Mineral bath, mud therapy may improve symptoms, function in knee OA patients

Balneotherapy and peloid therapy demonstrated efficacy in reducing pain and improving function in patients with knee osteoarthritis (OA) as opposed to physical therapy (PT) alone, a study has shown.

A combination of pharmaceutical and non-pharmaceutical measures has been recommended to effectively relieve pain, slow down disease progression, and improve function in individuals with knee OA. [Semin Arthritis Rheum 2014;44:253-263]

Therefore, the team sought to evaluate the potential of balneotherapy (natural mineral and/or thermal water baths) and peloid therapy (mud bath) – which have been used as natural remedies for musculoskeletal diseases – in this setting when combined with the most common* non-pharmaceutical alternatives. [Clin Rheumatol 2015;34:207-214; Eur J Integr Med 2017;9:148-150]

Ninety-two participants (mean age 64.6 years, 87 percent female) were randomized 1:1:1 to receive 10 30-minute PT sessions** either alone (control arm), or in combination (intervention arms) with balneotherapy*** or peloid therapy^# on alternate days. [Int J Biometeorol 2020;64:955-964]

Following treatment, compared with the control arm, significantly greater changes were seen in both intervention arms in terms of walking speed (0.20 [water] and 0.19 [mud] vs −0.24 m/sec; p<0.001 for both) and test of five sit-downs/stand-ups (3.83 vs 1.98; p=0.005 [bath] and 4.24 vs 1.98; p=0.002 [mud]).

Both interventions also significantly outdid control in terms of left leg flexion range (16.2 [water] and 16.8 [mud] vs 5.4 degrees), and flexor (1.12 and 1.04 vs 0.0) and extensor strength scores (1.20 and 1.25 vs 0.07). Results for the right leg similarly favoured both interventions over control (19.0 and 17.2 vs 5.1 degrees [flexion range], 1.17 and 1.08 vs 0.0 [flexor strength score], and 1.0 and 1.13 vs 0.07 [extensor strength score]; p<0.001 for all).

These effects were sustained up to a month after treatment (p<0.001 for all the above parameters).

As per KOOS^## questionnaire, stiffness was better in both intervention arms vs the control arm after treatment (67 vs 53; p=0.009 [water] and 64 vs 53; p=0.05 [mud]) and a month thereafter (70 vs 54; p=0.001 and 69 vs 54; p=0.004, respectively). Water bath fared better than PT alone in improving symptoms and pain after treatment (66 vs 54; p=0.02 [symptoms] and 65 vs 51; p=0.009 [pain]) and a month thereafter (67 vs 54; p=0.01 and 65 vs 52; p=0.01, respectively).

Harnessing the power of nature

Evidence has shown that sulphur mineral baths are superior to freshwater baths in reducing pain and stiffness in the long-term. [Eur J Phys Rehabil Med 2016;52:422-430] Other data reflect similarities between mud therapy and thermal packs in reducing pain and stiffness in individuals with knee OA. [Rheumatol Int 2018;38:1807-1824] “[These suggest] that the positive impact of mud packs [and mineral baths were] likely attributable to thermal effect,” noted the researchers.

“[Our findings] coincide with the results of the aforementioned studies. [M]ineral sodium chloride baths, peat mud applications, together with PT, were more effective than PT alone,” they said. All modalities were safe and well-tolerated, with no adverse effects observed, they added.

However, despite growing evidence reflecting the positive effects of natural alternatives, their roles in the OA treatment landscape remain unclear, they pointed out. Although EULAR^### 2003 recommendations included spa therapy in the list of non-pharmacological approaches for managing OA, the updated 2013 recommendations had no mention of it. [Ann Rheum Dis 2013;72:1125-1135; Ann Rheum Dis 2003;62:1145-1155]

The results also cannot be generalized to all knee OA stages, as the study included patients with mild-to-moderate knee OA, they added. As such, the team called for further probing in larger and longer trials to shed more light on the role of natural remedies in this setting, as well as in individuals with severe knee OA.