1. Balneotherapy in Rheumatologic Conditions Dr. Deniz EVCİK Kocatepe University,Dep. of PRM,Afyon- TURKEY

2. Balneotherapy consists of the use of natural thermal mineral water,The definitions of these water is based on the sum of the cations ( Na,K..etc) and the anions (Cl, SO4..etc) Afyon is a famous spa center with its hot springs.In our center the natural spring water flows at a temperature of 36-60Cº.

3. Balneotherapy is useful in prevention and treatment of all aspects of rheumatologic conditions. It is also an important part of rehabilitation, used in the treatment of impairments and disabilities.

4. Musculoskeletal system diseases Inflammatory arthritis (RA,AS,PsA…etc) Osteoarthritis Extraarticular soft tissue diseases (MPS,FMS) Mechanical neck and back pain Osteoporosis

5. Rheumatologic conditions Muscle relaxation and join relief Joint mobilization, increase ROM, Strengthening muscles Advancement in motor control, Improve well-being, quality of life

6. Aquatic exercises in Fibromyalgia A total of 53 patients diagnosed according to ACR criteria They divided into two groups. Group I (n=29) aquatic exercise program (swimming pool) Group II (n=23) home-based exercise program Evcik D, Yigit İ, Pusak H,, Kavuncu V, Geçici Ö

7. Grup I received pool based exercise program, Grup II received an home-based exercise program It consist of 10 min warming and 30 minutes aquatik program. Home exercises included warming, stretching, strengthening o Program three times a week, during five weeks.

8. Assessment parameters Pain (VAS) Number of tender points Beck depression scale (BDS) Functional capacity (FİQ) Assessments were done before and after 1,3 and 6 months of the therapy.

9. Results The mean age of group I was 43,8 and group II was 42.8 years. There was an improvement in VAS, BDS, FIQ and NTP in group I (p<0.05) In group II we observed an improvement in BDS,NTP and FIQ (p<0.05) except VAS.

10. Effectiveness of Balneotherapy on MMP-3, NO, TIMP-1 in knee OA A total of 22 (2M/20F) patients Balneotherapy were applied 20 minutes once a day and five times per week, totally 10 session. MMP-3, TIMP-1 and NO were measured four times ( before therapy, 5th day, at the end and after one week of the therapy ) Evcik D,Serteser M,Kavuncu V,Türel A

11. Clinical parameters Pain Visuel Analogue Scale, WOMAC pain scale, Functional capacity WOMAC functional capacity index Assessment were done before and after therapy

12. No statistically significant differences in MMP-3,TIMP-1 and NO values between the measurements (p>0.05) After therapy, pain (p<0.05) and functional capacity were statistically improved (p<0.001) There was a correlation between TIMP-1 and WOMAC pain (r = 45) and WOMAC functional index (r = 46) (p<0.05).

13. The efficacy of Balneotherapy and mud-pack therapy in patients with knee OA, Eighty patients with knee OA They randomised in to three groups. Group I (n=25) received balneotherapy, They had bathing in mineral water pools at 36 Cº Evcik D,Kavuncu V,Yeter A,Yiğit İ.

14. Group II (n=29) received mud-pack therapy Group III (n=26) had hot-pack application Mud-packs and hot-packs were heated to 42 Cº and applied over knees for 20 minutes Therapy once a day and five times per week (10 session)

15. Assessment parameters Pain, (VAS,WOMAC) (0-4 likert scale) Functional capacity (WOMAC functional and WOMAC global index) Quality of life (Nottingham Health Pofile) self-administered questionnaire

16. Physician’s global assessment (VAS) Maximum distance that patient can walk without pain Assessment was before and after three months.

17. Results Improvement in VAS and WOMAC pain scores in group I (p<0. 001), group II and III (p<0. 05). The WOMAC functional and global index improved in group I, group II and hot-pack group (p<0. 05).

18. Quality of life were significantly improved in balneotherapy and mud-pack therapy groups (p<0. 05). No difference in hot-pack therapy. The maximum distance was improved both in group I and II (p<0. 05) but not in group III. Physician’s global assessment was found to be improved in all groups (p<0. 05).

19. Effects on immune system? Effects on articular cartilage degradation? ( protection? ) Effects on inflammatory parameters? Is it cost effective?

20. Conclusion Finally Balneotherapy has positive effects on rheumatologic diseases. In order to be in scientific evidence, more trials are needed with a good methodologic quality (plasebo controlled, double blind). These researches should include not only BT but also with other therapies (peloidotherapy, thalassotherapy,hydrotherapy)

21. Balneotherapy should be considered as a part of aquatik rehabilitation. Rather than a single therapy, combined therapy including physical therapy modalities, rehabilitation techniques (such as exercises) should be prefered in rheumatologic diseases.

22. Thank you