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Kaerts M, Swinnen TW, Dankaerts W, de Vlam K, Neerinckx B. High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review. Rheumatol Adv Pract 2024; 8:rkae107. [PMID: 39247389 PMCID: PMC11379465 DOI: 10.1093/rap/rkae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Objectives Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA. Methods In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used. Results Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive. Conclusion High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.
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Affiliation(s)
- Marlies Kaerts
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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2
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Hailey LH, Amarnani R, Bundy C, McGagh D, James L, Kirtley S, O'Sullivan D, Steinkoenig I, Suribhatla R, Vivekanantham A, Coates LC. Lifestyle Modifications and Nonpharmacologic Interventions to Improve Outcomes in Psoriatic Arthritis: A Systematic Review. Clin Ther 2023; 45:841-851. [PMID: 37541907 DOI: 10.1016/j.clinthera.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a multisystem inflammatory disorder associated with significant mortality and morbidity, including functional impairment and psychological disability. Although evidence-based treatment recommendations are available for the use of drug treatments in PsA, there is little guidance for health professionals on nonpharmacologic and psychological interventions that may be useful in PsA. The objective of this systematic review (SR) was to identify how lifestyle modifications and the use of nonpharmacologic and psychological interventions may improve the outcomes of patients with PsA. METHODS Studies were included if they evaluated adults diagnosed with PsA and included exposure to nonpharmacologic interventions, psychological interventions, and lifestyle modifications. The outcomes used needed to have been validated in PsA. A systematic literature search was run on May 28, 2021, in the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), EMBASE, Global Health, MEDLINE, and PsycINFO databases to identify articles related to lifestyle modifications and nonpharmacologic or psychological interventions for adults with PsA published between 2010 and 2021. Two review authors independently screened and selected full-text studies for inclusion in the SR. Risk of bias was assessed with either the Risk of Bias 2 (ie, RoB 2) tool or Critical Appraisal Skills Program checklist depending on the study type. FINDINGS The search strategy identified 26,132 references. Eight studies examining lifestyle modifications and the effect on PsA were eligible to be included in the SR. Three of the 8 studies were randomized controlled trials, and 5 were nonrandomized studies. Three studies assessed physical activity, 3 assessed diet, 1 study assessed smoking, and another study assessed mud bath therapy. There was large heterogeneity between studies, and the measures of disease activity, and psychological and functional outcomes varied widely between studies. IMPLICATIONS Although this SR identified 8 relevant studies, these studies did not provide high-quality evidence to guide patients for non-drug treatments of PsA. The effectiveness of these interventions has therefore not been established. We found that physical activity seems to have a positive impact on disease activity and psychological well-being. Further well-designed research studies are needed to develop treatment recommendations. PROSPERO identifier: CRD42021257404.
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Affiliation(s)
- Louise H Hailey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Chris Bundy
- Behavioural Medicine/Health Psychology School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Dylan McGagh
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Lija James
- Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Rhea Suribhatla
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
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Kulisch Á, Mándó Z, Sándor E, Lengyel Z, Illés A, Kósa J, Árvai K, Lakatos P, Tóbiás B, Papp M, Bender T. Evaluation of the effects of Lake Hévíz sulfur thermal water on skin microbiome in plaque psoriasis: An open label, pilot study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:661-673. [PMID: 36864227 DOI: 10.1007/s00484-023-02443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/19/2023]
Abstract
Psoriasis is a chronic inflammatory skin disease. It is associated with changes in skin microbiome. The aim of this study was to evaluate how Lake Hévíz sulfur thermal water influences the composition of microbial communities that colonizes skin in patients with psoriasis. Our secondary objective was to investigate the effects of balneotherapy on disease activity. In this open label study, participants with plaque psoriasis underwent 30-min therapy sessions in Lake Hévíz, at a temperature of 36 °C, five times a week for 3 weeks. The skin microbiome samples were collected by swabbing method from two different areas (lesional skin-psoriatic plaque and non-lesional skin). From 16 patients, 64 samples were processed for a 16S rRNA sequence-based microbiome analysis. Outcome measures were alpha-diversity (Shannon, Simpson, and Chao1 indexes), beta-diversity (Bray-Curtis metric), differences in genus level abundances, and Psoriasis Area and Severity Index (PASI). Skin microbiome samples were collected at baseline, and immediately after treatment. Based on the visual examination of the employed alpha- and beta-diversity measures, no systematic difference based on sampling timepoint or sample location could be revealed in these regards. Balneotherapy in the unaffected area significantly increased the level of Leptolyngbya genus, and significantly decreased the level of Flavobacterium genus. A similar trend was revealed by the results of the psoriasis samples, but the differences were not statistically significant. In patients with mild psoriasis, a significant improvement was observed in PASI scores.
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Affiliation(s)
- Ágota Kulisch
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Zsuzsanna Mándó
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Enikő Sándor
- St. Andrew Hospital for Rheumatic Diseases, Schulhof Vilmos sétány 1., Hévíz, 8380, Hungary
| | - Zsuzsanna Lengyel
- Department of Dermatology, Venerology and Oncodermatology, Medical School, Clinical Center, University of Pécs, Akác utca 1., Pécs, 7632, Hungary
| | - Anett Illés
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
| | - János Kósa
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Kristóf Árvai
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Péter Lakatos
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Bálint Tóbiás
- Endocrine Molecular Pathology Research Group, Eötvös Lóránd Research Network, Korányi Sándor utca 2/a, Budapest, 1083, Hungary
- Vascular Diagnostics Kft., Lechner Ödön fasor 3. C. Lház. 3. Em. 1., Budapest, 1095, Hungary
| | - Márton Papp
- Centre for Bioinformatics, University of Veterinary Medicine Budapest, István utca 2., Budapest, 1078, Hungary
| | - Tamás Bender
- Polyclinic of the Hospitaller Brothers of St John of God, Árpád fejedelem útja 7., Budapest, 1023, Hungary.
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Duffin KC, Mazzuoccolo LD, Cura MJ, Esposito M, Fernandez AP, Gisondi P, Giunta A, Hillary T, Piaserico S, Solomon JA, Merola JF. Treatment of Psoriasis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol Suppl 2023; 50:131-143. [PMID: 36319014 DOI: 10.3899/jrheum.220316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Our aim was to summarize and evaluate the current quality of evidence regarding the efficacy of therapies for cutaneous psoriasis (PsO) in patients with psoriatic arthritis (PsA). METHODS A literature search of MEDLINE, Embase, Cochrane Library databases, and conference abstracts was conducted to identify interventional randomized controlled trials in patients with PsA between February 2013 and December 2021. Studies were included if PsO outcomes included achieving at least 75% improvement in the Psoriasis Area and Severity Index and the blinded comparison period was ≥ 10 weeks. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to assess quality of the evidence to inform and update the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. RESULTS A total of 116 studies and 36 abstracts identified in the initial search were screened. A total of 37 studies (40 treatment arms) met the criteria for final inclusion. Phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and tyrosine kinase 2 inhibitors, interleukin 17 inhibitors (IL-17i), IL-12/23i, IL-23i, and tumor necrosis factor inhibitors (TNFi) had high-quality data broadly supporting the efficacy of each class for plaque PsO over placebo. Head-to-head studies with high-quality data supported both IL-17i and IL-23i over TNFi. CONCLUSION Several pharmacologic therapeutic classes have high-quality evidence demonstrating efficacy for cutaneous PsO in the PsA population. The findings will be integrated into the 2021 GRAPPA treatment recommendations, intended to guide selection of a therapeutic class where efficacy in 1 or more cutaneous or musculoskeletal domains is required.
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Affiliation(s)
- Kristina Callis Duffin
- K. Callis Duffin, MD, Department of Dermatology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA;
| | - Luis Daniel Mazzuoccolo
- L.D. Mazzuoccolo, MD, MPH, M.J. Cura, MD, Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Julia Cura
- L.D. Mazzuoccolo, MD, MPH, M.J. Cura, MD, Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria Esposito
- M. Esposito, MD, Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anthony P Fernandez
- A.P. Fernandez, MD, PhD, Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paolo Gisondi
- P. Gisondi, MD, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Alessandro Giunta
- A. Giunta, MD, Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Tom Hillary
- T. Hillary, MD, Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Stefano Piaserico
- S. Piaserico, MD, PhD, Unit of Dermatology, Department of Medicine, University of Padua, Padova, Italy
| | - James A Solomon
- J.A. Solomon, MD, PhD, University Central Florida College of Medicine, and Florida State University College of Medicine, Orlando, Florida, and Carle-Illinois College of Medicine, Urbana, Illinois, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Division of Rheumatology and Immunology, Department of Dermatology and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Forestier R, Bugnard A, Thomas T. Balneotherapy in spondyloarthropathy: A systematic review. Therapie 2022; 77:723-730. [PMID: 35606192 DOI: 10.1016/j.therap.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/06/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022]
Abstract
AIM OF THE STUDY To evaluate the effectiveness of balneotherapy on spondyloarthritis. METHODS Two authors independently searched the CENTRAL, MEDLINE, SCOPUS, EMBASE and WEB OF SCIENCE databases until July 2017, for randomized controlled trials published in French or English, that included participants, and interventions: adults with spondyloarthritis, treated by balneotherapy program or one of its components and compared with any other intervention or no treatment. Internal validity, external validity, quality of the statistical analysis, and publication bias were systematically evaluated. We report the best level of evidence. RESULTS Nine articles were selected; the internal validity was high in two studies, average in one study, and low in six studies. With high internal validity, one study found a difference for pain between immersion in radon-rich water and tap water for the whole population or rheumatic disease, but the BASFI is not improved for the subgroup of patients with spondyloarthritis. The other study with high validity reported a significant 28-week improvement in quality of life and a composite index. In a study with moderate internal validity involving ankylosing spondylitis patients with associated with inflammatory bowel disease, a balneotherapy program demonstrated a relevant clinical improvement when compared to patients on waiting list. With low internal validity, TNFa inhibitors+spa therapy were found to be superior to a treatment with TNFa inhibitors alone in patients with psoriatic arthritis. CONCLUSIONS Two trials with high validity demonstrated improvements, but this systematic review is not sufficient to prove the efficacy of balneotherapy in spondyloarthritis. More trials are needed with larger sample size to confirm the preliminary results observed and conclusively determine the benefits of balneotherapy.
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Affiliation(s)
- Romain Forestier
- Centre de recherches rhumatologiques et thermales, villa Forestier, 3, avenue d'Albion, 73100 Aix-Les-Bains, France.
| | - Audric Bugnard
- Service de rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Thierry Thomas
- Service de rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
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6
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Shang H, Gu H, Zhang N. From traditional to novel treatment of arthritis: a review of recent advances in nanotechnology-based thermal therapy. Nanomedicine (Lond) 2021; 16:2117-2132. [PMID: 34525845 DOI: 10.2217/nnm-2021-0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Arthritis has been a heavy burden on the economy and society at large. Recently, nanomaterials that can convert near-infrared light into localized heat have demonstrated better targeting to arthritic joints, fewer side effects, ease of combined application with current therapeutics and enhanced efficacy for arthritis treatment. In this review, the authors summarize traditional thermal therapies for arthritis treatment and their molecular mechanisms and discuss the advantages and applications of nanotechnology-based thermal therapies for arthritis treatment. In conclusion, nanotechnology-based thermal therapies are effective alternatives or adjuvant strategies to the current pharmacological treatment of arthritis. Future clinical translation of thermal therapies could benefit from research elucidating their mechanisms and standardizing their parameters to optimize efficacy.
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Affiliation(s)
- Hongtao Shang
- School of Sports Sciences (main campus), Zhengzhou University, Zhengzhou, Henan, 450001, PR China
| | - Huan Gu
- Department of Chemistry, Chemical and Biomedical Engineering, University of New Haven, West Haven, CT 06516, USA
| | - Nan Zhang
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, 450001, PR China.,Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou University, Zhengzhou, Henan, 450001, PR China
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7
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Gouvêa PFM, Britschka ZMN, Gomes CDOMS, de Queiroz NGT, Salvador PAV, Silva PSC. Evaluation of the Use of Sterilized and Non-Sterilized Peruibe Black Mud in Patients with Knee Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041666. [PMID: 33572416 PMCID: PMC7916169 DOI: 10.3390/ijerph18041666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate the effects of treatment with Peruíbe Black Mud (PBM) on the clinical parameters and quality of life of patients with knee osteoarthritis and to compare the effects of PBM samples simply matured in seawater and PBM sterilized by gamma radiation. A controlled, double-blind trial was conducted with 41 patients divided into two treatment groups composed of 20 and 21 patients: one group was treated with matured PBM and the other with sterilized PBM. Evaluations were done using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study Short Form 36 (SF-36) questionnaires, the Kellgren and Lawrence (KL) radiographic scale, and the quantification of the serum levels of inflammatory biomarkers. An improvement in pain, physical functions, and quality of life was observed in all of the patients who underwent treatment with both simply matured and sterilized PBM. Nine patients showed remission in the KL radiographic scale, but no statistically significant differences were observed in the serum levels of inflammatory mediators before or after treatment. Peruíbe Black Mud proves to be a useful tool as an adjuvant treatment for knee osteoarthritis (OA), as shown by the results of the WOMAC and SF-36 questionnaires and by the remission of the radiographic grade of some patients on the Kellgren and Lawrence scale.
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Affiliation(s)
- Paulo Fávio Macedo Gouvêa
- Energy and Nuclear Research Institute, Av. Prof. Lineu Prestes 2242, Cidade Universitária, São Paulo 05508-000, SP, Brazil; (P.F.M.G.); (Z.M.N.B.); (P.A.V.S.)
| | - Zélia Maria Nogueira Britschka
- Energy and Nuclear Research Institute, Av. Prof. Lineu Prestes 2242, Cidade Universitária, São Paulo 05508-000, SP, Brazil; (P.F.M.G.); (Z.M.N.B.); (P.A.V.S.)
| | - Cristina de Oliveira Massoco Salles Gomes
- Department of Pathology, School of Veterinary Medicine and Animal Sciences, University of São Paulo, Av. Prof. Orlando Marques de Paiva, São Paulo 05508-270, SP, Brazil; (C.d.O.M.S.G.); (N.G.T.d.Q.)
| | - Nicolle Gilda Teixeira de Queiroz
- Department of Pathology, School of Veterinary Medicine and Animal Sciences, University of São Paulo, Av. Prof. Orlando Marques de Paiva, São Paulo 05508-270, SP, Brazil; (C.d.O.M.S.G.); (N.G.T.d.Q.)
| | - Pablo Antonio Vásquez Salvador
- Energy and Nuclear Research Institute, Av. Prof. Lineu Prestes 2242, Cidade Universitária, São Paulo 05508-000, SP, Brazil; (P.F.M.G.); (Z.M.N.B.); (P.A.V.S.)
| | - Paulo Sergio Cardoso Silva
- Energy and Nuclear Research Institute, Av. Prof. Lineu Prestes 2242, Cidade Universitária, São Paulo 05508-000, SP, Brazil; (P.F.M.G.); (Z.M.N.B.); (P.A.V.S.)
- Correspondence: ; Tel.: +55-1131-339-975
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8
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He X, Zhu B, Xie W, He Y, Song J, Zhang Y, Sun C, Li H, Tang Q, Sun X, Tan Y, Liu Y. Amelioration of imiquimod-induced psoriasis-like dermatitis in mice by DSW therapy inspired hydrogel. Bioact Mater 2021; 6:299-311. [PMID: 32954049 PMCID: PMC7471623 DOI: 10.1016/j.bioactmat.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022] Open
Abstract
Psoriasis is a long-lasting and recurrent autoimmune disease which is incurable so far. Dead Sea water (DSW) therapy is an effective approach to help control the symptoms of psoriasis due to the abundant mineral ions in DSW, which inspired the material formulation in this study. Rubidium-Sodium alginate/Polyacrylamide hydrogels (Rb-SA/PAAm gels) composed of sodium alginate and polyacrylamide interpenetrating network structure with different concentrations of rubidium and certain magnesium and zinc content were prepared for the treatment of psoriasis. The obtained results suggest the good mechanical properties of the Rb-SA/PAAm gels including toughness and swelling performance. In terms of in vitro tests, the Rb-SA/PAAm gels not only show nontoxicity to human keratinocyte cell line (Hacats) but also inhibits the activity against inflammatory NF-κβ signaling pathway. Meanwhile, they can release Rb+ which enable the Rb-SA/PAAm gels have better antibacterial ability to Streptococcus and Escherichia coli. The results obtained from in vivo tests indicate that these hydrogels could alleviate the symptoms of psoriasis caused by Imiquimod (IMQ) in mice by reducing the inflammatory factor in STAT3 pathway and therefore reduce the immune stimulation of the spleen. In conclusion, the 100Rb-SA/PAAm gel has demonstrated great potential to be a topical wettable dressing for psoriasis treatment.
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Affiliation(s)
- Xiang He
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
| | - Bing Zhu
- School of Materials Science and Engineering, Central South University, Changsha, 410083, China
| | - WeiJia Xie
- Xiangya School of Medicine, Central South University, Changsha, 410083, China
| | - Yu He
- Department of Material and Chemical Engineering, Zhengzhou University of Light Industry, Zhengzhou, 450002, China
| | - Jian Song
- Department of Mechanical Engineering, Munich School of Bioengineering, Technical University of Munich, 85748, Garching, Germany
| | - Yi Zhang
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
| | - Chi Sun
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
| | - Hao Li
- Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - QiYu Tang
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 410083, China
| | - XinXin Sun
- A. James Clark School of Engineering, University of Maryland, College Park, 20742, MD, United States
| | - Yanni Tan
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
| | - Yong Liu
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
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García-Villén F, Sánchez-Espejo R, Borrego-Sánchez A, Cerezo P, Cucca L, Sandri G, Viseras C. Correlation between Elemental Composition/Mobility and Skin Cell Proliferation of Fibrous Nanoclay/Spring Water Hydrogels. Pharmaceutics 2020; 12:E891. [PMID: 32962099 PMCID: PMC7559572 DOI: 10.3390/pharmaceutics12090891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
Inorganic hydrogels formulated with spring waters and clay minerals are used to treat musculoskeletal disorders and skin affections. Their underlying mechanism of action for skin disorders is not clear, although it is usually ascribed to the chemical composition of the formulation. The aim of this study was to assess the composition and in vitro release of elements with potential wound healing effects from hydrogels prepared with two nanoclays and natural spring water. In vitro Franz cell studies were used and the element concentration was measured by inductively coupled plasma techniques. Biocompatibility studies were used to evaluate the potential toxicity of the formulation against fibroblasts. The studied hydrogels released elements with known therapeutic interest in wound healing. The released ratios of some elements, such as Mg:Ca or Zn:Ca, played a significant role in the final therapeutic activity of the formulation. In particular, the proliferative activity of fibroblasts was ascribed to the release of Mn and the Zn:Ca ratio. Moreover, the importance of formulative studies is highlighted, since it is the optimal combination of the correct ingredients that makes a formulation effective.
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Affiliation(s)
- Fátima García-Villén
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
| | - Rita Sánchez-Espejo
- Andalusian Institute of Earth Sciences, CSIC-UGR (Consejo Superior de Investigaciones Científicas-Universidad de Granada), Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Ana Borrego-Sánchez
- Andalusian Institute of Earth Sciences, CSIC-UGR (Consejo Superior de Investigaciones Científicas-Universidad de Granada), Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Pilar Cerezo
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
| | - Lucia Cucca
- Department of Chemistry, University of Pavia, viale Taramelli 12, 27100 Pavia, Italy;
| | - Giuseppina Sandri
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Pavia, viale Taramelli 12, 27100 Pavia, Italy;
| | - César Viseras
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
- Andalusian Institute of Earth Sciences, CSIC-UGR (Consejo Superior de Investigaciones Científicas-Universidad de Granada), Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
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García-Villén F, Sánchez-Espejo R, Borrego-Sánchez A, Cerezo P, Perioli L, Viseras C. Safety of Nanoclay/Spring Water Hydrogels: Assessment and Mobility of Hazardous Elements. Pharmaceutics 2020; 12:pharmaceutics12080764. [PMID: 32806783 PMCID: PMC7464544 DOI: 10.3390/pharmaceutics12080764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
The presence of impurities in medicinal products have to be controlled within safety limits from a pharmaceutical quality perspective. This matter is of special significance for those countries and regions where the directives, guidelines, or legislations, which prescribe the rules for the application of some products is quite selective or incomplete. Clay-based hydrogels are quite an example of this matter since they are topically administered, but, in some regions, they are not subjected to well-defined legal regulations. Since hydrogels establish an intimate contact with the skin, hazardous elements present in the ingredients could potentially be bioavailable and compromise their safety. The elemental composition and mobility of elements present in two hydrogels have been assessed. Sepiolite, palygorskite, and natural spring water were used as ingredients. The release of a particular element mainly depends on its position in the structure of the hydrogels, not only on its concentration in each ingredient. As a general trend, elements' mobility reduced with time. Among the most dangerous elements, whose presence in cosmetics is strictly forbidden by European legal regulations, As and Cd were mobile, although in very low amounts (0.1 and 0.2 μg/100 g of hydrogel, respectively). That is, assuming 100% bioavailability, the studied hydrogels would be completely safe at normal doses. Although there is no sufficient evidence to confirm that their presence is detrimental to hydrogels safety, legally speaking, their mobility could hinder the authorization of these hydrogels as medicines or cosmetics. In conclusion, the present study demonstrates that hydrogels prepared with sepiolite, palygorskite, and Alicún spring water could be topically applied without major intoxication risks.
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Affiliation(s)
- Fátima García-Villén
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
| | - Rita Sánchez-Espejo
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, 18100 Armilla, Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Ana Borrego-Sánchez
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, 18100 Armilla, Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Pilar Cerezo
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
| | - Luana Perioli
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, 06123 Perugia, Italy;
| | - César Viseras
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 Granada, Spain; (F.G.-V.); (P.C.)
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, 18100 Armilla, Granada, Spain; (R.S.-E.); (A.B.-S.)
- Correspondence:
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11
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Cozzi F, Galozzi P, Ciprian L, Zanatta E, Polito P, Oliviero F, Carrara M, Punzi L. Mud-bath treatment of seronegative spondyloarthritis: experience at the Euganean Thermal Area. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:937-941. [PMID: 31342241 DOI: 10.1007/s00484-019-01761-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 05/19/2023]
Abstract
Mud-bath therapy (MBT) has been used as a treatment for rheumatic diseases and musculoskeletal complaints in the Euganean Thermal Area (near Padova, Italy) since ancient time. There is no consensus about the use of MBT in patients with inflammatory rheumatic diseases, although experimental studies have suggested a beneficial effect of MBT on chronic articular inflammation. To evaluate the effects of MBT in patients affected by seronegative spondyloarthritis, very common chronic inflammatory rheumatic diseases, randomized controlled trials (RCT) performed in the Euganean Thermal Area have been reviewed. A significant improvement of spondylitis parameters was observed in enteropathic spondylitis, without bowel symptom exacerbation. A long-term amelioration of clinical evaluation indices was found in ankylosing spondylitis. A significant improvement of cutaneous lesions, arthritis activity, and patient's functional ability was observed in psoriatic arthritis. MBT was usually well tolerated and adverse side effects were rarely reported. The review of the RCT suggests that MBT may exert additional beneficial effects in patients with seronegative spondyloarthritis treated with pharmacological therapy.
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Affiliation(s)
- Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy.
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Luca Ciprian
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
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12
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García-Villén F, Faccendini A, Miele D, Ruggeri M, Sánchez-Espejo R, Borrego-Sánchez A, Cerezo P, Rossi S, Viseras C, Sandri G. Wound Healing Activity of Nanoclay/Spring Water Hydrogels. Pharmaceutics 2020; 12:E467. [PMID: 32455541 PMCID: PMC7284335 DOI: 10.3390/pharmaceutics12050467] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND hydrogels prepared with natural inorganic excipients and spring waters are commonly used in medical hydrology. Design of these clay-based formulations continues to be a field scarcely addressed. Safety and wound healing properties of different fibrous nanoclay/spring water hydrogels were addressed. METHODS in vitro biocompatibility, by means of MTT assay, and wound healing properties were studied. Confocal Laser Scanning Microscopy was used to study the morphology of fibroblasts during the wound healing process. RESULTS all the ingredients demonstrated to be biocompatible towards fibroblasts. Particularly, the formulation of nanoclays as hydrogels improved biocompatibility with respect to powder samples at the same concentration. Spring waters and hydrogels were even able to promote in vitro fibroblasts motility and, therefore, accelerate wound healing with respect to the control. CONCLUSION fibrous nanoclay/spring water hydrogels proved to be skin-biocompatible and to possess a high potential as wound healing formulations. Moreover, these results open new prospects for these ingredients to be used in new therapeutic or cosmetic formulations.
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Affiliation(s)
- Fátima García-Villén
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 s/n Granada, Spain; (P.C.); (C.V.)
| | - Angela Faccendini
- Department of Drug Sciences, Faculty of Pharmacy, University of Pavia, Taramelli Street 12, 27100 Pavia, Italy; (A.F.); (D.M.); (M.R.); (S.R.); (G.S.)
| | - Dalila Miele
- Department of Drug Sciences, Faculty of Pharmacy, University of Pavia, Taramelli Street 12, 27100 Pavia, Italy; (A.F.); (D.M.); (M.R.); (S.R.); (G.S.)
| | - Marco Ruggeri
- Department of Drug Sciences, Faculty of Pharmacy, University of Pavia, Taramelli Street 12, 27100 Pavia, Italy; (A.F.); (D.M.); (M.R.); (S.R.); (G.S.)
| | - Rita Sánchez-Espejo
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Ana Borrego-Sánchez
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Pilar Cerezo
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 s/n Granada, Spain; (P.C.); (C.V.)
| | - Silvia Rossi
- Department of Drug Sciences, Faculty of Pharmacy, University of Pavia, Taramelli Street 12, 27100 Pavia, Italy; (A.F.); (D.M.); (M.R.); (S.R.); (G.S.)
| | - César Viseras
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Campus of Cartuja, 18071 s/n Granada, Spain; (P.C.); (C.V.)
- Andalusian Institute of Earth Sciences, CSIC-UGR, Avenida de las Palmeras 4, Armilla, 18100 Granada, Spain; (R.S.-E.); (A.B.-S.)
| | - Giuseppina Sandri
- Department of Drug Sciences, Faculty of Pharmacy, University of Pavia, Taramelli Street 12, 27100 Pavia, Italy; (A.F.); (D.M.); (M.R.); (S.R.); (G.S.)
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13
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Vaamonde-García C, Vela-Anero Á, Hermida-Gómez T, Fernández-Burguera E, Filgueira-Fernández P, Goyanes N, Blanco FJ, Meijide-Faílde R. Effect of balneotherapy in sulfurous water on an in vivo murine model of osteoarthritis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:307-318. [PMID: 31828429 DOI: 10.1007/s00484-019-01807-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
Osteoarthritis (OA) is a chronic joint disease that results in progressive cartilage destruction and subsequently joint dysfunction. Growing evidence indicates beneficial impact of balneological interventions in OA; however, their mechanisms of action are still unclear. Here, we evaluate the effect of balneotherapy in sulfurous water in an OA experimental model. Experimental OA was induced in Wistar rats by transection of the medial collateral ligament and removal of the medial meniscus of the left knee. Animals were randomized into three groups: non-treated (control) and balneotherapy using sulfurous water (SW) or tap water (TW). Macroscopic evaluation was performed, as well as evaluation of pain levels and analysis of motor function by rotarod test. Histopathological changes in articular cartilage and synovium were also evaluated. The presence of matrix metalloproteinase-13 (MMP-13) and oxidative damage markers was assessed by immunohistochemistry. Joint destabilization induced joint thickening, loss of joint flexion, and increased levels of pain. At day 40, animals from SW group presented lower pain levels than those from control group. Experimental OA also affected motor function. Balneotherapy in sulfur-rich water significantly improved joint mobility in relation to that in tap water. Besides, we observed that cartilage deterioration was lower in SW group than in the other two groups. Likewise, SW group showed reduced levels of MMP-13 in the cartilage. Conversely, we failed to observe any modulation on synovial inflammation. Finally, balneotherapy in sulfurous water diminished the presence of oxidative damage markers. Our results suggest the beneficial effect of balneotherapy in sulfur-rich water on an experimental model of OA, showing a reduced cartilage destruction and oxidative damage. Thus, these findings support the use of balneotherapy as a non-pharmacological treatment in OA.
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Affiliation(s)
- Carlos Vaamonde-García
- Facultad de Ciencias de la Salud, Grupo de Terapia Celular y Medicina Regenerativa, Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Campus de Oza, 15006, A Coruña, Spain.
| | - Ángela Vela-Anero
- Facultad de Ciencias de la Salud, Grupo de Terapia Celular y Medicina Regenerativa, Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Campus de Oza, 15006, A Coruña, Spain
- CIBER-BBN, Barcelona, Spain
| | - Tamara Hermida-Gómez
- Grupo de Investigación en Reumatología (GIR), Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Sergas, Universidad de A Coruña, As Xubias, 15006, A Coruña, Spain
| | - Elena Fernández-Burguera
- CIBER-BBN, Barcelona, Spain
- Grupo de Investigación en Reumatología (GIR), Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Sergas, Universidad de A Coruña, As Xubias, 15006, A Coruña, Spain
| | - Purificación Filgueira-Fernández
- Grupo de Investigación en Reumatología (GIR), Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Sergas, Universidad de A Coruña, As Xubias, 15006, A Coruña, Spain
| | - Noa Goyanes
- Grupo de Investigación en Reumatología (GIR), Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Sergas, Universidad de A Coruña, As Xubias, 15006, A Coruña, Spain
| | - Francisco J Blanco
- Grupo de Investigación de Reumatología, INIBIC-Hospital Universitario A Coruña, Departamento de Fisioterapia, Medicina y Ciencias Biomdicas, Universidad de A Coruña, A Coruña, Spain
| | - Rosa Meijide-Faílde
- Facultad de Ciencias de la Salud, Grupo de Terapia Celular y Medicina Regenerativa, Agrupación Estratégica CICA-INIBIC, Complexo Hospitalario Universitario A Coruña, Campus de Oza, 15006, A Coruña, Spain.
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Tang Y, Cheng S, Yang Y, Xiang X, Wang L, Zhang L, Qiu L. Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA? Quant Imaging Med Surg 2020; 10:86-95. [PMID: 31956532 DOI: 10.21037/qims.2019.08.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The aim of this study was to find out the most commonly involved sites and the most important ultrasonic features in psoriatic arthritis (PsA). Methods In total, 120 PsA patients and 320 psoriasis vulgaris (non-PsA) patients were assessed by grayscale and power Doppler (PD) ultrasound (US). Joints, tendons, enthesis, and bursa changes were observed. Weights of affected anatomical sites of PsA patients (overall weights >90%) were calculated. Affected anatomical sites between PsA and non-PsA patients were compared. Ultrasonic features of joint, tendon, entheses, and bursa changes between PsA and non-PsA patients were also compared. Finally, the test performance of ultrasonic features for the diagnosis of PsA was calculated. Results The anatomical sites with the highest weights were the Achilles tendon, quadriceps tendon, and knee; weights of these anatomical sites were all more than 5%. Among the affected anatomical sites of PsA patients, most of the anatomical sites were more greatly affected in the PsA patients than in the non-PsA patients (all P<0.05). The comparison of the affected Achilles tendon, quadriceps tendon, MTP1, subacromial-subdeltoid bursa, MCP4, and MCP3 showed no significance between PsA and non-PsA patients (all P>0.05). Joint synovial thickening, joint PD signal grades, joint bone erosions, tendon sheath synovial thickening, tendon sheath PD signals, enthesis bone erosions, and enthesis PD signals in PsA patients were higher than in non-PsA patients (all P<0.05). Joint PD signal grades, joint bone erosions, enthesis bone erosions, and enthesis PD signals showed the highest specificities, which were 96.06%, 95.15%, 96.93%, and 94.63% respectively. Conclusions The most common involvement sites of PsA were the Achilles tendon, quadriceps tendon, and knee, and some sites in non-PsA patients were also highly involved. The most important features in PsA included joint PD signal grades, joint bone erosion, entheses bone erosions, and entheses PD signals in US assessment.
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Affiliation(s)
- Yuanjiao Tang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Shan Cheng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yujia Yang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liyun Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lingyan Zhang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
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15
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Cozzi F, Ciprian L, Carrara M, Galozzi P, Zanatta E, Scanu A, Sfriso P, Punzi L. Balneotherapy in chronic inflammatory rheumatic diseases-a narrative review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:2065-2071. [PMID: 30276474 DOI: 10.1007/s00484-018-1618-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
Since ancient time, thermal baths and mudpacks have been used as treatments for rheumatic diseases and other musculoskeletal complaints. Despite basic researches suggest an anti-inflammatory effect of spa therapy, there is no consensus about the benefits of balneotherapy in patients with chronic inflammatory rheumatic diseases. The aim of this review is to summarize the currently available information on clinical effects of balneotherapy in these diseases. We did a literature search for articles considering the randomized controlled trials (RCTs) published until today. Although many selected studies do not have an elevated methodological quality, data from these RCTs support a beneficial effect of spa therapy. Balneotherapy highly improves the clinical course of the disease in patients with predominant axial involvement, such as with ankylosing and enteropathic spondylitis; the effects are less favorable in patients with predominant peripheral articular inflammation, such as rheumatoid arthritis. Good results have been observed in patients with psoriatic arthritis, but only few RCTs have been conducted on this disease. Spa therapy appears safe, and adverse events have been reported only in a few patients.
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Affiliation(s)
- Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Luca Ciprian
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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16
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Carbajo JM, Maraver F. Salt water and skin interactions: new lines of evidence. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1345-1360. [PMID: 29675710 DOI: 10.1007/s00484-018-1545-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as "Piezo" proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.
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Affiliation(s)
- Jose Manuel Carbajo
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Medicine, Universidad Complutense de Madrid, Plaza Ramon y Cajal, s/n, 28040, Madrid, Spain
| | - Francisco Maraver
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Medicine, Universidad Complutense de Madrid, Plaza Ramon y Cajal, s/n, 28040, Madrid, Spain.
- Professional School of Medical Hydrology, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
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Zhao CY, Jiang YX, Li JC, Xu ZH, Zhang Q, Su N, Yang M. Role of Contrast-enhanced Ultrasound in the Evaluation of Inflammatory Arthritis. Chin Med J (Engl) 2018; 130:1722-1730. [PMID: 28685724 PMCID: PMC5520561 DOI: 10.4103/0366-6999.209885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Contrast-enhanced ultrasound (CEUS) is a well-established imaging modality which has been put into clinical use in recent years with the development of second-generation contrast agent and imaging devices, and its applications in the assessment of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, have provoked abundant discussion and researches among radiologists and rheumatologists. To summarize the achievements of clinical studies on CEUS in the application of arthritis, and to keep up with the latest progresses of the imaging technique, we reviewed the literature in recent years, hoping to establish the role of CEUS in joint diseases. Data Sources: PubMed and EMBASE. Study Selection: We searched the database with the conditions “contrast-enhanced ultrasound AND arthritis” with the time limitation of recent 10 years. Clinical studies applying CEUS in inflammatory arthritis and review articles about development of CEUS in joint diseases in English were selected. Results: As it is proved by most studies in recent years, by delineating microvasculature within the inflamed joints, CEUS can indicate early arthritis with high sensitivity and specificity. Moreover, the imaging of CEUS has been proved to be consistent with histopathological changes of inflammatory arthritis. Quantitative analysis of CEUS permits further evaluation of disease activity. CEUS also plays a significant role in the therapeutic monitoring of the disease, which has been backed up by a number of studies. Conclusions: CEUS may be a new choice for the rheumatologists to evaluate inflammatory arthritis, because of its low price, ability to provide dynamic pictures, and high sensitivity to angiogenesis. It can also be applied in disease classification and therapeutic monitoring. More studies about CEUS need to be done to set up the diagnostic standards.
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Affiliation(s)
- Chen-Yang Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yu-Xin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Chu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhong-Hui Xu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qing Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Na Su
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Meng Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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18
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Tang Y, Yang Y, Xiang X, Wang L, Zhang L, Qiu L. Power Doppler Ultrasound Evaluation of Peripheral Joint, Entheses, Tendon, and Bursa Abnormalities in Psoriatic Patients: A Clinical Study. J Rheumatol 2018; 45:811-817. [PMID: 29657139 DOI: 10.3899/jrheum.170765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the prevalence rates of peripheral joint, enthesis, tendon, and bursa abnormalities by power Doppler (PD) ultrasonic examination in patients with psoriatic arthritis (PsA), psoriatic patients without clinical signs of arthritis (non-PsA psoriasis group), and healthy individuals, to detect subclinical PsA. METHODS A total of 253 healthy volunteers, 242 non-PsA psoriatic patients, and 86 patients with PsA were assessed by 2-dimensional and power Doppler (PD) ultrasound. Peripheral joint, enthesis, tendon, and bursa abnormalities were observed, characterizing abnormal PD. The affected patients and sites with abnormalities in various ages were compared among groups; PD signal grades for the abnormalities were also compared. RESULTS In the PsA group, significantly higher percentages of sites showing joint effusion/synovitis, enthesitis, and tenosynovitis in all age groups, and markedly higher rates of sites with bursitis were found in young and middle age groups, compared with the non-PsA and control groups (all p < 0.01). Meanwhile, the non-PsA group showed significantly higher rates of joint effusion/synovitis and enthesitis sites, and elevated PD signal grades of synovitis, enthesitis, and tenosynovitis in comparison with the control group, both in young and middle age groups (all p < 0.01). CONCLUSION Patients with PsA have high percentages and PD signal grades of peripheral joint, tendon, enthesis, and bursa involvement. Young and middle-aged non-PsA patients have high synovitis and enthesitis percentages, and elevated PD signal grades of synovitis, enthesitis, and tenosynovitis.
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Affiliation(s)
- Yuanjiao Tang
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University
| | - Yujia Yang
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University
| | - Xi Xiang
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University
| | - Liyun Wang
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University
| | - Lingyan Zhang
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University
| | - Li Qiu
- From the Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China. .,Y. Tang, MM, Department of Ultrasound, West China Hospital of Sichuan University; Y. Yang, BS, Department of Ultrasound, West China Hospital of Sichuan University; X. Xiang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Wang, BS, Department of Ultrasound, West China Hospital of Sichuan University; L. Zhang, MM, Department of Ultrasound, West China Hospital of Sichuan University; L. Qiu, MD, Department of Ultrasound, West China Hospital of Sichuan University.
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Karagülle M, Kardeş S, Dişçi R, Karagülle MZ. Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:195-205. [PMID: 28884308 DOI: 10.1007/s00484-017-1441-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36-37 °C for 20 min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2 weeks) and 3 and 6 months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p = 0.010) and with a trend in favor of spa group in patient global assessment (p = 0.058), function (p = 0.092), and disease activity (p = 0.098) at 3 months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p = 0.006) and patient (p = 0.020) and physician global (p = 0.011) assessments, and a trend toward improvements in pain (p = 0.069) and swollen joints (p = 0.070) at 6 months. A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects may last for 6 months.
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Affiliation(s)
- Mine Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey.
| | - Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
| | - Rian Dişçi
- Department of Biostatistics, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Müfit Zeki Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
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Maeda T, Kudo Y, Horiuchi T, Makino N. Clinical and anti-aging effect of mud-bathing therapy for patients with fibromyalgia. Mol Cell Biochem 2017; 444:87-92. [PMID: 29214470 DOI: 10.1007/s11010-017-3233-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Abstract
Spa bathing is known as a medical treatment for certain diseases causing chronic pains. Spa water contains mineral components which lower the specific heat of the water, resulting in a higher efficiency to warm body-core temperature. This phenomenon yields pain-relieving effect for rheumatoid arthritis, low back pain, sciatic neuralgia, fibromyalgia, etc. Here we introduce medical and biological effects of mud-spa-bathing therapy for fibromyalgia other than pain relief, the changes of blood examination data, and the telomere length of circulating leukocytes. The enrolled 7 patients with fibromyalgia syndrome were hospitalized and were subject to daily mud bathing at 40 °C for 10 min for about a month. Then, their subjective pain was reduced to about a quarter in average. They also showed lowered serum triglyceride and C-reactive protein level, maintaining the levels of aspartate transaminase and creatine phosphokinase, and increases of the red blood cell count, the serum albumin level, and the serum LDL-cholesterol level in comparison with cases without mud-bathing therapy, suggesting that mud bathing prevents inflammation and muscle atrophy and improves nutritional condition in fibromyalgia. In addition, the analysis of telomere length of peripheral leukocytes revealed a trend of negative correlation between telomere shortening and laboratory data change of hemoglobin and serum albumin. These telomeric changes can be explained hypothetically by an effect of mud bathing extending life-span of circulating leukocytes.
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Affiliation(s)
- Toyoki Maeda
- The Department of Internal Medicine, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita, 874-0838, Japan.
| | - Yoshihiro Kudo
- The Department of Rehabilitation, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita, 874-0838, Japan
| | - Takahiko Horiuchi
- The Department of Internal Medicine, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita, 874-0838, Japan
| | - Naoki Makino
- The Department of Internal Medicine, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita, 874-0838, Japan
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Morer C, Roques CF, Françon A, Forestier R, Maraver F. The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:2159-2173. [PMID: 28849535 DOI: 10.1007/s00484-017-1421-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 05/21/2023]
Abstract
The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study's methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients' population are needed to establish the role of minerals and other chemical compounds in spa therapy.
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Affiliation(s)
- Carla Morer
- Department of Physical Medicine and Rehabilitation. Medical Hydrology, Faculty of Medicine, Universidad Complutense de Madrid, Plaza Ramon y Cajal, s/n, 28040, Madrid, Spain
- Institut Català de la Salut, EAP 8B Porta, Centro Atención Primaria Rio de Janeiro, UTAC Muntanya, Barcelona, Spain
| | | | - Alain Françon
- Aix-les-Bains Rheumatologic and Thermal Research Center, 15 Avenue Charles de Gaulle, 73100, Aix-les-Bains, France
| | - Romain Forestier
- Aix-les-Bains Rheumatologic and Thermal Research Center, 15 Avenue Charles de Gaulle, 73100, Aix-les-Bains, France
| | - Francisco Maraver
- Department of Physical Medicine and Rehabilitation. Medical Hydrology, Faculty of Medicine, Universidad Complutense de Madrid, Plaza Ramon y Cajal, s/n, 28040, Madrid, Spain.
- Professional School of Medical Hydrology, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
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Ökmen BM, Eröksüz R, Altan L, Aksoy MK. Efficacy of peloid therapy in patients with chronic lateral epicondylitis: a randomized, controlled, single blind study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1965-1972. [PMID: 28620677 DOI: 10.1007/s00484-017-1386-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/02/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to assess the effect of peloid on pain, functionality, daily life activities, and quality of life of lateral epicondylitis (LE) patients. In this randomized, controlled, single-blind study, 75 patients who were diagnosed with chronic LE were enrolled to the study. Patients were randomized into two groups using the random number table. The patients in the first group (group 1) (n = 33), were given lateral epicondylitis band (LEB) (during the day for 6 weeks) + peloid therapy (five consecutive days a week for 2 weeks), and the second group (group 2) (n = 32), received LEB treatment alone. The patients were assessed by using Patient Rated Tennis Elbow Evaluation (PRTEE) and Nottingham Health Profile (NHP). The data were obtained before treatment (W0), immediately after treatment (W2), and 1 month after treatment (W6). In analysis of the collected data, the Wilcoxon signed rank test for intra-group comparisons and Mann-Whitney U test for comparisons between groups were used. Both in groups 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0 (p < 0.05). In comparison of difference scores between groups, although there was no statistically significant difference between the two groups at W2 when compared to W0 (p > 0.05), a statistically significant difference was found in favor of group 1 for all the evaluation parameters at W6 (p < 0.05). Our results have shown that peloid treatment could be effective in providing improvement in pain relief, function, daily life activities, and quality of life in LE patients.
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Affiliation(s)
- Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Rıza Eröksüz
- Department of Medical Ecology and Hydroclimatology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
- Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Zabotti A, Bandinelli F, Batticciotto A, Scirè CA, Iagnocco A, Sakellariou G. Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 2017; 56:1518-1532. [PMID: 28521047 DOI: 10.1093/rheumatology/kex179] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Indexed: 12/15/2022] Open
Abstract
Objective To systematically review the role of musculoskeletal US in patients suffering from PsA or psoriasis (Pso) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. Methods A systematic literature review was conducted through medical databases (MEDLINE via PubMed, Embase) and the grey literature up to September 2015 to inform a new study of the Musculoskeletal Ultrasound Study Group of the Italian Society for Rheumatology. All articles reporting data on musculoskeletal US in PsA or Pso were included and extracted according to the underlying clinical question. Results A total of 86 publications were included. The prevalence of US abnormalities showed a wide range for each examined feature (e.g. 37-95% for entheses thickness of the lower limbs). The performance of US for diagnosis of disease or elementary lesions was variable across studies, but no study evaluated the overall performance of US in addition to clinical findings for diagnosing PsA. Considering US in defining PsA and Pso prognosis, several works focused on US of entheses of lower limbs in Pso, while for the monitoring of PsA activity five different scoring systems were identified. Last, the results of the role of US in guiding intra-articular interventions were controversial for the clinical outcomes, but in favour of US for accuracy. Conclusion despite the recognized importance of US in the management of PsA and Pso, this review clearly demonstrated the need of pivotal research in order to optimize the use of US in the diagnosis and monitoring of psoriatic disease.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine
| | - Francesca Bandinelli
- Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Florence
| | | | - Carlo Alberto Scirè
- Epidemiology Unit of the Italian Society for Rheumatology (SIR), Milan.,Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Ferrara
| | - Annamaria Iagnocco
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin
| | - Garifallia Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Metin Ökmen B, Kasapoğlu Aksoy M, Güneş A, Eröksüz R, Altan L. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1403-1410. [PMID: 28210859 DOI: 10.1007/s00484-017-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/09/2017] [Accepted: 01/26/2017] [Indexed: 06/06/2023]
Abstract
Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)(n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.
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Affiliation(s)
- Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Aygül Güneş
- Department of Neurology, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Riza Eröksüz
- Department of Medical Ecology and Hydroclimatology, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
- Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa, Turkey
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