title: Effect of combined spa-exercise therapy on circulating TGF-beta1 levels in patients with ankylosing spondylitis.
abstract: BACKGROUND
  Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial joints with no satisfactory therapy. Reduction of joint pain has been reported after a course of therapy at a spa, Gasteiner Heilstollen, in Badgastein in Austria. The mechanism underlying this beneficial effect is not clearly understood and objective evidence for the biological response to therapy is lacking. The aim of this study was to find evidence for a biological response to speleotherapy in patients with AS and to study the involvement of the antiinflammatory cytokine TGF-beta1 in this response.
  
  
  METHODS
  83 patients with AS were treated in Badgastein for 3-4 weeks. Therapy included active exercises, hyperthermia and exposure to low doses of radon in a former mine. Response to therapy was assessed from measurement of morning pain and immunoassay of serum levels of TGF-beta1 before and after therapy. Ten AS patients who received conventional therapy and 10 patients with low back pain (LBP) served as controls.
  
  
  RESULTS
  A significant increase in TGF-beta1 (total and active) was found in AS patients after spa therapy. Mean concentration of total TGF-beta1 increased from 28,715 pg/ml to 43,136 pg/ml, (P<0.01) and active TGF-beta1 increased from 77 pg/ml to 1096 pg/ml (P<0.001). When the AS patients were divided into two groups according to pain reduction, group 1 (decrease in morning pain, responders: n=46) exhibited a 17-fold increase of active TGF-beta1 levels (96 pg/ml to 1654 pg/ml, P<0.0001) whereas group 2 (no change or an increase in morning pain: nonresponders: n=37), showed only 7-fold increase (53 pg/ml to 402 pg/ml, P<0.01). There was a moderate increase in active TGF-beta1 from 31 pg/ml to 42 pg/ml (P<0.05) in patients with LBP and no significant change was observed in the patients treated with conventional therapy.
  
  
  CONCLUSIONS
  These results demonstrate a significant increase in circulating TGF-beta1 in patients with AS after the combined spa-exercise therapy in Badgastein. The results also provide evidence for a biological response to speleotherapy and suggest that TGF-beta, through its antiinflammatory function, may play a role in this response.
authors.affiliation: Department of Hematology, Clinic of Internal Medicine I, University of Vienna, Austria.
authors.forename: Medhat
authors.initials: M
authors.lastname: Shehata
authors.forename: Josef D
authors.initials: JD
authors.lastname: Schwarzmeier
authors.forename: Martin
authors.initials: M
authors.lastname: Hilgarth
authors.forename: Dita
authors.initials: D
authors.lastname: Demirtas
authors.forename: Dorothea
authors.initials: D
authors.lastname: Richter
authors.forename: Rainer
authors.initials: R
authors.lastname: Hubmann
authors.forename: Petra
authors.initials: P
authors.lastname: Boeck
authors.forename: Guenther
authors.initials: G
authors.lastname: Leiner
authors.forename: Albrecht
authors.initials: A
authors.lastname: Falkenbach
mesh_terms: D000328:Adult; D000368:Aged; D001452:Balneology / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000097:blood* / Q000628:therapy*; D016212:Transforming Growth Factor beta / Q000097:blood*; D053773:Transforming Growth Factor beta1; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007155:Immunologic Factors; C508960:TGFB1 protein, human; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1