title: The efficacy of a topical gel prepared using Lake Urmia mud in patients with knee osteoarthritis.
abstract: OBJECTIVE
  Osteoarthritis (OA) is characterized by progressive cartilage degradation and secondary inflammation of the synovial membrane. Studies have shown that mud therapy may influence serum levels of several cytokines involved in the pathogenesis of OA and chondrocyte metabolism. The main targets of our research were to make use of Lake Urmia mud for topical gel formulation, evaluation of the possible therapeutic effects of this gel on symptoms of patients with knee OA and the evaluation of serum tumor necrosis factor-alpha (TNF-alpha) level after mud therapy in comparison with the application of a placebo.
  
  
  METHODS
  Fifty (50) patients suffering from knee OA participated in this study and randomized into two groups: case group and control group. Patients in the case group received mud therapy and the placebo was applied to patients in the control group. Three (3) parameters including pain, morning stiffness, and joint functionality were assessed in all patients. Visual analogue scale and Western Ontario McMaster Osteoarthritis index (WOMAC) were the employed scales for pain assessment. Functional capacity was evaluated by using WOMAC functional capacity and WOMAC global index. All the mentioned steps were done before and after treatment. Blood samples, in both groups, were collected for measuring tumor necrosis factor (TNF)-alpha serum level.
  
  
  RESULTS
  All the differences (for three parameters), in the case group, were statistically significant. TNF-alpha serum level reduction in both groups were detected: 19.41% in the case group and 1.76% in the control group.
  
  
  CONCLUSIONS
  Mud therapy using formulated gel is an effective method in knee OA treatment and pain reduction. Further studies may be needed for the evaluation of possible synergism between pharmacological treatment and mud therapy.
authors.affiliation: Department of Pharmacognosy and Hydrology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Nemati
authors.initials: N
authors.lastname: Mahboob
authors.forename: Kolahi
authors.initials: K
authors.lastname: Sousan
authors.forename: Azarmi
authors.initials: A
authors.lastname: Shirzad
authors.forename: Ghorbanihaghjo
authors.initials: G
authors.lastname: Amir
authors.forename: Varshoi
authors.initials: V
authors.lastname: Mohammad
authors.forename: Mokhtari
authors.initials: M
authors.lastname: Reza
authors.forename: Vatankhah Amir
authors.initials: VA
authors.lastname: Mansour
authors.forename: Valizadeh
authors.initials: V
authors.lastname: Hadi
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D007719:Knee Joint; D008875:Middle Aged; D009094:Mud Therapy; D009864:Ontario; D020370:Osteoarthritis, Knee / Q000628:therapy*; D059408:Pain Management; D020127:Recovery of Function; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D005782:Gels; D014409:Tumor Necrosis Factor-alpha