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Balneotherapy for rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

Balneotherapy (spa therapy or mineral baths) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain, improve joint motion and as a consequence to relieve patients' suffering and make them feel well. In this update we included one extra study.

Objectives

To assess the effectiveness of balneotherapy for rheumatoid arthritis.

Search methods

We searched the following databases up to October 2006: CENTRAL (Issue 3, 2006), PubMed, CINAHL, the database from the Cochrane 'Rehabilitation and Related Therapies' Field and Pedro. We also performed reference checking and personal communications with authors to retrieve eligible studies.

Selection criteria

Randomised controlled trials comparing balneotherapy with any other intervention or with no intervention.
Included patients were all suffering from definite or classical rheumatoid arthritis as defined by the American Rheumatism Association Criteria or by the criteria of Steinbrocker. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be among the main outcome measures.

Data collection and analysis

Two authors independently assessed quality and extracted data. Disagreements were solved by consensus.

Main results

One extra study is included in this update. Now seven trials (412 patients) were included in this review. Most trials reported positive findings on their main outcomes, but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. None of the trials performed an intention-to-treat analysis and only two performed a comparison of effects between groups.
Pooling of the data was not performed because of heterogeneity of the studies, multiple outcome measurements, and the overall poor data presentation.
We found a significant benefit of mineral baths compared to Cyclosporine A at eight weeks on pain in one study (RR=2.4; 95%CI: 1.4,3.8).

Overall there is insufficient evidence that balneotherapy is more effective than no treatment, that one type of bath is more effective than another, or that one type of bath is more effective than mudpacks, exercises or relaxation therapy.

Authors' conclusions

Silver level evidence was found for one study in favour of mineral baths compared to drug treatment at eight weeks. Insufficient evidence was found for all other comparisons. However the scientific evidence is insufficient because of poor methodological quality. Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws, an answer about the apparent effectiveness of balneotherapy cannot be provided at this moment.

摘要

背景

類風濕性關節炎的浴療法

浴療法﹝溫泉療法或礦泉療法﹞是治療關節炎的古老療法之一,浴療法的目標之一為緩解疼痛,及增進關節活動度以減輕病患的痛苦,在這個更新包括了1項其他的研究。

目標

評估浴療法對類風濕性關節炎的療效。

搜尋策略

我們於搜尋2006年10月前資料庫: CENTRAL (Issue 3, 2006)、PubMed、 CINAHL,其資料庫來自Cochrane Rehabilitation and Related Therapies Field 及Pedro。我們並檢查參考文獻,並與作者進行私人連繫以獲得合乎標準的研究。

選擇標準

包含浴療法的隨機對照試驗,所有患者皆為以美國風濕學會標準或Steinbrocker標準確診或典型的類風濕性關節炎。主要結果評估至少包括一項WHO/ILAR的核心結果指標。

資料收集與分析

2個作者分別評估試驗品質跟擷取數據,意見不一致者由兩者之共識決定。

主要結論

本篇更新加入一項其他的研究,7個研究﹝412例病患﹞包含於回顧中。大部分研究報告正向結果,但有某種程度之研究方法缺失。2篇試驗報告生活品質的結果,沒有任何研究採用意圖治療分析﹝ITT analysis﹞,且只有2個研究比較組間差異。因研究間有異質性,多項結果指標,及整體呈現資料不佳,因此未綜合分析結果。有一篇礦泉療法在8週時,在疼痛方面優於 Cyclosporine A (相對危險RR = 2.4 5% 信賴區間CI: 1.4, 3.8)。整體而言,浴療法的療效證據不充分,並未顯示比未治療好,也未顯現某種浴療比另一種浴療法好,或比泥巴浴mudpacks、運動、放鬆治療好。

作者結論

在一個研究當中所發現的銀級證據顯示:第八周時,相較於藥物治療,較偏好採用礦泉療法。其他的比較則證據不足。不過由於研究品質不良,科學證據並不足夠。因此,應該小心看待所提出的陽性結果。鑒於研究方法缺失,此刻仍無法回答浴療法確實療效。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

類風濕性關節炎之浴療法或是溫泉療法SPA療法。這篇Cochrane回顧呈現了從研究當中,所知關於類風濕性關節炎浴療法的效益。 這篇回顧顯示對於患有類風濕性關節炎患者而言: ■氡碳酸泉浴(Radoncarbon dioxin baths)與碳酸泉浴(carbon dioxin baths)相比,在疼痛方面沒有差異(只可能在第6個月)。 ■自來水浴(Tap water baths)與陸上運動、伸展運動相比,在疼痛方面沒有差異。 ■礦泉療法與服用Cyclosporine A藥物相比,在第8周時會有顯著的差異,不過可能也會造成副作用。 ■硫磺浴或死海浴與無治療相比,病人的整體感受並沒有差異。 ■這些研究當中,並沒有評估:關節腫脹疼痛、發炎(急性期反應物質)、醫師診斷整體健康情況、關節X光片及其他實驗室診斷項目。 ■沒有足夠證據顯示礦泉療法相較於服用Cyclosporine A藥物能夠提升病人整體感受。沒有足夠證據顯示可以透過不同的浴療法改善身體失能。 ■類風濕性關節炎與浴療法是什麼? 類風濕性關節炎是一種免疫系統(通常作用是抵抗感染)攻擊關節組織的疾病,使得關節腫脹、僵硬以及疼痛。一般來說手部與足部的小關節首先遭受影響。目前並沒有治癒類風濕性關節炎方法,因此目前的處置目標為緩解疼痛、僵直並且改善活動力。浴療法 (又稱礦泉療法或溫泉療法spa治療)是個古老並且廣受觀迎的療法。其方法是花時間浸泡在一個室內水池,水池溫度為攝氏31度∼36度(華氏88 – 97度);該療法使用的水質有很多種類,譬如氡或碳酸泉。

Plain language summary

Balneotherapy or spa-therapy for Rheumatoid Arthritis

This summary of a Cochrane review presents what we know from research about the effect of Balneotherapy for Rheumatoid Arthritis (RA).
The review shows that in people with RA:

- Radon-carbon dioxin baths compared with carbon dioxin baths may not lead to any difference in pain on the short-term, only possibly at 6 months.
- Tap water baths compared to land exercises or relaxation may not lead to any difference in pain.
- Mineral baths compared with taking the drug Cyclosporine A may lead to a significant difference in pain at 8 weeks, but may also lead to some side effects .
- Sulfur baths or Dead Sea baths compared to no treatment may not lead to any difference in the way people feel overall.

Swollen or tender joints, inflammation (acute phase reactants), the doctor's assessment of overall well-being, x-rays of joints and other laboratory tests were not measured in these studies.

Not enough data was provide to tell whether mineral baths would improve how people feel overall compared with taking the drug Cyclosporine A.

Not enough data was provided to tell whether physical disability would improve with various forms of balneotherapy.

What is RA and what is Balneotherapy?

In rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for RA at present, so the treatments aim to relieve pain and stiffness and improve your ability to move.

Balneotherapy (also called mineral baths or spa-therapy) is an ancient and popular therapy. It involves spending time in an indoor pool filled with mineral water at temperature of between 31 to 36 degrees Celsius (88 to 97 degrees Farenheit). Different types of mineral water can be used in this therapy, for example, radon or carbon dioxin.

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