1118 TheJournalofRheumatology2008;35:6 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2008. All rights reserved. Balneotherapy for Osteoarthritis. A Cochrane Review ARIANNE VERHAGEN, SITABIERMA-ZEINSTRA, JOHAN LAMBECK, JEFFERSON ROSACARDOSO, ROBdeBIE,MAARTENBOERS,andHENRICAC.W.deVET ABSTRACT. Objective.Balneotherapy(orspatherapy,mineralbaths)forpatientswitharthritisisoneoftheold- est forms of therapy. We assessed effectiveness of balneotherapy for patients with osteoarthritis (OA). Methods. We performed a broad search strategy to retrieve eligible studies, selecting randomized controlledtrialscomparingbalneotherapywithanyinterventionorwithnointervention.Twoauthors independently assessed quality and extracted data. Disagreements were solved by consensus. In the event of clinical heterogeneity or lack of data we refrained from statistical pooling. Results.Seventrials(498patients)wereincludedinthisreview:oneperformedanintention-to-treat analysis, 2 provided data for our own analysis, and one reported a “quality of life” outcome. We found silver-level evidence of mineral baths compared to no treatment (effect sizes 0.34–1.82). Adverse events were not measured or found in included trials. Conclusion.Wefoundsilver-levelevidenceconcerningthebeneficialeffectsofmineralbathscom- pared to no treatment. Of all other balneological treatments, no clear effects were found. However, thescientificevidenceisweakbecauseofthepoormethodologicalqualityandtheabsenceofanade- quate statistical analysis and data presentation. (First Release May 1 2008; J Rheumatol 2008;35:1118–23) KeyIndexingTerms: OSTEOARTHRITIS METAANALYSIS BALNEOTHERAPY SYSTEMATICREVIEW FromtheDepartmentofGeneralPractice,ErasmusMedicalCentre University,Rotterdam;TheHalliwick-HydrotherapyInstitute,VMMalden, TheNetherlands;PhysicalTherapyDepartment,UniversidadeEstadual deLondrina,Londrina,Brazil;DepartmentofEpidemiology,Maastricht University,Maastricht;DepartmentofClinicalEpidemiologyand Biostatistics,VUUniversityMedicalCentre;andEMGO-Institute,VU UniversityMedicalCentre,Amsterdam,TheNetherlands. A.P.Verhagen,PhD;S.M.A.Bierma-Zeinstra,PhD,Departmentof GeneralPractice,ErasmusMedicalCentreUniversity;J.Lambeck,PT, Halliwick-HydrotherapyInstitute;J.R.Cardoso,PT,PhysicalTherapy Department,UniversidadeEstadualdeLondrina;R.A.deBie,PhD, Professor,DepartmentofEpidemiology,MaastrichtUniversity;M.Boers, MD,PhD,Professor,DepartmentofClinicalEpidemiologyand Biostatistics,VUUniversityMedicalCentre;H.C.W.deVet,PhD, Professor,VUUniversityMedicalCentre. AddressreprintrequeststoDr.A.P.Verhagen,DepartmentofGeneral Practice,ErasmusMedicalCentreUniversity,POBox2040,3000CA Rotterdam,TheNetherlands.E-mail:a.verhagen@erasmusmc.nl Based on a Cochrane Review published in The Cochrane Library 2007, Issue 4 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as newevidenceemergesandinresponsetofeedbackandThe Cochrane Library should be consulted for the most recent versionofthereview. Osteoarthritis (OA) is a degenerative joint disease marked by degeneration of the articular cartilage, hypertro- phy of bone at the margins, and changes in the synovial membrane 1 .OAisoneofthemostcommonformsofarthri- tisandaffectsmenandwomenequally.FormanyadultsOA isoneofthemostimportantcausesoflongtermdisability 1,2 . While it can involve any joint, OA usually affects the hips, knees, hands, and spine. The knee appears to be the joint most prone to the development of OA 3 . This may be because it is a major weight-bearing joint, and prone to effects of obesity, trauma, as well as metabolic diseases 4 . Movement or weight-bearing exacerbates pain in the knee. Stiffness, edema and deformity, and reduced function such asinwalkingarecommoncomplaintsinpatientswithOAof the knee. There is no cure for OA at present, so treatment often focusesonmanagementofsymptomssuchaspain,stiffness, and mobility. Treatment options include pharmacological interventions, physiotherapy treatments, or balneotherapy. The term balneotherapy, from the Latin balneum (bath) and classically used to mean bathing in thermal or mineral waters,hasbeendistinguishedfromhydrotherapy;sincethe beginningofthiscentury,however,bothtermswereaccept- ed for all forms of treatment with water 5 . We use the term balneotherapy since bathing for therapeutic use very often happens in spas. The water (thermal, sea, or tap water) is generallyusedatatemperatureofaround34°C 6 .Thehydro- static force (Archimedes’ principle) brings about relative pain relief by reducing loading 6 ; the water reduces gravity on painful and rheumatic joints. Bathinginwater(balneotherapyorspatherapy)wasfre- quently used in classical medicine as a cure for diseases. Water from mineral and thermal springs was particularly valued 7 . In Homeric times baths were applied primarily to cleanseandrefresh.AtthetimeofHippocrates,bathingwas regarded as more than a simple hygienic measure. It was considered beneficial to cure most illnesses 8 . The Romans used water for therapeutic treatment of orthopedic condi- tions, but after the Roman era spa therapy fell into disuse. www.jrheum.org Downloaded on November 18, 2022 from