights infection, inflames the lining of your joints, making them painful, stiff and swollen. The small joints of your hands and feet are usually affected first. No cure for RA is known at present, so treatments aim to relieve pain and stiffness while improving your ability to move.
Balneotherapy (bathing in water) is a type of therapy that aims to reduce pain and improve daily functioning. Balneotherapy often takes place at centres with thermal baths or seawater baths.
Authors' conclusions: 
Overall evidence is insufficient to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy.