Medical Hydrology and Balneology: Environmental Aspects

A possible physiological mechanism of thermal
crisis during spa therapy with mud pack and
sulphur baths in patients with osteoarthritis
Jokic A (1) , Sremcevic N (1) , Karagulle M (2) , Davidovic J (3) , Karagulle MZ (2)
(1) Specialized Rehabilitation Hospital, Banja Koviljača Spa,Serbia
(2) Istanbul University, Istanbul Medical Faculty, Department of Medical Ecology and
Hydroclimatology, Turkey
(3) Military Academy, Belgrade, Serbia.
jokic71@gmail.com
Introduction and Objectives
Thermal crisis or bath reaction is an experimentally well known phenomenon
which usually appears in the patients during the first week (mostly on 3rd to 5th
day) of a spa therapy. It has been estimated that it is experienced as a clinical presentation
up to 60% of the patients. Symptoms associated with this reaction include
malaise, fever, tachycardia, headache, fatigue, insomnia and pain.
We aimed to investigate the changes in the plasma levels of oxidative system
enzymes as possible indicators of bath reaction in the patients with osteoarthritis
during a spa therapy course consisting of mud pack and sulfur bath applications.
Materials and Methods
Thirty patients (20 female and 10 male) with knee and/or hip osteoarthritis (OA)
of both sexes who were diagnosed according to the American College of Rheumatology
Criteria included in this prospective uncontrolled study. Blood samples were
taken by venipuncture before and at the end of spa therapy as well as on the 5th day
for the assay of Copper-Zinc superoxide dismutase (CuZnSOD) and catalase (CAT)
activity. All patients had native mineral mud pack of 420C on affected joints for 20
minutes and went into individual bath-like pool containing native sulfurous water,
where the temperature was adjusted individually according to the patient\'s wish
(32-340C) for 20 minutes a day, 6 consecutive days a week, over 3 weeks.
Results
The mean blood SOD activity (±SD) before the therapy was found 1836.47
±738.92 U/gHb. On day 5 during therapy, it was increased to 1942.15 ± 779.35
U/gHb, but then at the end decreased to the level even lower than before therapy,
1745.98 ± 450.89 U/gHb (p=0.530, F test). Mean measured CAT activity (±SD)
was found 20.56 ±5.86 kU/gHb at the beginning, on the 5th day, decreased to 18.92
±4.72 kU/gHb, and at the end it was lowest, 16.16 ± 3.98 kU/gHb. This change was
statistically significant as compared to before the treatment values (p=0.002, F-test).
Balnea
2012, núm. 6, 194-195
194
ISBN: 978-84-669-1887-0
978-84-669-3482-4