Effect of mud compress therapy on cartilage destruction detected by CTX-II in patients with knee osteoarthritis

Effect of local mud application in patients with knee osteoarthritis - A systematic review and meta-analysis

Mud therapy is a safe, cost-effective approach for Knee Osteoarthritis (OA), promoting healing through warmth and minerals, providing pain relief, and improving function. The main objective of the current review is to assess the effectiveness of local mud application for pain management in patients with Knee OA. The published papers were obtained from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrails.gov, Web of Science, and references from relevant systematic reviews from 1990 January to February 2023. Trials meeting the predefined criteria were included in this meta-analysis. The main focus of this study was to assess pain as a primary outcome measure. R software version 4.3.1 and Cochrane Risk of Bias Tool 1 were used to derive meta-analysis and risk of bias in the included studies. A meta-analysis was performed using the fixed-effects model to obtain a summary of treatment effects, which calculated the effect size (standardized mean difference; SMD) along with a 95% Confidence Interval (CI).In the current meta-analysis, a total of ten studies with 560 Knee OA patients were included. Findings demonstrated significant effects of local mud application on pain (SMD: -0.36, 95% CI: -0.56, -0.16), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale (SMD: -0.49, 95% CI: -0.68, -0.29) for individuals suffering from Knee OA. The current study identified compelling evidence to support the recommendation of mud application as an effective intervention for individuals with Knee OA. While local mud application may serve as a supplementary therapy alongside conventional medical approaches for improved Knee OA management, additional high-quality randomized controlled trials are required to validate these findings.

Evaluation of the therapeutic and the chemical effects of balneological treatment on clinical and laboratory parameters in knee osteoarthritis: a randomized, controlled, single-blinded trial

The purpose of this study was to investigate the therapeutic and the chemical effects of balneological treatment (peloidotherapy + hydrotherapy), and its effects on serum levels of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and insulin-like growth factor-1 (IGF-1) in patients with knee osteoarthritis (OA). Sixty-four (64) knee OA patients were randomly divided into study and control groups. Balneological treatment, consisting of hydrotherapy, and peloidotherapy were given to both groups. Unlike the study group, in the control group, the peloid was applied over a stretch film cover, preventing any contact between the skin and peloid. Clinical outcome measures of the study were pain degree, patient's and investigator's global assessment on visual analog scale (VAS-pain, VAS-PGA, VAS-IGA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (pain, stiffness, and physical function). Patients were evaluated at baseline, post-treatment (after 10th session), and 3 and 6 months after treatment. Blood samples were taken at baseline, post- treatment, and 6 months after treatment for analysis of IL-1β, TNF-α, and IGF-1 serum levels. When compared with the baseline, VAS measurements decreased significantly in almost all evaluation periods in both groups, and no difference was observed between the groups. In the study group, WOMAC scores showed significant improvement in all assessments. In the control group, pain and physical function subscores of WOMAC significantly decreased at post-treatment and 3 months after treatment. In group comparison, pain and stiffness subscores showed a significant difference in favor of the study group at 6 months after treatment. No clinically significant improvement was seen in levels of IL-1β and IGF-1 in both groups during the whole assessment period. Because of TNF-α kit failure, we could not evaluate the measurements. In conclusion, balneological treatment is an effective treatment option to improve the pain and functional capacity of patients with knee OA. The application of peloid by contact with the skin is superior in the long-term period, which means that in addition to the thermal effect, the chemical content of peloid can also contribute to the therapeutic effect.

Balneotherapy year in review 2021: focus on the mechanisms of action of balneotherapy in rheumatic diseases

Balneotherapy (BT) is one of the most commonly used non-pharmacologic complementary therapies for different rheumatic diseases. Its beneficial properties probably derived from a combination of mechanical, thermal, and chemical effects, but the exact mechanism of action is not elucidated. This review aimed at summarizing the current knowledge about the effects of BT, and identifying its possible mechanism of action in different rheumatic diseases. Pubmed and Scopus were used to perform a search of the literature to extract articles including terms related to BT and rheumatic diseases published in the period from 2010 to 2021. We selected pre-clinical studies, randomized controlled trials, and clinical trials. The results of clinical studies confirmed the beneficial properties on different mediators and factors of inflammation, oxidative stress, cartilage metabolism, and humoral and cellular immune responses in patients affected by chronic degenerative musculoskeletal disorders. The data derived from OA and RA-induced murine models revealed the efficacy of different BT treatments in decreasing pain, inflammation, and improving mobility, as well as in reducing the expression of matrix-degrading enzymes and markers of oxidative stress damage. Different in vitro studies analyzed the potential effect of a mineral water, as a whole, or of a mineral element, demonstrating their anti-inflammatory, antioxidant, and chondroprotective properties in OA cartilage, synoviocytes and chondrocytes, and osteoblast and osteoclast cultures. The presented data are promising and confirm BT as an effective complementary approach in the management of several low-grade inflammation, degenerative, and stress-related pathologies, as rheumatic diseases.

A Computational Evaluation of the temperature distribution generated by thermal splints designed to treat knee pain

A 3D modeling study was performed to evaluate the temperature distribution produced due to knee thermal splints to facilitate future investigations into the possible relationship between the temperature distribution and the pain relief related performance of the splints. Water and phase change material (PCM) were used as splint fillers at two different temperatures (42 °C and 44 °C). Free cooling and a temperature-controlled thermal splint were also considered. The study showed that a PCM filled splint or a temperature-controlled splint produced relatively larger and deeper temperature changes compared to the one produced with a water filled splint. With a PCM filled splint it was possible to reach a temperature increase of 1 °C in muscle tissue (42.61 cm³) and not only in fatty tissue.

The effects of Tiszasüly and Kolop mud pack therapy on knee osteoarthritis: a double-blind, randomised, non-inferiority controlled study

The aim of this non-inferiority study was to evaluate and compare the effects of Tiszasüly and Kolop mud pack therapy on pain, function and quality of life in patients with knee osteoarthritis. In this double-blind, randomised, follow-up study, 60 patients with knee osteoarthritis were treated with either Tiszasüly hot mud pack (group 1) or with Kolop hot mud pack (group 2) on 10 occasions for 2 weeks (10 working days). One hundred millimetre visual analogue scale (VAS) for knee pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lequesne Index for physical function and EuroQoL-5D for quality-of-life measurements were recorded at baseline, at the end of treatment (week 2) and 3 months later (week 12). In both groups, all measured parameters improved significantly from the baseline until the end of treatment and during the follow-up period (p < 0.05). There were no significant differences between the groups in terms of the WOMAC, KOOS, EQ-5D and Lequesne Index at any visits. Knee pain improved in both groups at week 2 and week 12; the only significant difference visible between the groups was at the end of the treatment in favour of the Tiszasüly mud pack group (p = 0.009). Tiszasüly and Kolop mud packs both have a favourable effect on knee pain, physical function and quality of life in patients with knee osteoarthritis. Our results proved non-inferiority of Tiszasüly mud pack.

Repairing effects of glucosamine sulfate in combination with etoricoxib on articular cartilages of patients with knee osteoarthritis

Purpose

To evaluate the repairing effects of glucosamine sulfate combined with etoricoxib on articular cartilages of patients with knee osteoarthritis (KOA).

Methods

A total of 106 KOA patients were randomly divided into control (n = 40) and experimental groups (n = 66) and treated with etoricoxib alone and glucosamine sulfate plus etoricoxib, respectively. Changes in WOMAC score and clinical efficacy were observed. The synovial fluid was extracted. Bone metabolism indices, growth factors, inflammatory factors, matrix metalloproteinases (MMPs), and NO-induced apoptosis-related factors were measured by ELISA. JNK and Wnt5a mRNA levels were determined using RT-PCR.

Results

After treatment, the total WOMAC scores of both groups significantly declined (P < 0.05), being lower in experimental group. The total effective rate of experimental group was higher (P < 0.05). BGP and OPG levels rose, especially in experimental group (P < 0.05). CTX-II, COMP, and RANKL levels decreased, particularly in experimental group (P < 0.05). TGF-β, IGF-1, and FGF-2 levels increased, especially in experimental group (P < 0.05). Both groups, particularly experimental group, had decreased levels of IL-1β, IL-17, IL-18, TNF-α, MMP-3, MMP-9, and MMP-13 (P < 0.05). JNK and Wnt5a mRNA levels of both groups dropped, which were lower in experimental group (P < 0.05). NO and LPO levels reduced, being lower in experimental group. SOD level rose, especially in experimental group (P < 0.05).

Conclusion

Glucosamine sulfate plus etoricoxib can repair the articular cartilages of KOA patients. Probably, JNK and Wnt5a are downregulated to inhibit the secretion of MMPs through lowering the levels of inflammatory factors, thereby delaying cartilage matrix degradation. NO-induced chondrocyte apoptosis may be suppressed via the SOD pathway.

Mud therapy and rehabilitation - scientific relevance in the last six years (2015 – 2020) Systematic literature review and meta-analysis based on the PRISMA paradigm

Abstract Background. Balneotherapy is a stimulation - adaptation treatment method applied in the forms of bathing, drinking, and inhalation cures performed with natural therapeutic factors, a method which is acting in three main ways: thermally, mechanically, and chemically. Mud or peloids are natural therapeutic factors formed by natural processes under the influence of biological and geological phenomena, which in a finely dissolved state and mixed with water (mud) are used in medical practice in the form of baths or local procedures. Objective. This systematic review aims to rigorously select related articles and identify within their content, the main possible uses of therapeutic mud and physiological mechanisms, to see the main region of scientific interest for pelotherapy, and to discuss the value of mud therapy in rehabilitation medicine. Methods. The working method is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for open-access articles published in English, between January 2015 and December 2020, from the following databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the latter was also used to identify ISI indexed articles). The contextually searched syntax used was ”Pelotherapy/Peloidotherapy/Mud-therapy/ /Fango-therapy AND Rehabilitation”. The selected articles were analyzed in detail regarding pathologies addressed by mud therapy and country scientific relevance for this therapeutic method. The meta-analysis proceeded was designated to estimate the prevalence of various pathologies in the use of mud therapy. Results. Our search identified, first, 394 articles. Based on the successive filtering stages and, respectively, on the classification criteria of the Physiotherapy Evidence Database (PEDro), we finally identified/retained and analyzed 68 articles. Although, in principle, a rigorous method – and we have followed the PRISMA type paradigm – there still might be some missing works of our related article selection. On the other hand, to augment/ consolidate our documentation base, we have used also 40 papers freely found in the literature, and even – aiming, too, at an as exhaustive knowledge underpinning as possible – derogatively, we have also considered some articles which, probably being very new, couldn't yet have reached the PEDro threshold score we have settled. Conclusions. This paper overviews the current state-of-the-art knowledge in the approach of peloidotherapy in rehabilitation, with a focal point on the therapeutic properties of peloids. Keywords: mud-therapy, pelotherapy, peloidotherapy, fango therapy, rehabilitation, balneotherapy, natural therapeutic factors,

Rheumatology in Ukraine

Rheumatology in Ukraine is based on established research and clinical infrastructure that enable the integration with regional and global societies. This article overviews current state of Ukrainian rheumatology, important steps toward expanding clinical settings, and opportunities for strengthening cooperation of local rheumatologists and patients with rheumatic diseases with related international societies. The main achievements and some challenges encountered by the Association of Rheumatologists of Ukraine are outlined. The Association supports continuing medical education of local specialists and explores options for advancing research and publishing in rheumatology. One of the main challenges still remains the creation of registries of patients with rheumatic diseases and expansion of activities of public societies with interest in combating rheumatic diseases. The issue of inadequate access to immunobiological therapies is also highlighted.

Prevalence of osteoarthritis and association between smoking patterns and osteoarthritis in China: a cross-sectional study

Objective

The aims of this study were to estimate the prevalence of radiographic osteoarthritis (OA) and to assess the association between smoking patterns and OA prevalence in adults aged 50 years or older belonging to the Shanxi province of China.

Methods

A cross-sectional study in the rural regions of the Shanxi province was conducted among 2638 Chinese adults (aged ≥50 years). Demographic characteristics and behavioral information were collected through epidemiological surveys. All participants with joint pain underwent plain radiographic examination and were diagnosed by a professional orthopedist. Associations between smoking patterns and the prevalence of OA were assessed using binary logistic regression modeling.

Results

Among 2638 individuals (men, 50.3% and women, 49.7%; mean age, 61.5 years) included in the analysis, 49.8% had radiographic OA and 27.5% had knee OA. The prevalence of radiographic OA was higher in women than in men (P<0.001). After adjusting for potential confounding factors, there was a nonsignificant correlation between smoking and OA prevalence in the multivariate model. Odds ratios (ORs) for all types of OA and knee OA were higher in active and passive smokers than in nonsmoking individuals after adjustments (OR 1.374; 95% confidence interval [CI] 1.049–1.802; OR 1.440; 95% CI 1.059–1.958, respectively).

Conclusions

This study showed that smoking may not be an independent risk factor for OA; however, there was a positive correlation between active and passive smoking and OA.

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

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.

Review of Prospects of Biological Fluid Biomarkers in Osteoarthritis

Osteoarthritis (OA) is a degenerative disease of the joints and is one of the leading causes of disability in adults. However, there are no key therapeutics for OA and medical treatment is based on managing the symptoms and slowing down progression of the disease. Diagnostics based on clinical examination and radiography have provided little information about metabolic changes in joint tissues, disease onset and progression. Due to lack of effective methods for early detection and evaluation of treatment outcome, the measurement of biochemical markers (biomarkers) shows promise as a prospective method aiding in disease monitoring. OA biomarkers that are present in biological fluids such as blood, urine and synovial fluid, sources that are easily isolated from body, are of particular interest. Moreover, there are increasingly more studies identifying and developing new biomarkers for OA. In this review, efforts have been made to summarize the biomarkers that have been reported in recent studies on patients. We also tried to classify biomarkers according to tissue metabolism (bone, cartilage and synovial metabolism markers), pathological pathways (inflammatory and genetic markers) and biological function (chemokines, growth factors, acute phase proteins, etc.).