title: Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy.
abstract: OBJECTIVE
  This study is designed to show the efficacy of balneotherapy and balneotherapy (BT) + nonsteroid antiinflammatory drug (NSAID) use in Ankylosing spondylitis (AS) patients.
  
  
  METHODS
  In this prospective study, BT, BT+ NSAID and NSAID therapy in 61 patients with AS were evaluated by ASAS core set. BT group (21 patients) was treated only with BT for 20 min, once a day, 5 days a week, over a period of 3 weeks. BT+NSAID group (20 patients) was treated with 1000 mg naproxen as well as BT. NSAID group (20 patients) was treated with 1000 mg naproxen. All of the participants did respiratory and postural exercises for 20 min a day and for the whole study period. Each patient was evaluated on admission (before treatment), at the end of the therapy and 6 months after the treatment.
  
  
  RESULTS
  At the end of the study, statistically significant improvement was observed in all the clinical parameters of the patients in BT (G1), BT+NSAID (G2) and NSAID (G3) groups. This significant symptomatic and clinical improvement was maintained even 6 months after the treatment. The changes from baseline to follow up were similar in G1 and G2 except duration of morning stiffness (DMS) and chest expansion (CE). Improvements in CE and DMS were better in G1 and G2, respectively. Improvements observed in G1 and G2 were superior to the improvements observed in G3 for the variables of morning pain, nocturnal pain, DMS, global well being of the patient, occiput-wall distance, CE, finger to floor distance and functional index. In Schober test, improvement observed in G1 was statistically superior to G3.
  
  
  CONCLUSIONS
  We concluded that BT can be suggested as an effective symptomatic treatment modality in patients with AS. Furthermore, sufficient improvement in clinical parameters can be obtained by BT alone.
authors.affiliation: Department of Physical Therapy and Rehabilitation, Uludag University Atatürk Balneotherapy and Rehabilitation Center, Bursa, Turkey.
authors.forename: Merih
authors.initials: M
authors.lastname: Yurtkuran
authors.forename: Alev
authors.initials: A
authors.lastname: Ay
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Karakoç
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001452:Balneology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009288:Naproxen / Q000627:therapeutic use; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009288:Naproxen