title: Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial.
abstract: BACKGROUND
  Balneotherapy is one of the most commonly used non-pharmacological approaches for osteoarthritis (OA). Recent data indicate that some biomarkers could be useful to predict OA progression and to assess therapeutic response.
  
  
  OBJECTIVE
  To evaluate the effects of mud-bath therapy on serum biomarkers in patients with knee OA.
  
  
  METHODS
  The study group comprised 103 patients with primary symptomatic bilateral knee OA who were randomly assigned to receive a cycle of mud-bath therapy over a period of 2 weeks or to continue their standard therapy alone. Clinical and biochemical parameters were assessed at baseline and after 2 weeks. Clinical assessments included global pain score on a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Index (WOMAC) subscores for knee OA. Cartilage oligomeric matrix protein (COMP), C-terminal cross-linked telopeptide type II collagen (CTX-II), myeloperoxidase (MPO) and high sensitivity C-reactive protein (hsCRP) serum levels were assessed by ELISA.
  
  
  RESULTS
  At the end of mud-bath therapy we observed a statistically significant improvement in VAS and WOMAC subscores. Serum levels of COMP, MPO and hsCRP did not show any significant modification in either group, while a significant increase (P < 0.001) in CTX-II serum levels was observed in the mud-bath group after the treatment.
  
  
  CONCLUSIONS
  A cycle of mud-bath therapy added to the usual treatment had a beneficial effect on pain and function in patients with knee OA. The evaluation of serum biomarkers showed a significant increase of CTX-II only, perhaps due to an increase of cartilage turnover induced by thermal stress.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Pascarelli
authors.forename: Sara
authors.initials: S
authors.lastname: Cheleschi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bacaro
authors.forename: Giacomo M
authors.initials: GM
authors.lastname: Guidelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Fioravanti
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D064236:Cartilage Oligomeric Matrix Protein / Q000097:blood*; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009094:Mud Therapy / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D010147:Pain Measurement / Q000379:methods; D009195:Peroxidase / Q000097:blood*; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D064236:Cartilage Oligomeric Matrix Protein; D002097:C-Reactive Protein; D009195:Peroxidase