Medical Hydrology and Balneology: Environmental Aspects

Clinical effects of mud-bath therapy in patients
with psoriatic arthritis treated with TNFinhibitors
Cozzi F (1) , Raffeiner B (1) , Ciprian L (1) , Botsios C (2) , Perissinotto E (1) , Rizzo M (1) ,
Zanatta E (1) , Pigatto E (1) , Punzi L (1)
(1) Rheumatology Unit of Department of Medicine, Padova, Italy
(2) Department of Environmental Medicine and Public Health, Padova, Italy
franco.cozzi@unipd.it
Introduction and Objectives
Mud packs and thermal baths have been used since ancient times for the treatment
of rheumatic diseases and other musculoskeletal disorders. Many studies have
demonstrated the utility of thermal therapy in chronic inflammatory rheumatic
diseases, but only a few data have been reported in psoriatic arthritis (PA).
The aim of this work was to evaluate the effects of a cycle of mud-bath treatment,
in addition to pharmacological therapy with TNF-inhibitors, on the clinical
manifestations of psoriatic arthritis (PA).
Materials and Methods
After obtaining permission from the local Ethics Committee, 32 patients with
PA (24 women and 8 men, mean age 53.2 years and mean disease duration of 11.8
years), in follow-up in the Rheumatology Unit of Padova University were enrolled.
All had peripheral joint involvement and were treated with TNF-inhibitors
(adalimubab, etanercept or infliximab) for at least six months. Patients were randomized
into two groups: 18 were submitted to a cycle of mud-bath treatment
maintaining pharmacological therapy (group A), 14 were treated with TNFinhibitors
alone (group B, controls). The mud-bath treatment was performed in a
spa resort of Montegrotto, near Padova in North-East Italy, according to the classical
schedule used in the Euganean Thermal Area.
Both group of patients were evaluated with clinical indexes and validated questionnaires
to measure disease activity and health status perceived by the patient
(DAS28, number of swollen and tender joints, GH, VAS pain, BASDAI, PASI,
HAQ, SF-36). CPR serum levels were also measured. The evaluations were performed
at baseline (T0) and after 45 days (T1). Statistical analysis was performed
by Student t-test and Wilcoxon test.
Results
In patients treated with thermal therapy (group A), all clinical parameters
(DAS28, number of swollen joints and tender joints, VAS pain, BASDAI, PASI,
Balnea
2012, núm. 6, 173-174
173
ISBN: 978-84-669-1887-0
978-84-669-3482-4