Nuran EYVAZ

ROMATİZMAL HASTALIKLARDA KAPLICA TEDAVİSİ

Kaplıca tedavisi birçok hastalığın tedavisinde olduğu gibi kronik romatizmal hastalıkların yönetiminde de önemli bir rol oynamaktadır. Etki mekanizması kimyasal, termal, mekanik ve immünmodülatör olmak üzere geniş bir spektrum içermektedir. Son yıllarda balneoterapinin tek başına veya diğer geleneksel tıbbi tedavilere tamamlayıcı olarak önemi giderek artmaktadır. Çeşitli araştırmalardan elde edilen sonuçlar balneoterapinin faydalı etkilerini ortaya koymaktadır. Bu çalışmada, laboratuar parametreleri ve klinik açıdan yapılan çalışmalar gözden geçirilerek, romatizmal hastalıklarda kaplıca tedavisinin etkisi güncel bilgiler ışığında sunulmuştur.

Anahtar Kelimeler:

Kaplıca Tedavisi, spa terapisi

BALNEOTHERAPY IN RHEUMATIC DISEASES

Balneotherapy is defined as application of drinking cures, inhalation cures, baths or application of mud and other natural peloid packs to benefit from the therapeutic effects of thermal or mineral ground water. The term balneotherapy, the term spa therapy, or spa treatment are terms used interchangeably. Balneotherapy can be applied at spa centers within spa therapy programs at regular intervals in the form of cure programs. It plays an important role in the management of chronic rheumatic diseases as well as in the treatment of many chronic diseases. Therapeutic effect of thermal spring water used in spa treatment according to physical, chemical composition and temperature varies. Turkey constitutes a rich resource with many spa centers indifferent locations. These centers have a wide range of thermal and mineral waters with various contents such as sulfur, radon, bicarbonate, carbondioxide, etc. Although it cannot be fully clarified due to various views on the mechanism of action of balneotherapy, the predictable mechanisms of action includes a broad spectrum of chemicals, thermal, mechanical and ımmunomodulatory. The aim of treatment in rheumatic diseases is to reduce pain, prevent joint damage and functional loss. Despite the recent improvements achieved in pharmacologic therapies, it is still not possible to prevent the deterioration of the quality of life and labor loss caused by functional losses due to rheumaticdiseases. At this point in the management of rheumatic diseases the importance of balneotherapy alone or as a complementary to other traditional medical therapies has increased in recent years. Results from several studies suggest that the beneficial effects of balneotherapy on functional losses. In this review, studies which obtains the laboratory parameters and clinical test are reconsidered and the effect of spa treatment in rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and osteoarthritis are presented in the light of current information.

Keywords:

Balneotherapy; spa therapy; rheumatic diseases,

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1. Fioravanti A, Cantarini L, Guidelli GM, et al. Mechanisms of action of spa therapies in rheumatic diseases: What scientific evidence is there? Rheumatol Int. 2011;31(1):1–8.
2. Dündar Ü, Kavuncu V. Balneotherapy in Osteoarthritis.. Türkiye Klinikleri JPM&R-Special Topics 2008;1(2):69-74.
3. Öncel S. the Effectiveness of Balneotherapy in Prevention and Treatment of Osteoarthritis. Türk Geriatr Derg. 2011;14(1):111–7.
4. Beyazova M, Gökçe-Kutsal Y (editorler). Fiziksel Tıp ve Rehabilitasyo. In: Karagülle Z. Kaplıca tedavisi, balneoterapi, hidroterapi. Ankara; Güneş Kitabevi. 2000;878–908.
5. Matz H, Orion E, Wolf R. Balneotherapy in dermatology. Dermatol Ther. 2003;16(2):132–40.
6. Nasermoaddeli A, Kagamimori S. Balneotherapy in medicine: A review. Environ Health Prev Med. 2005;10(4):171–9.
7. Becker BE. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications. PM R. 2009;1(9):859–72.
8. Cımbız, A., Beydemir, F., Manisalıgil, Ü. et al. Kaplıca tedavisinin akut kardiyopulmoner etkilerinin değerlendirilmesi. Dumlupınar Üniversitesi Fen Bilimleri Enstitüsü Dergisi 006: 27-42.
9. Becker BE. The biologic aspects of hydrotherapy. J Back Musculoskelet Rehabil. 1994;4(4):255–64.
10. Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150(3699):971–9.
11. Karaca Ş, Kulaç M, Özel H, Kavuncu V. Dermatolojide Balneo-Foto-Terapi Balneo-Photo-Therapy In Dermatology.Kocatepe Tıp Derg. 2005;7–15.
12. Hizmetli S. Yaşlılara Yönelik Hidroklimatoloji Balneoterapi Uygulamaları. Türk Fiz Tıp Rehab Derg. 2009;(10):100–3.
13. Fioravanti A, Iacoponi F, Bellisai B, Cantarini L, Galeazzi M. Short- and long-term effects of spa therapy in knee osteoarthritis. Am J Phys Med Rehabil. 2010;89(2):125–32.
14. Gaál J, Varga J, Dsci ZS, Kurkó J. Balneotherapy in elderly patients : Effect on pain from degenerative knee and spine conditions and on quality of life. Isr Med Assoc J. 2008;10(5):365-9.
15. Pagourelias ED, Zorou PG, Tsaligopoulos M, Athyros VG, Karagiannis A, Efthimiadis GK. Carbon dioxide balneotherapy and cardiovascular disease. Int J Biometeorol. 2011;55(5):657–63.
16. Carbajo JM, Maraver F. Sulphurous mineral waters: New applications for health. Evidence-based Complement Altern Med. 2017;(4):1-11.
17. Sukenik S, Buskila D, Neumann L et al. Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area. Ann Rheum Dis. 1990;49(2):99-102.
18. Yamaoka K, Mitsunobu F, Hanamoto K, Shibuya K, Mori S, Tanizaki Y, et al. Biochemical comparison between radon effects and thermal effects on humans in radon hot spring therapy. J Radiat Res. 2004;45(1):83–8.
19. Franke A, Reiner L, Resch KL. Long-term benefit of radon spa therapy in the rehabilitation of rheumatoid arthritis: A randomised, double-blinded trial. Rheumatol Int. 2007;27(8):703–13.
20. Tenti S, Fioravanti A, Guidelli GM et al. New evidence on mechanisms of action of spa therapy in rheumatic diseases. Tang (Humanitas Medicine). 2014;4(1):1–8.
21. Burguera EF, Vela-Anero Á, Magalhães J et al. Effect of hydrogen sulfide sources on inflammation and catabolic markers on interleukin 1β-stimulated human articular chondrocytes. Osteoarthr Carti. 2014;22(7):1026–35.
22. Odabasi E, Turan M, Erdem H et al. Does Md Pack Treatment Have Any Chemical Effect? A Randomized Controlled Clinical Study. J Altern Complement Med. 2008;14(5):559–65.
23. Ortega E, Gálvez I. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients : regulation of the altered inflammatory and stress feedback response. Int J Biometeorol. 2017; 61(10):1777-85.
24. Bellometti S, Cecchettin M, Galzigna L. Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. Clin Chim Acta. 1997;268(1-2):101–6.
25. Bellometti S, Galzigna L. Serum levels of a prostaglandin and a leukotriene after thermal mud pack therapy. Journal of investigative medicine: the official publication of the American Federation for Clin Res, 1998; 46: 140-5.
26. Bellometti S, Poletto M, Gregotti C et al. F. Mud bath therapy influences nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients. Int J Clin Pharmacol Res. 2000;20(3–4):69–80.
27. Xu L, Wu L, Liu T et al. Effect of a 21-day balneotherapy program on blood cell counts , ponogen levels , and blood biochemical indexes in servicemen in sub-health condition. J Phys Ther Sci. 2017;29(9):1573–7.
28. Shehata M, Schwarzmeier JD, Hilgarth M, D et al. Effect of combined spa-exercise therapy on circulating TGF-β1 levels in patients with ankylosing spondylitis. Wien Klin Wochenschr. 2006;118(9–10):266–72.
29. Elkayam O, Wigler I, Tishler M, et al. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1991;18(12):1799–803.
30. Van Tubergen A, Boonen A, Landewé R, et al. Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: A randomized controlled trial. Arthritis Care Res (Hoboken). 2002;47(5):459–67.
31. Altan L, Bingöl Ü, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol. 2006;35(4):283–9.
32. Dagfinrud H, Kb H, Tk K. Physiotherapy interventions for ankylosing spondylitis ( Review ). Pshysiotherapy Interv Ankyl spondylitis. 2009;(1):1–45.
33. Van Der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91.
34. Colina M, Ciancio G, Garavini R, et al. Combination treatment with etanercept and an intensive spa rehabilitation program in active ankylosing spondylitis. Int J Immunopathol Pharmacol. 2009;22(4):1125–9.
35. Ciprian L, Lo Nigro A, Rizzo M, et al. The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int. 2013;33(1):241–5.
36. Sukenik S, Flusser D, Abu-shakra M. Balneotherapy in autoimmune disease. Isr J Med Sci. 1997 ;33(4):258-61.
37. Codish S, Abu-Shakra M, Flusser D, Friger M, Sukenik S. Mud compress therapy for the hands of patients with rheumatoid arthritis. Rheumatol Int. 2005;25(1):49–54.,
38. Jaroslav Stančiak, Jozef Novotný. The Quality of life of the patients with rheumatoid arthritis before and after balneotherapy. J Heal Sci. 2015;3(5):232–40.
39. Karagülle M, Kardeş S, Karagülle MZ. Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients. Int J Biometeorol. 2017;61(11):1945–56.
40. Santos I, Cantista P, Vasconcelos C. Balneotherapy in rheumatoid arthritis—a systematic review. Int J Biometeorol. 2016;60(8):1287–301.
41. Elkayam O, Ophir J, Brener S, et al. Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis. Rheumatol Int. 2000;19(3):77–82.
42. Cozzi F, Raffeiner B, Beltrame V, et al. Effects of mud-bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound (CEUS). Jt Bone Spine. 2015;82(2):104–8.
43. Forestier R, Erol Forestier FB, Francon A. Spa therapy and knee osteoarthritis: A systematic review. Ann Phys Rehabil Med. 2016;59(3):216–26.
44. Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M. Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol. 2012;56(4):583–90.
45. Cozzi F, Ciprian L, Carrara M, et al. Balneotherapy in chronic inflammatory rheumatic diseases—a narrative review. Int J Biometeorol. 2018;62(12):2065–71.