title: Exploratory data analysis on the effects of non pharmacological treatment for knee osteoarthritis.
abstract: OBJECTIVE
  Osteoarthritis (OA) is a chronic rheumatic disease characterized by progressive cartilage destruction mediated by cytokines and other molecules. Chondrocyte activity and metabolism have attracted interest as targets of drug intervention, and spa-therapy can influence the serum levels of several cytokines. We investigated the effects of spa-therapy on clinical and ultrasonographic (US) findings and serum levels of cartilage oligomeric matrix protein (COMP) and several cytokines, chemokines, and growth factors in a prospective cohort of patients with symptomatic knee OA.
  
  
  METHODS
  Patients (n=53) with primary symptomatic knee OA were treated for 12 consecutive days with locally applied mud-packs. Assessments were made at baseline, immediately after completion of the treatment cycle, and 6 and 12 months after completion of treatment. They included visual analogue scale (VAS) ratings of pain, the Lequesne algofunctional index for knee OA, and US with calculation of a semiquantitative score that expressed the severity of the local inflammatory process. Serum levels of 27 cytokines (including interferon--inducible protein-10 [IP-10]), chemokines, and growth factors were measured with multiplex bead-based immunoassays, and COMP levels were determined by ELISA.
  
  
  RESULTS
  US scores, VAS pain ratings, and Lequesne indexes indicated significant improvement after spa-therapy and at the 6- and 12-month follow-ups. Serum IP-10 levels also dropped significantly (p=0.0035), and this reduction was positively correlated with improvement of the Lequesne index (p=0.031).
  
  
  CONCLUSIONS
  In patients with knee OA, spa-therapy can modulate serum levels of proinflammatory cytokines/chemokines and produce improvements in joint pain and function that persists for up to 1 year.
authors.affiliation: Dipartimento di Clinica e Terapia Medica, Sezione di Reumatologia, Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: C
authors.initials: C
authors.lastname: Perricone
authors.forename: C
authors.initials: C
authors.lastname: Alessandri
authors.forename: M
authors.initials: M
authors.lastname: Modesti
authors.forename: A
authors.initials: A
authors.lastname: Iagnocco
authors.forename: C
authors.initials: C
authors.lastname: Croia
authors.forename: M
authors.initials: M
authors.lastname: Di Franco
authors.forename: G
authors.initials: G
authors.lastname: Valesini
mesh_terms: D001494:Baths / Q000379:methods*; D064236:Cartilage Oligomeric Matrix Protein; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D016326:Extracellular Matrix Proteins / Q000097:blood; D006023:Glycoproteins / Q000097:blood; D006294:Health Resorts; D006801:Humans; D064235:Matrilin Proteins; D009094:Mud Therapy / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D010147:Pain Measurement; D014463:Ultrasonography
chemical_list: D064236:Cartilage Oligomeric Matrix Protein; D016207:Cytokines; D016326:Extracellular Matrix Proteins; D006023:Glycoproteins; D064235:Matrilin Proteins; C577553:TSP5 protein, human