1. Effect of balneotherapy on plasma cytokine levels
Dr. Gabriella Mészáros, Dr. György Nagy Ph.D.
Polyclinic of the Hospitaller Brothers of the St. John of God in Budapest
Semmelweis University, I. Dept. of Rheumatology

2. Mud Pack Therapy and Thermal Bath
Chronic low back pain
Osteoarthritis
Fibromyalgia
Rheumatoid arthritis
Spondylarthritis ankylopoetica
Arthropathia psoriatica

3. Mud Pack Therapy and Thermal Bath
Effect of mud-pack and thermal bath
treatment
Physical-thermal effects
Chemical effects
Biological / molecular changes

4. Mud Pack Therapy and Thermal Bath in
Rheumatoid Arthritis 1 . .
Cosh (1982) : spa treatment is recommended only in remission . .
Elkayam (1991)
Sukenik (1992)
Shlomi (2003)
Thermal bath, mud pack treatment or
combination .

5. Mud Pack Therapy and Thermal Bath in
Rheumatoid Arthritis 2 .
Reducing objective and subjective parameters
of activity and severity
Morning stiffness, hand grip strength, activities of daily
living, patient self-assessment of disease severity,
reduction in number of active joints, Ritchie index.

6. Mud Pack Therapy and Thermal Bath in
Rheumatoid Arthritis 3 .
Bellometti (2000): se NO , se MPO , se GSH-peroxidase level -
-37 Rheumatoid arthritis patients- mud bath treatment (20’,45°C, daily)
 bath (20’, 38°C, daily)
Background: NO (nitric-oxid):
- produced by chondrocytes, fibroblasts, endothel cells affected by
pro-inflammatory cytokines (eg.:TNF-; IL-1);
- inhibits collagen and proteoglycan synthesis;
- activates MMP-s;
- induces apoptosis.
-se nitrate (>18,6 mol/l), nitrite (>1,7 mol/l) concentrations are higher in RA than
in healthy controls (p<0.01).
-in active RA the serum level of nitrate and nitrite are higher than
in remission (p<0.01).
Degradation
of articular
cartilage
(Y Ersoy Ann Rheum Dis 2002)

7. Mud Pack Therapy and Thermal Bath in Rheumatoid Arthritis 4 .
Cozzi (2004): Lewis rat adjuvant-arthritis (subplantar FCA inj.)
macrophage activation , pro-inflammatory cytokines 
expansion of autoreactive T-and B-cells +
mud (15 min; 40-42°C)- thermal bath (10 min, 37-38°C)

8. TNF- IL-1 Time/day Time/day Mud-bath p<0,05 vs control Mud-bath
/F. Cozzi et al. Clinical and Exp. Rheumatology 2004 /

9. Mud Pack Therapy and Thermal Bath in
Rheumatoid Arthritis 5.
Thermal effect
Minerals
(trace elements)
Muscle-tone
Joint mobility
Pain intensity
Neuroendocrine- system
-endorphine, ACTH,
cortisol
Antiinflammatory effect
Reduction of objective and subjective indices
Change of some cytokines/
biochemical marker‘s levels
(Jezova 1985)
(Bender T )
Skin microcirculation 
pl.:NO , MPO ,
IGF-1 
(Bellometti 1998)
TNF-α , IL-1β  (Bellometti 1997)
PGE2  (Bellometti 1998)
Leukotriene B4 
Hydromechanical effect
Tissue compresses
Zn ?
Trace elements?

10. Mud Pack Therapy and Thermal Bath in Osteoarthritis 1 .
OA patomechanisms
Kelley’s Textbook of Rheumatology

11. Mud Pack Therapy and Thermal Bath in
Osteoarthritis 2 . .
Elkayam (1991)
Wigler (1995) .
Bath and mud pack treatments on the
knees .
Index of severity, night pain, tenderness on palpation
and pain on motion.

12. Mud Pack Therapy and Thermal Bath in Osteoarthritis 3 .
Bellometti (1997):
-22 osteoarthritis patients a total of 12 mud pack treatments (20’,40°C, daily)+ bath (10-12’,37-38°C, total of 12 days, daily)
 22 control group of patient - bath (10-12’,37-38°C, daily, total of 12)
-se IGF-1 and se TNF- level 30 min. before the first and
2 hours after the last (12 th ) treatment;

13. Mud Pack Therapy and Thermal Bath in Osteoarthritis 4 .
TNF-
pg/ml
IGF-1
ng/ml
120
100 80 60 40 20
Before treatment
IGF-1
TNF-
After treatment
p<0,01
Bellometti Clinica Chimica Acta (1997)

14. Mud Pack Therapy and Thermal Bath in Osteoarthrosis 5 .
Bellometti (2005): MMP-3 , MMP 8,9 
50 patients with osteoarthritis
I. group: mud bath therapy (20’,40° C,5 times)
II.group: mud bath therapy (20’,40°C,10 times)
 30 patients with osteoarthritis- control group
-Values of MMP-1,-2,-3,-8,-9, TIMP-1,-2
se MMP-3 value  in the II.group  Control group (p<0,05)

15. Conclusion

16. Mud packs treatment
and thermal bath
Kelley’s Textbook of Rheumatology

17. Thank You for Your Attention!