Rheumatol Int (2007) 27:523–529 DOI 10.1007/s00296-006-0266-5 123 ORIGINAL ARTICLE Therapeutic eVect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial Luca Cantarini · Graziana Leo · Chiara Giannitti · Gabriele Cevenini · Pietro Barberini · Antonella Fioravanti Received: 10 February 2006 / Accepted: 18 October 2006 / Published online: 15 November 2006  Springer-Verlag 2006 Abstract Spa therapy and short wave therapy are two of the most commonly used non-pharmacological approaches for osteoarthritis. The aim of this study was to assess their eYcacy in comparison to conventional therapy in patients with osteoarthritis of the knee in a single blind, randomized, controlled trial. Seventy-four outpatients were enrolled; 30 patients were treated with a combination of daily local mud packs and arsen- ical ferruginous mineral bath water from the thermal resort of Levico Terme (Trento, Italy) for 3 weeks; 24 patients were treated with short wave therapy for the same period and 20 patients continued regular, routine ambulatory care. Patients were assessed at baseline, upon completion of the 3-week treatment period, and 12 weeks later. Spa therapy and short wave therapy both demonstrated eVective symptomatic treatment in osteoarthritis of the knee at the end of the treatment, but only the spa therapy was shown to have eYcacy persistent over time. Our study demonstrated the supe- riority of arsenical ferruginous spa therapy compared to short wave therapy in the treatment of osteoarthritis of the knee, probably in relationship to the speciWc eVects of the minerals in this water. Keywords Knee osteoarthritis · Randomized clinical trial · Arsenical ferruginous waters · Spa therapy · Short wave therapy Introduction Osteoarthritis (OA) is the most common rheumatic disease in developed countries [1]. Conservative treatment of OA is mainly based on symptomatic drugs, such as analgesic or non-steroidal anti-inXammatory drugs (NSAIDs); adverse events are not rare, especially in older patients [2]. These motives often induce recourse to other com- plementary or alternative therapies [3]. Spa therapy is one of the most commonly used non- pharmacological approaches for OA. The eYcacy of spa treatments in rheumatic diseases has been bol- stered by ancient tradition, but in spite of their long history and popularity, only a few randomized, con- trolled trials on the use of these therapies in patients with rheumatic diseases have been conducted [4–11]. The mechanisms of action of mud packs and baths are not completely known, and it is diYcult to distin- guish the eYcacy of the thermal method from the ben- eWts that could be derived from a stay in the spa environment [12]. For this reason, spa treatments are still being dis- cussed and their role in modern medicine is still not clear [13]. Short wave therapy is another non-pharmacological treatment that is often used in the treatment of OA, L. Cantarini · G. Leo · C. Giannitti · A. Fioravanti (&) Rheumatology Unit, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy e-mail: Woravanti7@virgilio.it G. Cevenini Department of Surgery and Bioengineering, University of Siena, Siena, Italy P. Barberini Clinical Bioengineering, Azienda Ospedaliera Senese, Siena, Italy