Serial Mud Packs Induce Anti-inflammatory Effects in Knee Osteoarthritis – A Randomized, Prospective Clinical Study

Abstract

Background Mud bath and pack have been used to treat musculoskeletal disorders since ancient times. However, the actual mechanisms of action of mud therapy on the inflammatory processes are complex and still not clarified.

Methods Therefore, the clinical effects of serial mud packs in patients with knee osteoarthritis were investigated on the molecular level. A total of 52 patients were recruited from an in-patient rheumatology clinic. The participants were randomized in 2 groups: the intervention group (IG, n=26) underwent 9 mud packs in 21 days and a standardized multimodal physical therapy in an in-patient setting, whereas the control group (CG, n=26) only received the multimodal physical therapy. Primary outcome parameters were changes in the serum levels of interleukin(IL)-1ß and IL-10. Secondary outcome parameters were changes of the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Western Ontario and Mc Master Universities Arthritis (WOMAC) index and pain (visual analog scale - VAS).

Results The IG presented after the serial mud packs significantly decreased pro-inflammatory IL-1ß levels and significantly increased anti-inflammatory IL-10 levels, whereas the CG showed no changes of the 2 cytokines. CRP and ESR remained within in the normal range in both groups without significant changes. Furthermore, the IG presented a significant decrease of the WOMAC index and pain (VAS).

Conclusions The results suggest an additive anti-inflammatory effect of serial mud packs within a multimodal physical therapy concept in patients with knee osteoarthritis and could explain the beneficial clinical effects.

Zusammenfassung

Hintergrund Heiltorfbäder und -packungen werden seit der Antike zur Behandlung von muskuloskelettalen Erkrankungen eingesetzt. Die tatsächlichen Wirkmechanismen der Heiltorftherapie auf den Entzündungsprozess sind jedoch komplex und noch nicht geklärt.

Methoden Daher wurden die klinischen Wirkungen von seriellen Heiltorfpackungen bei Patienten mit Gonarthrose auf molekularer Ebene untersucht. Insgesamt wurden 52 Patienten aus einer rheumatologischen Klinik rekrutiert und in 2 Gruppen randomisiert: Die Interventionsgruppe (IG, n=26) erhielt stationär 9 Heiltorfpackungen in 21 Tagen und eine standardisierte multimodale physikalische Therapie, während die Kontrollgruppe (KG, n=26) nur die multimodale physikalische Therapie erhielt. Primäre Outcome-Parameter waren Änderungen der Serum-Zytokinwerte von Interleukin(IL)-1ß und -10. Die sekundären Outcome-Parameter waren Änderungen vom C-reaktiven Protein (CRP), der Blutsenkungsgeschwindigkeit (BSG), dem Western Ontario and McMaster Universities Arthritis (WOMAC) Index und der Schmerzen (VAS – visuelle Analogskala).

Ergebnisse Die IG zeigte nach den seriellen Heiltorfpackungen eine signifikante Verminderung der Serumspiegel vom pro-inflammatorischen IL-1ß und einen signifikanten Anstieg des anti-inflammatorischen IL-10, während die CG keine Veränderungen der beiden Zytokine zeigte. CRP und BSG waren in beiden Gruppen baseline und nach der Therapie im Normbereich gelegen. Nur die IG zeigte eine signifikante Verbesserung im WOMAC Index und eine signifikante Schmerzabnahme (VAS).

Schlussfolgerungen Die Resultate legen einen additiven entzündungshemmenden Effekt der seriellen Heiltorfpackungen innerhalb eines multimodalen physikalischen Therapiekonzepts bei Gonarthrose nahe und bieten eine Erklärungsmöglichkeit für die vorteilhaften klinischen Wirkeffekte.

Key words

serial mud packs - knee osteoarthritis - cytokines - pain - WOMAC index

Schlüsselwörter

serielle Heiltorfpackungen - Gonarthrose - Zytokine - Schmerz - WOMAC Index

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