EFFICIENCY OF CONTEMPORARY BALNEOLOGICAL INTERVENTIONS IN PATIENTS WITH OSTEOARTHRITIS
Keywords:
balneotherapy, thermal waters, SPA-therapy, peloid-therapy, osteoarthritis, degenerative joint diseasesAbstract
Osteoarthritis (OA) can be defined as a chronic joint disease that causes pain, permanent disability and functional limitation. However, with the advances in contemporary medicine, conservative and/or surgical treatment options are increasing, which also raises the cost of treatment, considering that more and more people need therapy. Balneotherapy is commonly used in rehabilitation programs for the prevention and treatment of osteoarthritis of various joint localizations (more commonly knee and hip joints). The aim of this report is to present the possibilities of treatment, prevention and rehabilitation of patients with osteoarthritis by means of Balneology. For this purpose, a comprehensive review of published articles in the available databases (Google Scholar, Pubmed, Science Direct, PEDro), which contain information on balneotherapy, in particular application of mineral waters and healing mud in patients with degenerative joint diseases, was performed. The search was conducted using keywords that are directly related to the topic of this article: mineral water balneotherapy, thermal waters, naturally aerated mineral waters, healing mud, osteoarthritis, knee joint, hip joint, small hand joints, pain, muscle weakness, muscle imbalance, stiffness, daily activity, functional limitation, rehabilitation. The review included articles containing information on randomized and non-randomized clinical trials, meta-analyses and scientific reviews regarding the use of balneotherapy in patients with osteoarthritis. Evidence was found that showed osteoarthritis to be highly disabling in large groups of people. On the other hand, evidence was found for the beneficial effects of mineral waters and healing mud in improving the long-term symptoms of osteoarthritis. Balneotherapy could have a credible effect in reducing pain, stiffness and functional impairment. Some therapies are effective in terms of reducing inflammatory activity and have a stimulating anti-inflammatory effect. Although this type of treatment is centuries old, it nowadays requires a scientifically sound explanation of the mechanisms by which the sangiogenesis effect is achieved and this is why research in this field continues. The application of balneotherapy (mineral waters and healing mud) is probably a therapeutic strategy with a very positive effect in patients with osteoarthritis. The negative goods of the complaint may be successfully reduced by balneotherapy and mud therapy. Prophylaxis and treatment with natural mineral waters and healing mud have the ability to reduce symptoms and improve functional activity in patients with osteoarthritis. Principally, these goods are enhanced by the chemical, physical and thermal characteristics of the balneological factors. However, research regarding their mechanisms of action is ongoing, allowing for a more precise definition of the pathways by which balneotherapeutic interventions work in patients with osteoarthritis.
References
Antonelli, M., Donelli, D., & Fioravanti, A. (2018). Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatology international, 38(10), 1807–1824.
Bender, T., Bálint, G., Prohászka, Z., et al. (2014). Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. International journal of biometeorology, 58(3), 311–323.
Bender, T., Bariska, J., Vághy, R., Gomez, R., & Imre Kovács (2007). Effect of balneotherapy on the antioxidant system--a controlled pilot study. Archives of medical research, 38(1), 86–89.
Bernetti, A., Mangone, M., Alviti, F., et al (2020). Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy. International journal of biometeorology, 64(6), 905–914.
Branco, M., Rêgo, N. N., Silva, P. H., et al. (2016). Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur. journal of physical and rehabilitation medicine, 52(4), 422–430.
Ciani, O., Pascarelli, N. A., Giannitti, C., et al. (2017). Mud-Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial. Arthritis care & research, 69(7), 966–972.
Corsello, T., Komaravelli, N., & Casola, A. (2018). Role of Hydrogen Sulfide in NRF2- and Sirtuin-Dependent Maintenance of Cellular Redox Balance. Antioxidants (Basel, Switzerland), 7(10), 129.
Courties, A., Kouki, I., Soliman, N., Mathieu, S., & Sellam, J. (2024). Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthritis and cartilage, 32(11), 1397–1404. Klemm, P., Schulz, N., Boettger, P., & Lange, U. (2024). Heat therapy in rheumatic and musculoskeletal diseases – an overview of clinical and molecular effects. International Journal of Hyperthermia, 41(1).
Dischereit, G., Goronzy, J. E., Müller-Ladner, U., Fetaj, S., & Lange, U. (2019). Wirkeffekte serieller Heiltorfbäder bei entzündlich-rheumatischen und degenerativen Erkrankungen [Effects of serial mud baths on inflammatory rheumatic and degenerative diseases]. Zeitschrift fur Rheumatologie, 78(2), 143–154.
Dogaru G, Radulescu A. (2015) Therapeutic effects of carbonated mineral Waters in cardiovascular rehabilitation. Balneo Research Journal, 6(1):36-39. DOI: http://dx.doi.org/10.12680/balneo.2015.1083
Eckert, D., Evic, M., Schang, J., et al. (2024). Osteo-immunological impact of radon spa treatment: due to radon or spa alone? Results from the prospective, thermal bath placebo-controlled RAD-ON02 trial. Frontiers in immunology, 14, 1284609.
Protano, C., Fontana, M., De Giorgi, A., et al. (2023). Balneotherapy for osteoarthritis: a systematic review. Rheumatology international, 43(9), 1597–1610.
Fraioli, A., Mennuni, G., Fontana, M., Nocchi, S., Ceccarelli, F., Perricone, C., & Serio, A. (2018). Efficacy of Spa Therapy, Mud-Pack Therapy, Balneotherapy, and Mud-Bath Therapy in the Management of Knee Osteoarthritis. A Systematic Review. BioMed research international, 2018, 1042576.
GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396(10258), 1204–1222.
Grozeva A. Balneologichni resursi v Burgaski region. (2019) Znatsi. ISBN:978-6197497-31-1.
Grozeva A. (2022) Vazmozhnosti na kalolechenieto i morelechenieto za rehabilitatsia na patsienti s kasen postkovid sindrom. In spiro, 1 (64)
Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. Lancet (London, England), 393(10182), 1745–1759.
Karagülle, M., Kardeş, S., Dişçi, R., et al. (2016). Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis. International journal of biometeorology, 60(10), 1481–1491.
Kloesch, B., Liszt, M., Steiner, G., & Bröll, J. (2012). Inhibitors of p38 and ERK1/2 MAPkinase and hydrogen sulphide block constitutive and IL-1β-induced IL-6 and IL-8 expression in the human chondrocyte cell line C-28/I2. Rheumatology international, 32(3), 729–736.
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, N.J.), 72(2), 220–233.
Koleva I. Yoshinov B, Eneva V. and al. (2022) Introduction to Physical Prevention, Physical Therapy and Rehabilitation. (pp. 95-130), Steno- Sofia ISBN 978-619-241-184-8
Long, H., Liu, Q., Yin, H., Wang, K., Diao, N., Zhang, Y., Lin, J., & Guo, A. (2022). Prevalence Trends of Site-Specific Osteoarthritis From 1990 to 2019: Findings From the Global Burden of Disease Study 2019. Arthritis & rheumatology (Hoboken, N.J.), 74(7), 1172–1183.
Maier, A., Wiedemann, J., Rapp, F., Papenfuß, F., Rödel, F., Hehlgans, S., Gaipl, U. S., Kraft, G., Fournier, C., & Frey, B. (2020). Radon Exposure-Therapeutic Effect and Cancer Risk. International journal of molecular sciences, 22(1), 316.
Masiero, S., Vittadini, F., Ferroni, C., et al. (2018). The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. International journal of biometeorology, 62(2), 243–252.
Masiero S. (2008). Thermal rehabilitation and osteoarticular diseases of the elderly. Aging clinical and experimental research, 20(3), 189–194.
Matsumoto, H., Hagino, H., Hayashi, K., et al. (2017). The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol., 36(8), 1839–1847.
Mennuni, G., Fontana, M., Perricone, C., et al. (2021). A meta-analysis of the effectiveness of mud-bath therapy on knee osteoarthritis. La Clinica terapeutica, 172(4), 372–387.
Monova H, Ismail I, Radeva N, Kircheva K. (2022) Mud therapy – sustainable over the centuries. The path to health and longevity. Varna Medical Forum, 11(1):126-131
Mratskova G. COVID-19 Rehabilitation. (2023) Application of physical factors in persistent rheumatic and musculoskeletal symptoms after COVID-19. "KOTA" Stara Zagora; ISBN: 978-954-305-635-4
Nishimura, N., Sugenoya, J., Matsumoto, T., et al. (2002). Effects of repeated carbon dioxide-rich water bathing on core temperature, cutaneous blood flow and thermal sensation. European journal of applied physiology, 87(4-5), 337–342.
O'Neill, T. W., McCabe, P. S., & McBeth, J. (2018). Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best practice & research. Clinical rheumatology, 32(2), 312–326.
Onik, G., Knapik, K., Górka, D., & Sieroń, K. (2025). Health Resort Treatment Mitigates Neuropsychiatric Symptoms in Long COVID Patients: A Retrospective Study. Healthcare (Basel, Switzerland), 13(2), 196.
Ortega-Collazos, E., Hinchado, M. D., Otero, E., López-Jurado, C. F., Gálvez, I., Legido, J. L., Muñoz-Torrero, J. F. S., Ortega, E., & Torres-Piles, S. (2024). Balneotherapy (Mud-Bath Therapy) with a Peloid Enriched with Rosmarinic Acid Enhances Clinical Outcomes and Innate Immune Benefits in Elderly Patients with Osteoarthritis: A Pilot Study. Applied Sciences, 14(24), 12017. https://doi.org/10.3390/app142412017
Passali, D., Gabelli, G., Passali, G. C.,et al. (2017). Radon-enriched hot spring water therapy for upper and lower respiratory tract inflammation. Otolaryngologia polska = The Polish otolaryngology, 71(4), 8–13.
Popławska NA, Woźniak K, Śliz J, Skorupska M, Czeczotka MJ. (2024). The Beneficial Effect of Balneotherapy on Osteoarthritis. Med Og Nauk Zdr., 30(3): 192–196. doi: 10.26444/monz/190328.
Rapolienė, L., Taletavičienė, G., Balčius, A. et al. Short and Long-term effects of balneotherapy on musculoskeletal pain and fatigue associated with stress. Int J Biometeorol (2025).
Protano, C., Fontana, M., De Giorgi, A., et al. (2023). Balneotherapy for osteoarthritis: a systematic review. Rheumatology international, 43(9), 1597–1610.
Steinmetz, Jaimie D. et al. (2023). Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology, Volume 5, Issue 9, e508 - e522.
Stelmach P, Jurasiński D, Błotnicka, A, Górski, Z. (2025). Developing virtual tour platforms for creating sustainable development of spa resorts: an example from poland. Tourism Cases,
Teległów A, Seremak J, Golec J, et al. (2023). The effect of sulfur baths on hemorheological properties of blood in patients with osteoarthritis. Sci Rep., 13(1):7960.
Valiullina, S.A. & Pogonchenkova, I.V. (2020). Medical rehabilitation of children with COVID-19 in Moscow. Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine of the Department of Health of the City of Moscow. 89 p. (In Russ.)
