1. Anti-oxidant status in patients with Rheumatoid Arthritis after Spa Therapy Dr. Mine Karagülle

2. Oxygen metabolism has an important role in the pathogenesis of rheumatoid arthritis. Reactive oxygen species (ROS) produced in the course of cellular oxidative phosphorylation, and by activated phagocytic cells during oxidative bursts, exceed the physiological buffering capacity and result in oxidative stress. The excessive production of ROS can damage protein, lipids, nucleic acids, and matrix components. They also serve as important intracellular signaling molecules that amplify the synovial inflammatory–proliferative response.

3. Plasma lipid peroxidation and antioxidant levels in patients with rheumatoid arthritis A.Kamanlı, M.Nazroğlu, N. Aydilek, C.Hacevliyagil Cell Biochem Funct 2004; 22: 53–57. increased lipid peroxidation and decreased enzymic and non-enzymic antioxidants in RA oxidant stress plays a very important role in the pathogenesis of RA.

4. Antioxidant status & lipid peroxidation in patients with rheumatoid arthritis F. Karataş, I. Özateş, H. Canatan, I. Halifeoğlu, M. Karatepe, R. Çolak Indian J Med Res 118, October 2003, pp 178-181 There was an increased oxidative stress and a low antioxidant status in patients with RA. These changes are probably due to efforts for reducing lipid peroxidation and hence to lower tissue damage.

5. This study aims to elucidate plasma oxidant/antioxidant status in patients with rheumatoid arthritis (RA). Fasting blood samples were obtained from 24 patients with RA and 20 control subjects. Antioxidant potential (AOP) value, nonenzymatic superoxide radical scavenger activity (NSSA), and malondialdehyde (MDA) levels were measured to establish plasma oxidant/antioxidant status in the patient and control groups.

6. Patients with RA had lower AOP and NSSA but higher MDA levels than those of the control subjects,

7. These results could be seen as an indication of reduced antioxidant capacity and oxidant stress in RA patients suggest that the antioxidant system is impaired and peroxidation reactions are accelerated in patients with RA

8. RA and Oxidation The antioxidant defense system is compromised in rheumatoid arthritis patients. There is a shift in the oxidant/antioxidant balance in favor of lipid peroxidation, which could lead to the tissue damage observed in the disease. Oxygen free radicals have been implicated as mediators of tissue damage in rheumatoid arthritis (RA). Therapeutic coadministration of antioxidants along with conventional drugs to such patients has been considered beneficial

9. Study We designed a study to elucidate plasma oxidant/antioxidant status in patients with rheumatoid arthritis (RA) who underwent a 2-week spa therapy course, with the aim of evaluating the antioxidant effects of such therapy

10. Study We included 50 patients with RA (ACR Criteria) who were already receiving conventional treatment and were randomly divided into two groups of 25 each.

11. Study Treatment group received spa therapy for 2 weeks in addition to conventional treatment Control group continued rutine conventional treatment

12. Study Fasting blood samples of patients of both groups were collected before and after the spa course for antioxidant potential (AOP) value, nonenzymatic superoxide radical scavenger activity (NSSA), and malondialdehyde (MDA) levels were measured as described by Durak et al.

13. Malondialdehyde (MDA) (nmol/ml) MDA is a product of lipid peroxidation and thereby functions as a marker of oxidative stress. The level of MDA in plasma or serum has been reported to be higher in RA patients than in control subjects an indication of oxidant stress in these patients.

14. Antioxidant Defense Potential (AOP) (nmol/ml h) To give a more comprehensive evaluation into oxidant/antioxidant status Developed by Durak et al (1999) expressed as nanomoles/milliliter-hour Patients with RA had lower AOP levels which is an indication of reduced antioxidant capacity in these patients.

15. Nonenzymatic Superoxide Radical Scavenger Activity (NSSA) (U/ml) To give a more comprehensive evaluation into oxidant/antioxidant status Developed by Durak et al (1999) expressed as Unites/milliliter Patients with RA had lower NSSA levels which is an indication of reduced antioxidant capacity in RA patients.

16. Results The levels of MDA, NSSA and AOP in our patients at the begining and after 2 weeks were in accordance with the levels found previous study of Durak et. but were somehow higher and lower than the levels of healthy controls (Durak et al)

17. Results; MDA nmol/mL After 2-week spa therapy; increased in SPA group, decreased in control group No statisticaly significant change intergroup (p=0.5) and beetween group (p=0.2) comparisons

18. Results; NSSA U/mL After 2-week spa therapy; increased in both groups Statisticaly significant increase in SPA group (p<0,05) No statisticaly significant change in control group (p=0,5) No statisticaly significant difference between the two groups (p=0,7)

19. Results; AOP U/mL After 2-week spa therapy; increased in both groups No statisticaly significant change intergroup and difference beetween group comparisons

20. Discussions As expected RA patients had higher levels of MDA and lower levels of NSSA and AOP than healthy controls Indicating that the antioxidant system is impaired and peroxidation reactions are accelerated in patients with RA

21. Discussions After a 2-week spa therapy period MDA levels increased although not statisticaly significant suggesting that peroxidation reactions are accelerated after or during spa therapy And spa therapy may cause an extra oxidative stress

22. Discussions After a 2-week spa therapy period NSSA (statisticaly significant) and AOP levels increased Suggesting that antioxidant potential and activity are improved

23. Discussions Eventhough, a 2-week spa therapy in RA patients when added to rutine conventional therapy seems to cause and acceleration in lipid peroxidation, hence an oxidative stress This is contrbalanced with an increase anti-oxidative potential and activity which is already impaired in this patients

24. Discussions Spa therapy complementing conventional therapy in RA patients may exert some beneficial effects on oxidation processes These effects may have a therapeutic potential But, more studies are required to define the role of antioxidative effects of spa therapy in reported efficacy of this intervention in the management of RA

25. THANKS FOR YOUR ATTENTİON