title: Effects of mud-bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound (CEUS).
abstract: OBJECTIVE
  Despite the efficacy of TNF inhibitors, most patients with psoriatic arthritis maintain a residual synovial inflammation. The main aim of the study was to evaluate the effects of mud-bath therapy on clinical picture of PsA patients treated with TNF inhibitors. The secondary outcome was to assess synovial inflammation in hand joints detected by contrast-enhanced ultrasound. Other aims were to verify the risk of arthritis flare and to evaluate the effects of spa treatment on functional ability and on quality of life.
  
  
  METHODS
  Thirty-six patients with psoriatic arthritis, treated in the last 6 months with TNF inhibitors, were enrolled. After 1:1 randomisation, 18 patients (group A) underwent mud-bath therapy (12 mudpacks and 12 thermal baths), maintaining treatment with TNF inhibitors; 18 patients (group B) continued pharmacological therapy alone. CRP, PASI, DAS28, swollen and tender joint count, VAS pain, HAQ and SF-36 were evaluated at baseline (T0) and after 45 days (T1). Synovial inflammation detected by contrast-enhanced ultrasound, analysed by a software system, was also assessed.
  
  
  RESULTS
  A significant improvement in PASI (P<0.005), DAS28 (P<0.05), swollen joint count and tender joint count (P<0.001), and HAQ (P<0.001) between T0 and T1 was observed in group A. No patient underwent a flare-up of arthritis. Ultrasound videos demonstrated a significant appearance delay (P<0.05) and faster washout (P<0.02) of contrast dye in group A patients with respect to group B.
  
  
  CONCLUSIONS
  These data suggest a decrease of residual synovial inflammation and a beneficial clinical effect of spa therapy in psoriatic arthritis patients treated with TNF inhibitors.
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy. Electronic address: franco.cozzi@unipd.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Cozzi
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Bernd
authors.initials: B
authors.lastname: Raffeiner
authors.affiliation: Radiology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Beltrame
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ciprian
authors.affiliation: Radiology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coran
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Constantin
authors.initials: C
authors.lastname: Botsios
authors.affiliation: Unit of Statistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Grisan
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ramonda
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Oliviero
authors.affiliation: Radiology Unit, Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stramare
authors.affiliation: Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging* / Q000628:therapy*; D003131:Combined Modality Therapy; D003287:Contrast Media; D005260:Female; D050823:Hand Joints; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009094:Mud Therapy; D011788:Quality of Life; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D014409:Tumor Necrosis Factor-alpha
keywords: Contrast-enhanced ultrasound (CEUS); Mud-bath therapy; Psoriatic arthritis; Synovial inflammation; TNF inhibitors