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Takeda M, Choi J, Maeda T, Managi S. Effects of bathing in different hot spring types on Japanese gut microbiota. Sci Rep 2024; 14:2316. [PMID: 38282062 PMCID: PMC10822857 DOI: 10.1038/s41598-024-52895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Abstract
Hot springs have been used for a variety of purposes, including the treatment and amelioration of illness and recreation. Japan has ten different types of therapeutic springs (described here as spa types), which are traditionally believed to have different efficacy. However, more research must be conducted to determine how they affect healthy people. Therefore, this study focused on the gut microbiota and aimed to investigate changes in the gut microbiota in healthy people after bathing in different spa types. Using Beppu's hot springs (simple, chloride, bicarbonate, sulfur, and sulfate types), 136 healthy Japanese adults living in the Kyushu area participated in the study and bathed in the same hot spring for seven days. Fecal samples were collected before and after the 7-day bathing period, and the relative abundance of the gut microbiota was determined by 16S rRNA sequencing. The results showed that the relative abundance of Bifidobacterium bifidum increased significantly after seven consecutive days of bathing in the bicarbonate spring. Significant increases in other gut microbiota were also observed after bathing in simple, bicarbonate, and sulfur springs. These results suggest that bathing in different hot springs may affect the gut microbiota in healthy individuals differently.
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Affiliation(s)
- Midori Takeda
- Urban Institute & Department of Civil Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
| | - Jungmi Choi
- Urban Institute & Department of Civil Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
| | - Toyoki Maeda
- Department of Internal Medicine, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, Oita, 874-0838, Japan
| | - Shunsuke Managi
- Urban Institute & Department of Civil Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan.
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Eckert D, Evic M, Schang J, Isbruch M, Er M, Dörrschuck L, Rapp F, Donaubauer AJ, Gaipl US, Frey B, Fournier C. Osteo-immunological impact of radon spa treatment: due to radon or spa alone? Results from the prospective, thermal bath placebo-controlled RAD-ON02 trial. Front Immunol 2024; 14:1284609. [PMID: 38292488 PMCID: PMC10824901 DOI: 10.3389/fimmu.2023.1284609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Musculoskeletal disorders (MSDs) are associated with pain and lead to reduced mobility and quality of life for patients. Radon therapy is used as alternative or complementary to pharmaceutical treatments. According to previous reports, radon spa leads to analgesic and anti-inflammatory effects, but the cellular and molecular mechanisms are widely unknown. A previous study (RAD-ON01) revealed, that bone erosion markers like collagen fragments (C-terminal telopeptide, CTX) are reduced after radon spa treatment in serum of patients with degenerative MSDs. Within the scope of the prospective, placebo-controlled RAD-ON02 trial presented here, we analyzed the influence of radon and thermal spa treatment on osteoclastogenesis. From patient blood, we isolate monocytes, seeded them on bone slices and differentiated them in the presence of growth factors into mature osteoclasts (mOCs). Subsequent analysis showed a smaller fraction of mOCs after both treatments, which was even smaller after radon spa treatment. A significantly reduced resorbed area on bone slices reflects this result. Only after radon spa treatment, we detected in the serum of patients a significant decrease of receptor activator of NF-κB ligand (RANKL), which indicates reduced differentiation of OCs. However, other markers for bone resorption (CTX) and bone formation (OPG, OCN) were not altered after both treatments. Adipokines, such as visfatin and leptin that play a role in some MSD-types by affecting osteoclastogenesis, were not changed after both treatments. Further, also immune cells have an influence on osteoclastogenesis, by inhibiting and promoting terminal differentiation and activation of OCs, respectively. After radon treatment, the fraction of Treg cells was significantly increased, whereas Th17 cells were not altered. Overall, we observed that both treatments had an influence on osteoclastogenesis and bone resorption. Moreover, radon spa treatment affected the Treg cell population as well as the Th17/Treg ratio were affected, pointing toward a contribution of the immune system after radon spa. These data obtained from patients enrolled in the RAD-ON02 trial indicate that radon is not alone responsible for the effects on bone metabolism, even though they are more pronounced after radon compared to thermal spa treatment.
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Affiliation(s)
- Denise Eckert
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Megi Evic
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Jasmin Schang
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Maike Isbruch
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Melissa Er
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Lea Dörrschuck
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Felicitas Rapp
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
| | - Anna-Jasmina Donaubauer
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Udo S. Gaipl
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Claudia Fournier
- Department of Biophysics, GSI Helmholtzzentrum Für Schwerionenforschung, Darmstadt, Germany
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Boudjani R, Challal S, Semerano L, Sigaux J. Impact of different types of exercise programs on ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:3989-4000. [PMID: 36369692 DOI: 10.1080/09638288.2022.2140842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE This systematic review and meta-analysis of controlled studies aimed to assess the efficacy of different types of exercise programs (EP) on ankylosing spondylitis (AS) activity, function and mobility. METHODS We searched PubMed/Medline, Cochrane Library and Embase databases for reports of controlled trials of patients with AS published up to May 2022. The studies were classified by intervention into categories defined by the 4 exercise domains established by the American College of Sports Medicine and then adopted by the European League Against Rheumatism: aerobic, muscle strength, flexibility, neuromotor performance. RESULTS We found a moderate effect of EP as a whole on BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) (-0.60, 95% CI -0.95, -0.25, p < 0.001), BASFI (Functional) (-0.63, 95% CI -0.84, -0.42, p < 0.0001) and BASMI (Metrology) (-0.52, 95% CI -0.88, -0.15, p < 0.01). The effect of "flexibility + muscle strength" EP was large for BASMI, moderate for BASDAI and BASFI. The effect of "flexibility + muscle strength + aerobic" EP was large for BASFI, moderate for BASDAI. CONCLUSIONS EP, regardless of the specific type of exercise, have a moderate effect on AS activity, function and mobility. EP including flexibility and muscle strength exercises may have a large effect, especially for mobility. Programs including aerobic exercise showed significant efficacy for function.IMPLICATIONS FOR REHABILITATIONIn ankylosing spondylitis (AS), any exercise program (EP), regardless of the type of exercises involved, showed a moderate effect on disease activity, function and spinal mobility.In AS, EP combining flexibility and strength exercises showed the largest effect on spinal mobility and should be encouraged.In AS, EP combining flexibility, muscle strength and aerobic exercises may be particularly effective on patient function.
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Affiliation(s)
| | | | - Luca Semerano
- Rheumatology Department, Hospital Avicenne, Bobigny, France
- INSERM UMR 1125 Sorbonne Paris Nord, Bobigny, France
| | - Johanna Sigaux
- Rheumatology Department, Hospital Avicenne, Bobigny, France
- INSERM UMR 1125 Sorbonne Paris Nord, Bobigny, France
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Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ. Korean treatment recommendations for patients with axial spondyloarthritis. Korean J Intern Med 2023; 38:620-640. [PMID: 37482652 PMCID: PMC10493447 DOI: 10.3904/kjim.2023.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and Kmbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5-12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13-16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Ju Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Seon Mi Ji
- National Health Insurance Service, Wonju,
Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine. Incheon,
Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu,
Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju,
Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul,
Korea
| | - Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital. Daejeon,
Korea
| | - Youngim Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Seung Ho Lee
- Korea Ankylosing Spondylitis Society, Seoul,
Korea
| | - Jun Hong Lim
- Korea Ankylosing Spondylitis Corporation, Daejeon,
Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
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5
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Takeda M, Nakamura H, Otsu H, Mimori K, Maeda T, Managi S. Hot spring bathing practices have a positive effect on mental health in Japan. Heliyon 2023; 9:e19631. [PMID: 37809617 PMCID: PMC10558852 DOI: 10.1016/j.heliyon.2023.e19631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Hot springs have long been used for medical purposes throughout the world. Recently, the positive effects of hot spa-bathing on circulatory diseases have been reported, while there are few reports on the mental effects of hot spa-bathing. Therefore, the purpose of this study was to clarify the relationship between hot spa-bathing habits and mental health throughout Japan. We conducted a nationwide online survey, including questions on bathing behavior, subjective satisfaction, lifestyle, and illness. The results showed a significant positive correlation between hot spa-bathing habits and multiple subjective satisfaction levels regarding mental health effects. The factor analysis results indicated that hot spa-bathing habits tended to be associated with good mental health, high health consciousness, and disease. Our study revealed that subjective satisfaction was higher among individuals with hot spa-bathing habits, suggesting that the hot spring spa-bathing habit may have a positive influence on mental health.
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Affiliation(s)
- Midori Takeda
- Urban Institute & Department of Civil Engineering, Kyushu University, Japan
| | | | - Hajime Otsu
- Department of Surgery, Kyushu University Beppu Hospital, Japan
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University, United States
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Japan
| | - Toyoki Maeda
- Department of Internal Medicine, Kyushu University Beppu Hospital, Japan
| | - Shunsuke Managi
- Urban Institute & Department of Civil Engineering, Kyushu University, Japan
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6
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Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ. Korean treatment recommendations for patients with axial spondyloarthritis. JOURNAL OF RHEUMATIC DISEASES 2023; 30:151-169. [PMID: 37476674 PMCID: PMC10351367 DOI: 10.4078/jrd.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and KMbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5~12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13~16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ju Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Mi Ji
- National Health Insurance Service, Wonju, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
| | - Youngim Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ho Lee
- Korea Ankylosing Spondylitis Society, Seoul, Korea
| | - Jun Hong Lim
- Korea Ankylosing Spondylitis Corporation, Daejeon, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Maccarone MC, Scanu A, Coraci D, Masiero S. The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review. Healthcare (Basel) 2023; 11:1899. [PMID: 37444733 PMCID: PMC10340743 DOI: 10.3390/healthcare11131899] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.
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Affiliation(s)
- Maria Chiara Maccarone
- Department of Neuroscience, Physical Medicine and Rehabilitation School, University of Padua, Via Giustiniani 2, 35128 Padua, Italy;
| | - Anna Scanu
- Neurorehabilitation Unit, Department of Neuroscience, University of Padua, 35128 Padua, Italy; (A.S.); (D.C.)
- Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Daniele Coraci
- Neurorehabilitation Unit, Department of Neuroscience, University of Padua, 35128 Padua, Italy; (A.S.); (D.C.)
| | - Stefano Masiero
- Department of Neuroscience, Physical Medicine and Rehabilitation School, University of Padua, Via Giustiniani 2, 35128 Padua, Italy;
- Neurorehabilitation Unit, Department of Neuroscience, University of Padua, 35128 Padua, Italy; (A.S.); (D.C.)
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8
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Garrido-Cumbrera M, Collantes-Estévez E, Navarro-Compán V, Zarco-Montejo P, Sastre C, Correa-Fernández J, Gratacós J. Patients with Axial Spondyloarthritis are Great Consumers of Healthcare Resources, Especially Young and Women: Results from the Spanish Atlas. Rheumatol Ther 2023; 10:729-739. [PMID: 36877341 PMCID: PMC10140249 DOI: 10.1007/s40744-023-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION This study aimed to assess high healthcare utilization over 1 year in patients with axial spondyloarthritis (axSpA) and factors associated with increased healthcare utilization. METHODS A total of 530 unselected patients with axSpA from the Atlas of Axial Spondyloarthritis in Spain-who had used at least one healthcare resource-were included in the present study. Total health care utilization was obtained from the total number of healthcare visits, medical tests, hospital admissions and emergency visits, during the 12 months prior to the survey. Linear regression was used to analyse possible factors associated with higher healthcare utilization. RESULTS A total of 530 patients with axSpA participated in this study: mean age was 45.3 years and 51.1% were female. In the previous 12 months, 77.9% (n = 530) used at least one healthcare resource, with the median healthcare utilization at 25. In the multiple linear regression, the only categorical factor associated with higher healthcare utilization was female gender (β = 12.854), while the continuous factors associated with higher healthcare utilization were higher disease activity (β = 3.378), longer diagnostic delay (β = 0.959), younger age (β = - 0.737) and greater functional limitation (β = 0.576). CONCLUSION Half of patients with axSpA used 25 or more healthcare resources during 1 year. Higher healthcare utilization was associated with younger age, female gender, greater disease activity, higher functional limitation and longer diagnostic delay. Optimal monitoring of patients with axSpA may help to reduce their healthcare utilization.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, Seville, Spain. .,Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain. .,Axial Spondiloarthritis International Federation (ASIF), London, UK.
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | | | | | | | | | - Jordi Gratacós
- Hospital Universitari Parc Taulí, Sabadell, Spain.,I3PT, Medicine Department UAB, Barcelona, Spain
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9
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Maccarone MC, Magro G, Albertin C, Barbetta G, Barone S, Castaldelli C, Manica P, Marcoli S, Mediati M, Minuto D, Poli P, Sigurtà C, Raffaetà G, Masiero S. Short-time effects of spa rehabilitation on pain, mood and quality of life among patients with degenerative or post-surgery musculoskeletal disorders. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:29-36. [PMID: 36207541 PMCID: PMC9546417 DOI: 10.1007/s00484-022-02381-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Clinical trials have demonstrated traditional spa therapy effects in musculoskeletal disorders (MSDs). This is the first observational study in Italy aimed at evaluating in real-life the short-time effects of spa rehabilitation on pain, mood and quality of life (QoL) among degenerative or post-surgery MSDs patients. Through the involvement of six Italian spa facilities, 160 patients were enrolled; data from 123 patients were finally analysed. Seventy-nine patients (64.3%) accessed the spa for degenerative MSDs, while 44 (35.8%) had a post-surgical condition. All the patients included in the study underwent 12 sessions of water-based exercise (joint exercises, muscle strengthening, gait training, proprioceptive and balance techniques) conducted in thermal or in warm water pools, six sessions per week, for a period of 2 weeks from March 2019 up to October 2019. A group of 45 patients (36.6%) also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for 2 weeks. Evaluation before and after the treatment included the Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12) and the EuroQol-5D (EQ-5D). The analysis of the scores reported in the questionnaires after the treatment showed a significant improvement in all the scores evaluated. Comparison between patients that performed water-based exercise protocols alone (group A) and patients that in addition to water exercise performed traditional thermal interventions (group B) showed no statistically significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D variations; only NRSa value reduction was lower in group B. Sulphate water was found to be associated with a lower reduction of all the scores considered, when compared to the other water types. Patients with degenerative or post-surgery MSDs showed favourable effects on pain, mood and QoL after water exercise training alone or in combination with traditional thermal therapy. Our research provides the first proof that spa rehabilitation can be in real-life conditions an appropriate alternative strategy for post-orthopaedic surgical outcomes recovery. In the future, these results will need to be further investigated.
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Affiliation(s)
| | - Giacomo Magro
- Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy
| | | | | | | | | | | | | | | | | | | | | | - Gloria Raffaetà
- Second Orthopaedic and Traumatologic Clinic of Pisa, University of Pisa, Pisa, Italy
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy
- Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy
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Efficacy of Siwan Traditional Therapy on Erythrocyte Sedimentation Rate, Lipid Profile, and Atherogenic Index as Cardiac Risk Factors Related to Rheumatoid Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010054. [PMID: 36676677 PMCID: PMC9861765 DOI: 10.3390/medicina59010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The most frequent cause of mortality in rheumatoid arthritis (RA) patients is cardiovascular disease (CVD). Inflammation, dyslipidemia, and decreased physical activity are some of the main risk factors for CVD. Siwan sand therapy is a type of traditional therapy used in Egypt to treat RA. The approach of this therapy depends on the experience of the healers. The aim of the current study was to compare the effects of three sessions of Siwan traditional therapy to five sessions on common CVD risk factors and physical function in rheumatoid arthritis patients. Materials and Methods: Thirty patients (9 male and 21 female) were assigned into two groups of equal size: group (A) received three sessions of Siwan traditional therapy in the form of a sand bath. Group (B) received the same form of therapy for five days. Erythrocyte sedimentation rate (ESR), lipid profile, atherogenic index of plasma (AIP), and a health assessment questionnaire (HAQ) were measured before and after treatment. Results: There was a significant increase above normal within group (A) for ESR (p = 0.001), triglycerides (TG; p = 0.015), total cholesterol (Tot-Chol; p = 0.0001), and low-density lipoprotein (LDL; p = 0.0001). However, there were no considerable differences in high-density lipoprotein (HDL; p = 0.106), very low-density lipoprotein (VLDL; p = 0.213), AIP (p = 0.648), and HAQ (p = 0.875). For the second group, there were significant changes within group B only in Tot-Chol (p = 0.0001), HDL (p = 0.0001), VLDL (p = 0.0001), AIP (p = 0.008), and HAQ (p = 0.014). There was a significant difference between both groups regarding HDL (p = 0.027), LDL (p = 0.005), AIP (p = 0.029), ESR (p = 0.016), and HAQ (p = 0.036). Conclusions: For RA patients, five days of Siwan traditional therapy caused significant changes regarding inflammation, Tot-Chol, LDL, HDL, AIP, and functional activity when compared to three days of Siwan hot sand therapy.
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Forestier R, Bugnard A, Thomas T. Balneotherapy in spondyloarthropathy: A systematic review. Therapie 2022; 77:723-730. [PMID: 35606192 DOI: 10.1016/j.therap.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/06/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022]
Abstract
AIM OF THE STUDY To evaluate the effectiveness of balneotherapy on spondyloarthritis. METHODS Two authors independently searched the CENTRAL, MEDLINE, SCOPUS, EMBASE and WEB OF SCIENCE databases until July 2017, for randomized controlled trials published in French or English, that included participants, and interventions: adults with spondyloarthritis, treated by balneotherapy program or one of its components and compared with any other intervention or no treatment. Internal validity, external validity, quality of the statistical analysis, and publication bias were systematically evaluated. We report the best level of evidence. RESULTS Nine articles were selected; the internal validity was high in two studies, average in one study, and low in six studies. With high internal validity, one study found a difference for pain between immersion in radon-rich water and tap water for the whole population or rheumatic disease, but the BASFI is not improved for the subgroup of patients with spondyloarthritis. The other study with high validity reported a significant 28-week improvement in quality of life and a composite index. In a study with moderate internal validity involving ankylosing spondylitis patients with associated with inflammatory bowel disease, a balneotherapy program demonstrated a relevant clinical improvement when compared to patients on waiting list. With low internal validity, TNFa inhibitors+spa therapy were found to be superior to a treatment with TNFa inhibitors alone in patients with psoriatic arthritis. CONCLUSIONS Two trials with high validity demonstrated improvements, but this systematic review is not sufficient to prove the efficacy of balneotherapy in spondyloarthritis. More trials are needed with larger sample size to confirm the preliminary results observed and conclusively determine the benefits of balneotherapy.
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Affiliation(s)
- Romain Forestier
- Centre de recherches rhumatologiques et thermales, villa Forestier, 3, avenue d'Albion, 73100 Aix-Les-Bains, France.
| | - Audric Bugnard
- Service de rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Thierry Thomas
- Service de rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
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Effects of Corrective Exercises on Lumbar Lordotic Angle Correction: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084906. [PMID: 35457772 PMCID: PMC9025799 DOI: 10.3390/ijerph19084906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/27/2023]
Abstract
Lumbar lordosis is one of the most important parts of the spine, which is of special importance due to its unique position and direct contact with the pelvis. The aim of this study was to combine the results of several studies and to evaluate the magnitude of the effect of different Lumbar lordotic angle correction programs through meta-analysis. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Four databases were searched for articles collection: PubMed, Cochrane Library, Web of Science, and Google Scholar. The key search terms were: “Lumbar Lordotic angle”, “Lordosis”, “Hyperlordosis”, “Corrective exercise”, and “Low back pain. “The articles included in our study were limited to original articles written only in English that met the following inclusion criteria: (1) participants with lumbar lordosis or hyperlordosis or low back pain; (2) different programs of corrective exercises were applied; (3) Lumbar lordotic angle used as outcome measures. Ten studies are included in our systematic review and meta-analysis. The effect size for the Lumbar lordotic angle outcome was (SMD = 0.550, p ˂ 0.001, moderate effect size). Subgroup analysis for Lumbar lordotic angle: Subgroup Younger group (SMD = 0.640, p ˂ 0.001), Subgroup Older group, (SMD = 0.520, p ˂ 0.001). Subgroup Treatment (SMD = 0.527, p ˂ 0.001), Subgroup No treatment (SMD = 0.577, p = 0.002). This was the only outcome assessed in our analysis. The current meta-analysis indicates that different correction methods have a positive effect on subjects with lumbar lordosis or hyperlordosis. In the following research, we should try to determine which corrective methods have the best effects.
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Güneri FD, Forestier FBE, Forestier RJ, Karaarslan F, Odabaşi E. YouTube as a source of information for water treatments. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:781-789. [PMID: 35094110 PMCID: PMC8800846 DOI: 10.1007/s00484-021-02236-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 05/05/2023]
Abstract
The purpose of the study was to investigate the quality and reliability of YouTube videos as a source of information in water treatments. We searched videos on YouTube ( www.youtube.com ) using the following keywords: "health resort medicine," "spa treatment," "spa therapy," "hydrotherapy," "thermal medicine," "balneology," and "balneotherapy" on June 17th, 2021. The global quality scale (GQS) was used to evaluate the quality of the videos. The assessment of reliability was evaluated using the modified DISCERN tool. Some other video parameters and sources of the videos were also recorded. One hundred twenty-one (121) videos were analyzed. The most common video source was advertisement (46.3%). GQS and modified DISCERN median scores were generally low. They were superior for "hydrotherapy" and "balneotherapy" and were also higher in videos uploaded by health-related persons or organizations (physicians, health-related professionals, and health-related websites). A statistically significant positive correlation was found between investigated parameters (like view ratio, number of likes, video power index, video length) and GQS. Only video length was correlated with modified DISCERN for investigated parameters. The median video power index scores were statistically higher for "spa therapy" and "spa treatment." The YouTube content linked with water treatments has poor quality and reliability most of time. The hydrotherapy and balneotherapy keywords have the best quality and reliability.We think that designers of water treatment videos should involve health professionals more often so that the content of their video will better explain the details of medical conditions or interventions.The scientific experts should ensure a consensus in terminology to straighten the awareness of water treatments for patients and physicians.
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Affiliation(s)
- Fulya Demircioğlu Güneri
- Department of Medical Ecology and Hydroclimatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | | | | | - Fatih Karaarslan
- Department of Medical Ecology and Hydroclimatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Odabaşi
- Department of Medical Ecology and Hydroclimatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Deloch L, Hehlgans S, Rückert M, Maier A, Hinrichs A, Flohr AS, Eckert D, Weissmann T, Seeling M, Nimmerjahn F, Fietkau R, Rödel F, Fournier C, Frey B, Gaipl US. Radon Improves Clinical Response in an Animal Model of Rheumatoid Arthritis Accompanied by Increased Numbers of Peripheral Blood B Cells and Interleukin-5 Concentration. Cells 2022; 11:cells11040689. [PMID: 35203348 PMCID: PMC8870723 DOI: 10.3390/cells11040689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Radon treatment is used as an established therapy option in chronic painful inflammatory diseases. While analgesic effects are well described, little is known about the underlying molecular effects. Among the suspected mechanisms are modulations of the anti-oxidative and the immune system. Therefore, we aimed for the first time to examine the beneficial effects of radon exposure on clinical outcome as well as the underlying mechanisms by utilizing a holistic approach in a controlled environment of a radon chamber with an animal model: K/BxN serum-induced arthritic mice as well as isolated cells were exposed to sham or radon irradiation. The effects on the anti-oxidative and the immune system were analyzed by flow-cytometry, qPCR or ELISA. We found a significantly improved clinical disease progression score in the mice, alongside significant increase of peripheral blood B cells and IL-5. No significant alterations were visible in the anti-oxidative system or regarding cell death. We conclude that neither cell death nor anti-oxidative systems are responsible for the beneficial effects of radon exposure in our preclinical model. Rather, radon slightly affects the immune system. However, more research is still needed in order to fully understand radon-mediated effects and to carry out reasonable risk-benefit considerations.
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Affiliation(s)
- Lisa Deloch
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-8544279
| | - Stephanie Hehlgans
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (S.H.); (F.R.)
| | - Michael Rückert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Andreas Maier
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany; (A.M.); (A.H.); (D.E.); (C.F.)
| | - Annika Hinrichs
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany; (A.M.); (A.H.); (D.E.); (C.F.)
- Department of Physics, Goethe Universität Frankfurt am Main, 60323 Frankfurt am Main, Germany
| | - Ann-Sophie Flohr
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Denise Eckert
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany; (A.M.); (A.H.); (D.E.); (C.F.)
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
| | - Michaela Seeling
- Department of Biology, Institute of Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91058 Erlangen, Germany; (M.S.); (F.N.)
| | - Falk Nimmerjahn
- Department of Biology, Institute of Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91058 Erlangen, Germany; (M.S.); (F.N.)
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (S.H.); (F.R.)
| | - Claudia Fournier
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany; (A.M.); (A.H.); (D.E.); (C.F.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Udo S. Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.R.); (A.-S.F.); (T.W.); (R.F.); (B.F.); (U.S.G.)
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
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15
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DONMEZ U, OZTURK C, CİNAR E, KOCANAOGULLARİ H, GUCENMEZ S, HEPGULER S. Do physical therapy modalities have additional benefit over exercise therapy in the management of Ankylosing Spondylitis? A randomized controlled trial. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.1037447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Klemm P, Preusler P, Hudowenz O, Asendorf T, Müller-Ladner U, Neumann E, Lange U, Tarner IH. Multimodal rheumatologic complex treatment in patients with spondyloarthritis - a prospective study. Eur J Intern Med 2021; 93:42-49. [PMID: 34344550 DOI: 10.1016/j.ejim.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Aim of this study was to prospectively assess the effects of multimodal rheumatologic complex treatment (MRCT), a special concept of in-patient physical treatment (PT) for treating spondyloarthritis (SpA), namely radiographic (r-) and non-radiographic (nr-) axial (ax-) SpA and psoriatic arthritis (PsA). METHODS r-, nr-axSpA and PsA patients receiving a 16-day MRCT were eligible. MRCT was delivered to participants over 64 PT sessions of various modalities with a minimum of 1,400 min of treatment. Primary outcome was a change in pain levels measured on a numeric rating scale (NRS, 0 - 10) between baseline and discharge. Secondary outcomes were assessments of i) disease activity ii) functional disabilities iii) serum cytokine levels iv) analgesic usage v) patient global health assessment and patients' satisfaction with their therapeutic response to MRCT from baseline to discharge and over a 12-week follow-up. RESULTS 50 patients completed the study and were analysed. Pain levels were improved significantly (p < 0.001, 95% confidence interval -2.25 to -0.8,). Further analyses revealed no influencing factors or relevant inter-group differences. Positive effects of MRCT lasted up to 12 weeks after discharge. Analgesic usage was reduced compared to baseline. Patient global health assessment continued to be improved throughout the whole follow-up. No MRCT-related harms were recorded. CONCLUSION MRCT as a multimodal treatment concept with a strong emphasis on PT reduces pain in SpA meaningfully and facilitates reduced analgesic usage.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
| | - Paulina Preusler
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Ole Hudowenz
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Elena Neumann
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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Hofmann W, Lettner H, Hubmer A. Dosimetric Comparison of Exposure Pathways to Human Organs and Tissues in Radon Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10870. [PMID: 34682614 PMCID: PMC8535235 DOI: 10.3390/ijerph182010870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
Three therapeutic applications are presently prescribed in the radon spas in Gastein, Austria: exposure to radon in a thermal bath, exposure to radon vapor in an exposure chamber (vapor bath), and exposure to radon in the thermal gallery, a former mine. The radiological exposure pathways to human organs and tissues in these therapeutic radon applications are inhalation of radon and radon progeny via the lungs, radon transfer from water or air through the skin, and radon-progeny deposition on the skin in water or air. The objectives of the present study were to calculate radon and radon-progeny doses for selected organs and tissues for the different exposure pathways and therapeutic applications. Doses incurred in red bone marrow, liver, kidneys, and Langerhans cells in the skin may be correlated with potential therapeutic benefits, while doses to the lungs and the basal cells of the skin indicate potential carcinogenic effects. The highest organ doses among the three therapeutic applications were produced in the thermal gallery by radon progeny via inhalation, with lung doses of 5.0 mSv, and attachment to the skin, with skin doses of 4.4 mSv, while the radon contribution was less significant. For comparison, the primary exposure pathways in the thermal bath are the radon uptake through the skin, with lung doses of 334 μSv, and the radon-progeny attachment to the skin, with skin doses of 216 μSv, while the inhalation route can safely be neglected.
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Affiliation(s)
- Werner Hofmann
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria; (H.L.); (A.H.)
| | - Herbert Lettner
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria; (H.L.); (A.H.)
- Radiological Measurement Laboratory, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Alexander Hubmer
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria; (H.L.); (A.H.)
- Radiological Measurement Laboratory, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
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Kataoka T, Shuto H, Naoe S, Yano J, Kanzaki N, Sakoda A, Tanaka H, Hanamoto K, Mitsunobu F, Terato H, Yamaoka K. Radon inhalation decreases DNA damage induced by oxidative stress in mouse organs via the activation of antioxidative functions. JOURNAL OF RADIATION RESEARCH 2021; 62:861-867. [PMID: 34370027 PMCID: PMC8438471 DOI: 10.1093/jrr/rrab069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/10/2021] [Indexed: 06/13/2023]
Abstract
Radon inhalation decreases the level of lipid peroxide (LPO); this is attributed to the activation of antioxidative functions. This activation contributes to the beneficial effects of radon therapy, but there are no studies on the risks of radon therapy, such as DNA damage. We evaluated the effect of radon inhalation on DNA damage caused by oxidative stress and explored the underlying mechanisms. Mice were exposed to radon inhalation at concentrations of 2 or 20 kBq/m3 (for one, three, or 10 days). The 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels decreased in the brains of mice that inhaled 20 kBq/m3 radon for three days and in the kidneys of mice that inhaled 2 or 20 kBq/m3 radon for one, three or 10 days. The 8-OHdG levels in the small intestine decreased by approximately 20-40% (2 kBq/m3 for three days or 20 kBq/m3 for one, three or 10 days), but there were no significant differences in the 8-OHdG levels between mice that inhaled a sham treatment and those that inhaled radon. There was no significant change in the levels of 8-oxoguanine DNA glycosylase, which plays an important role in DNA repair. However, the level of Mn-superoxide dismutase (SOD) increased by 15-60% and 15-45% in the small intestine and kidney, respectively, following radon inhalation. These results suggest that Mn-SOD probably plays an important role in the inhibition of oxidative DNA damage.
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Affiliation(s)
- Takahiro Kataoka
- Corresponding author. Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan. Phone: +81-86-235-7208;
| | - Hina Shuto
- Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Shota Naoe
- Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Junki Yano
- Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Norie Kanzaki
- Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency, 1550 Kamisaibara, Kagamino-cho, Tomata-gun, Okayama 708-0698, Japan
| | - Akihiro Sakoda
- Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency, 1550 Kamisaibara, Kagamino-cho, Tomata-gun, Okayama 708-0698, Japan
| | - Hiroshi Tanaka
- Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency, 1550 Kamisaibara, Kagamino-cho, Tomata-gun, Okayama 708-0698, Japan
| | - Katsumi Hanamoto
- Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Fumihiro Mitsunobu
- Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Hiroaki Terato
- Advanced Science Research Center Okayama University, 5-1 Shikata-cho 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Kiyonori Yamaoka
- Graduate School of Health Sciences, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
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[Development of quality standards for patients with axial spondyloarthritis for use in Germany]. Z Rheumatol 2021; 81:730-743. [PMID: 34379181 DOI: 10.1007/s00393-021-01019-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
Quality standards (QS) are measurable constructs designed to quantify gaps in care and subsequently to improve quality of care. The Assessment of SpondyloArthritis International Society (ASAS) recently generated and published international QS for the management of patients with axial spondyloarthritis (axSpA) for the first time. The German Society of Rheumatology (DGRh) then decided to translate, review and possibly adopt these standards by a group of experts from different care settings. Against this background, national QS for the management of patients with axSpA for Germany were developed for the first time. The main focus was on feasibility and practical relevance. Ultimately, nine QS were defined with which the quality of care in Germany can and should be measured and improved.
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Gaisberger M, Fuchs J, Riedl M, Edtinger S, Reischl R, Grasmann G, Hölzl B, Landauer F, Dobias H, Eckstein F, Offenbächer M, Ritter M, Winklmayr M. Endogenous anandamide and self-reported pain are significantly reduced after a 2-week multimodal treatment with and without radon therapy in patients with knee osteoarthritis: a pilot study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1151-1160. [PMID: 33649972 PMCID: PMC8213596 DOI: 10.1007/s00484-021-02095-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 05/12/2023]
Abstract
Multimodal therapies comprising spa applications are widely used as non-pharmaceutical treatment options for musculoskeletal diseases. The purpose of this randomized, controlled, open pilot study was to elucidate the involvement of the endocannabinoid system in a multimodal therapy approach. Twenty-five elderly patients with knee osteoarthritis (OA) received a 2-week spa therapy with or without combination of low-dose radon therapy in the Bad Gastein radon gallery. A 10-point numerical rating scale (pain in motion and at rest), WOMAC questionnaire, and the EuroQol-5D (EQ-5D) questionnaire were recorded at baseline, and during treatment period at weeks one and two, and at 3-month and 6-month follow-ups. Plasma levels of the endocannabinoid anandamide (AEA) were determined at baseline and at 2 weeks, and serum levels of several cartilage metabolism markers at all five time-points. A significant and sustained reduction of self-reported knee pain was observed in the study population, but no further significant effect of the additional radon therapy up and above base therapy. This pain reduction was accompanied by a significant reduction of AEA plasma levels during treatment in both groups. No significant differences were seen in serum marker concentrations between the groups treated with or without radon, but a small reduction of serum cartilage degradation markers was observed during treatment in both groups. This is the first study investigating AEA levels in the context of a non-pharmacological OA treatment. Since the endocannabinoid system represents a potential target for the development of new therapeutics, further studies will have to elucidate its involvement in OA pain.
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Affiliation(s)
- M. Gaisberger
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - J. Fuchs
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - M. Riedl
- Dept. of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - S. Edtinger
- Department of Physical Medicine and Rehabilitation, Kardinal Schwarzenberg Klinikum, Schwarzach im Pongau, Austria
| | - R. Reischl
- Bioanalytical Research Labs, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - G. Grasmann
- Bioanalytical Research Labs, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - B. Hölzl
- Department of Internal Med., Landesklinik St. Veit im Pongau, SALK, Paracelsus Med. Univ., Salzburg, Austria
| | - F. Landauer
- Dept. of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - H. Dobias
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - F. Eckstein
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
| | | | - M. Ritter
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - M. Winklmayr
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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21
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Zhu Q, Chen J, Xiong J, Lu L, Zhu S, Zhong Z, Tang G, Zhou X, Guo H. The efficacy of moxibustion and acupuncture therapy for ankylosing spondylitis: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2021; 100:e25179. [PMID: 33847616 PMCID: PMC8051999 DOI: 10.1097/md.0000000000025179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis is a complex and progressive autoimmune inflammatory disease with a worldwide prevalence ranging up to 0.9%. Several systematic reviews and meta-analyses of traditional Chinese medicine alternative therapies, such as acupuncture or moxibustion, have demonstrated the effectiveness of moxibustion and acupuncture in the treatment of ankylosing spondylitis. However, there is no relevant literature to comprehensively evaluate the evidence. The purpose of this overview is to synthesize and evaluate the reliability of evidence generated in the systematic review (SR) and meta-analysis of moxibustion and acupuncture as a primary or complementary therapy for patients with ankylosing spondylitis. METHODS PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched for systematic reviews and meta-analysis that review the efficacy of acupuncture or moxibustion as the primary treatment for patients with Ankylosing Spondylitis. The literature published before August 2020 will be selected. Additionally, the relevant SRs and meta-analyses that unpublished or ongoing will be searched in PROSPERO and INPLASY. The methodological guidelines for overviews will be used to review and extract data by 2 reviewers, and their will do it independently. Methodology quality will be analyzed by the assessment of multiple systematic reviews-2and the risk of bias by POBIS. For the included studies, we will adopt the following results as primary evaluation indicators: effective rate, visual analogue scale and bath AS disease activity index. Reviewers will assess the certainty of evidence by Grading of Recommendations Assessment, Development and Evaluation. RESULTS The results will be published in a peer-reviewed journal. CONCLUSION This overview will provide comprehensive evidence of moxibustion and acupuncture for patients with Ankylosing Spondylitis.
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Affiliation(s)
- Qingyuan Zhu
- Nanchang Hongdu Hospital of Traditional Chinese Medicine
| | - Jun Chen
- Jiangxi University of Traditional Chinese Medicine
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lunbin Lu
- Jiangxi University of Traditional Chinese Medicine
| | - Siyuan Zhu
- Jiangxi University of Traditional Chinese Medicine
| | | | - Genhua Tang
- Jiangxi University of Traditional Chinese Medicine
| | - Xingchen Zhou
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Han Guo
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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ÜNAL ENGİNAR A, UĞURLU H. Ankilozan Spondilitte Fizik Tedavinin Etkinliği: Randomize Kontrollü Bir Çalışma. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.843202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Gur Kabul E, Basakci Calik B, Oztop M, Cobankara V. The efficacy of manual soft-tissue mobilization in ankylosing spondylitis: A randomized controlled study. Int J Rheum Dis 2021; 24:445-455. [PMID: 33644986 DOI: 10.1111/1756-185x.14072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/19/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
AIM The aim of this randomized controlled study was to investigate the effect of soft-tissue mobilization in patients with ankylosing spondylitis (AS). METHOD Twenty-one patients (mean age 44.57 ± 10.40 years) were randomly divided into two groups. There were 13 patients (11 females, 2 males, age 43.69 ± 9.94 years) in the intervention group and 8 patients (5 females, 3 males, age 46.00 ± 11.67 years) in the control group. In the intervention group, soft-tissue mobilization therapy and 20 spinal mobility exercises were applied. The control group received only 20 spinal mobility exercises. The Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and Bath AS Metrology Index (BASMI) were used for assessment of disease activity, functional level, and mobility, respectively. Nottingham Health Profile (NHP) for quality of life and Roland Morris Disability Questionnaire (RMDQ) were used to determine disability levels. RESULTS We found significant differences between pretreatment and post-treatment scores of BASDAI (P = 0.049); BASFI (P = 0.009; lateral lumbar flexion (P = 0.005), maximal intermalleolar distance (P = 0.001) and total score (P = 0.001) of BASMI; pain subtest (P = 0.036) and total score (P = 0.036) of NHP; and RMDQ score (P = 0.004) in the intervention group. However, in the control group the BASMI score (P = 0.049) was observed to worsen significantly. Delta values were compared and differences in BASFI (P = 0.039), and in lateral lumbar flexion (P = 0.027), maximal intermalleolar distance (P = 0.045) and total score (P = 0.001) of BASMI were significant in favor of intervention group. Only tragus-to-wall distance (P = 0.039) of BASMI was observed to worsen significantly in the control group. CONCLUSION We recommend the use of soft-tissue mobilization in addition to the exercises to treat AS patients.
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Affiliation(s)
- Elif Gur Kabul
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Bilge Basakci Calik
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Mucahit Oztop
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
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Kardeş S, Karagülle M. PATHOPHYSIOLOGICAL MECHANISMS OF BALNEOTHERAPY WITH POTENTIAL IMPLICATIONS FOR CENTRAL ASIAN SPAS AND SANATORIUMS. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2020.1.2.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Spa therapy includes all modalities/ treatments based on evidence that are administered in spas or sanatoriums. Balneotherapy, the immersion in mineral water, is the main balneological modality in spa therapy programs. Clinical trials performed in Europe, Turkey, and Israel have shown clinical benefits of spa therapy/ balneotherapy in several diseases mainly pertaining to rheumatic and musculoskeletal diseases and dermatological diseases as well. However, mechanisms by which balneotherapy may improve the clinical symptoms of patients have been less evaluated/ documented in the literature. Although the literature on mechanisms of action of balneotherapy has still been evolving and accumulating, some evidence from preliminary studies paves the way for generating a hypothesis that balneotherapy has an influence on physiological mechanisms, immune system, inflammation, and oxidative stress. Extrapolation of the evidence-based clinical practice and scientific experience of Europe, Turkey, and Israel to Central Asian spas and sanatoriums is although possible; future studies investigating clinical efficacy, safety profile, and possible mechanisms of action of balneotherapy of regional spas are needed to better understand the role of balneotherapy and whether it has any local differences.
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25
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Maier A, Wiedemann J, Rapp F, Papenfuß F, Rödel F, Hehlgans S, Gaipl US, Kraft G, Fournier C, Frey B. Radon Exposure-Therapeutic Effect and Cancer Risk. Int J Mol Sci 2020; 22:ijms22010316. [PMID: 33396815 PMCID: PMC7796069 DOI: 10.3390/ijms22010316] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/18/2023] Open
Abstract
Largely unnoticed, all life on earth is constantly exposed to low levels of ionizing radiation. Radon, an imperceptible natural occurring radioactive noble gas, contributes as the largest single fraction to radiation exposure from natural sources. For that reason, radon represents a major issue for radiation protection. Nevertheless, radon is also applied for the therapy of inflammatory and degenerative diseases in galleries and spas to many thousand patients a year. In either case, chronic environmental exposure or therapy, the effect of radon on the organism exposed is still under investigation at all levels of interaction. This includes the physical stage of diffusion and energy deposition by radioactive decay of radon and its progeny and the biological stage of initiating and propagating a physiologic response or inducing cancer after chronic exposure. The purpose of this manuscript is to comprehensively review the current knowledge of radon and its progeny on physical background, associated cancer risk and potential therapeutic effects.
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Affiliation(s)
- Andreas Maier
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Julia Wiedemann
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Felicitas Rapp
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Franziska Papenfuß
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt am Main, 60590 Frankfurt am Main, Germany; (F.R.); (S.H.)
| | - Stephanie Hehlgans
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt am Main, 60590 Frankfurt am Main, Germany; (F.R.); (S.H.)
| | - Udo S. Gaipl
- Translational Radiation Biology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Gerhard Kraft
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Claudia Fournier
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany; (A.M.); (J.W.); (F.R.); (F.P.); (G.K.); (C.F.)
| | - Benjamin Frey
- Translational Radiation Biology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Correspondence:
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26
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Busija L, Ackerman IN, Haas R, Wallis J, Nolte S, Bentley S, Miura D, Hawkins M, Buchbinder R. Adult Measures of General Health and Health‐Related Quality of Life. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:522-564. [DOI: 10.1002/acr.24216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Romi Haas
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Jason Wallis
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Sandra Nolte
- Charité – Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany, ICON GmbH, Munich, Germany, and Deakin University Burwood Victoria Australia
| | - Sharon Bentley
- Queensland University of Technology Kelvin Grove Queensland Australia
| | | | - Melanie Hawkins
- Deakin University, Burwood, Victoria, Australia, and Swinburne University of Technology Melbourne Victoria Australia
| | - Rachelle Buchbinder
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
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27
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Andreasen RA, Kristensen LE, Baraliakos X, Strand V, Mease PJ, de Wit M, Ellingsen T, Hansen IMJ, Kirkham J, Wells GA, Tugwell P, Maxwell L, Boers M, Egstrup K, Christensen R. Assessing the effect of interventions for axial spondyloarthritis according to the endorsed ASAS/OMERACT core outcome set: a meta-research study of trials included in Cochrane reviews. Arthritis Res Ther 2020; 22:177. [PMID: 32711571 PMCID: PMC7382035 DOI: 10.1186/s13075-020-02262-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022] Open
Abstract
The Assessment of SpondyloArthritis international Society (ASAS) has defined core sets for (i) symptom-modifying anti-rheumatic drugs (SM-ARD), (ii) clinical record keeping, and (iii) disease-controlling anti-rheumatic therapy (DC-ART). These include the following domains for all three core sets: “physical function,” “pain,” “spinal mobility,” “spinal stiffness,” and “patient’s global assessment” (PGA). The core set for clinical record keeping further includes the domains “peripheral joints/entheses” and “acute phase reactants,” and the core set for DC-ART further includes the domains “fatigue” and “spine radiographs/hip radiographs.” The Outcome Measures in Rheumatology (OMERACT) endorsed the core sets in 1998. Using empirical evidence from axSpA trials, we investigated the efficacy (i.e., net benefit) according to the ASAS/OMERACT core outcome set for axSpA across all interventions tested in trials included in subsequent Cochrane reviews. For all continuous scales, we combined data using the standardized mean difference (SMD) to meta-analyze outcomes involving the same domains. Also, through meta-regression analysis, we examined the effect of the separate SMD measures (independent variables) on the primary endpoint (log [OR], dependent variable) across all trials. Based on 11 eligible Cochrane reviews, from these, 85 articles were screened; we included 43 trials with 63 randomized comparisons. Mean (SD) number of ASAS/OMERACT core outcome domains measured for SM-ARD/physical therapy trials was 4.2 (1.7). Six trials assessed all proposed domains. Mean (SD) for number of core outcome domains for DC-ART trials was 5.8 (1.7). No trials assessed all nine domains. Eight trials (16%) were judged to have inadequate (i.e., high risk of) selective outcome reporting bias. The most responsible core domains for achieving success in meeting the primary objective per trial were pain, OR (95% CI) 5.19 (2.28, 11.77), and PGA, OR (95% CI) 1.87 (1.14, 3.07). In conclusion, selective outcome reporting (and “missing data”) should be reduced by encouraging the use of the endorsed ASAS/OMERACT outcome domains in clinical trials. Overall outcome reporting was good for SM-ARD/physical therapy trials and poor for DC-ART trials. Our findings suggest that both PGA and pain provide a valuable holistic construct for the assessment of improvement beyond more objective measures of spinal inflammation.
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Affiliation(s)
- Rikke A Andreasen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Odense, Denmark.,Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark
| | | | - Vibeke Strand
- Division Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Philip J Mease
- Swedish Medical Centre/Providence St. Joseph Health and University of Washington, Seattle, USA
| | | | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Inger Marie J Hansen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Odense, Denmark
| | - Jamie Kirkham
- Centre for Biostatistics, Manchester Academic Health Science, Manchester, UK
| | - George A Wells
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University Hospital, Copenhagen F, Denmark. .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
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28
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Cozzi F, Galozzi P, Ciprian L, Zanatta E, Polito P, Oliviero F, Carrara M, Punzi L. Mud-bath treatment of seronegative spondyloarthritis: experience at the Euganean Thermal Area. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:937-941. [PMID: 31342241 DOI: 10.1007/s00484-019-01761-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 05/19/2023]
Abstract
Mud-bath therapy (MBT) has been used as a treatment for rheumatic diseases and musculoskeletal complaints in the Euganean Thermal Area (near Padova, Italy) since ancient time. There is no consensus about the use of MBT in patients with inflammatory rheumatic diseases, although experimental studies have suggested a beneficial effect of MBT on chronic articular inflammation. To evaluate the effects of MBT in patients affected by seronegative spondyloarthritis, very common chronic inflammatory rheumatic diseases, randomized controlled trials (RCT) performed in the Euganean Thermal Area have been reviewed. A significant improvement of spondylitis parameters was observed in enteropathic spondylitis, without bowel symptom exacerbation. A long-term amelioration of clinical evaluation indices was found in ankylosing spondylitis. A significant improvement of cutaneous lesions, arthritis activity, and patient's functional ability was observed in psoriatic arthritis. MBT was usually well tolerated and adverse side effects were rarely reported. The review of the RCT suggests that MBT may exert additional beneficial effects in patients with seronegative spondyloarthritis treated with pharmacological therapy.
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Affiliation(s)
- Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy.
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Luca Ciprian
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
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29
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Klemm P, Hudowenz O, Asendorf T, Dischereit G, Müller-Ladner U, Lange U, Tarner IH. Evaluation of a special concept of physical therapy in spondyloarthritis: German multimodal rheumatologic complex treatment for spondyloarthritis. Clin Rheumatol 2020; 39:1513-1520. [DOI: 10.1007/s10067-019-04887-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
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[Patient information and shared decision-making in orthopaedics]. DER ORTHOPADE 2019; 48:902-904. [PMID: 31720716 DOI: 10.1007/s00132-019-03781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Maier A, Wiedemann J, Adrian JA, Dornhecker M, Zipf A, Kraft-Weyrather W, Kraft G, Richter S, Teuscher N, Fournier C. α-Irradiation setup for primary human cell cultures. Int J Radiat Biol 2019; 96:206-213. [PMID: 31682776 DOI: 10.1080/09553002.2020.1683641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: We present an α-irradiation setup for the irradiation of primary human cell cultures under controlled conditions using 241Am α-particles.Materials and Methods: To irradiate samples with α-particles in a valid manner, a reliable dosimetry is a great challenge because of the short α-range and the complex energy spectrum. Therefore, the distance between α-source and sample must be minimal. In the present setup, this is achieved by cells growing on a 2 μm thick biaxially-oriented polyethylene terephthalate (boPET) foil which is only 2.7 mm apart from the source. A precise and reproducible exposure time is realized through a mechanical shutter. The fluence, energy spectra and the corresponding linear energy transfer are determined by the source geometry and the material traversed. They were measured and calculated, yielding a dose rate of 8.2 ± 2.4 Gy/min. To improve cell growth on boPET foils, they were treated with air plasma. This treatment increased the polarity and thus the ability of cells attaching to the surface of the foil. Several tests including cell growth, staining for a marker of DNA double-strand breaks and a colony-forming assay were performed and confirm our dosimetry.Conclusion: With our setup, it is possible to irradiate cell cultures under defined conditions with α-particles. The plasma-treated foil is suitable for primary human cell cultures as shown in cell experiments, confirming also the expected number of particle traversals.
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Affiliation(s)
- Andreas Maier
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Julia Wiedemann
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Julia Anna Adrian
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Physics Department, Technical University, Darmstadt, Germany
| | - Maximilian Dornhecker
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Biophysics Department, Goethe University, Frankfurt, Germany
| | - Andreas Zipf
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Physics Department, Technical University, Darmstadt, Germany
| | | | - Gerhard Kraft
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Sandra Richter
- Fraunhofer-Institut für Mikrostruktur von Werkstoffen und Systemen IMWS, Halle, Germany
| | - Nico Teuscher
- Fraunhofer-Institut für Mikrostruktur von Werkstoffen und Systemen IMWS, Halle, Germany
| | - Claudia Fournier
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
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Hofmann W, Winkler-Heil R, Lettner H, Hubmer A, Gaisberger M. Radon transfer from thermal water to human organs in radon therapy: exhalation measurements and model simulations. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2019; 58:513-529. [PMID: 31256227 PMCID: PMC6768894 DOI: 10.1007/s00411-019-00807-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/21/2019] [Indexed: 05/10/2023]
Abstract
The transfer of radon from thermal water via the skin to different human organs in radon therapy can experimentally be determined by measuring the radon activity concentration in the exhaled air. In this study, six volunteers were exposed to radon-rich thermal water in a bathtub, comprising eleven measurements. Exhaled activity concentrations were measured intermittently during the 20 min bathing and 20 min resting phases. Upon entering the bathtub, the radon activity concentration in the exhaled breath increased almost linearly with time, reaching its maximum value at the end of the exposure, and then decreased exponentially with time in the subsequent resting phase. Although for all individuals the time-dependence of exhaled radon activity was similar during bathing and resting, significant inter-subject variations could be observed, which may be attributed to individual respiratory parameters and body characteristics. The simulation of the transport of radon through the skin, its distribution among the organs, and the subsequent exhalation via the lungs were based on the biokinetic model of Leggett and co-workers, extended by a skin and a subcutaneous fat compartment. The coupled linear differential equations describing the radon activity concentrations in different organs as a function of time were solved numerically with the program package Mathcad. An agreement between model simulations and experimental results could only be achieved by expressing the skin permeability coefficient and the arterial blood flow rates as a function of the water temperature and the swelling of the skin.
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Affiliation(s)
- W Hofmann
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020, Salzburg, Austria.
| | - R Winkler-Heil
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020, Salzburg, Austria
| | - H Lettner
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020, Salzburg, Austria
| | - A Hubmer
- Biological Physics, Department of Chemistry and Physics of Materials, University of Salzburg, Hellbrunner Str. 34, 5020, Salzburg, Austria
| | - M Gaisberger
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Strubergasse 21, 5020, Salzburg, Austria
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Liang Z, Fu C, Zhang Q, Xiong F, Peng L, Chen L, He C, Wei Q. Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil 2019; 43:895-902. [PMID: 31355676 DOI: 10.1080/09638288.2019.1645218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the efficacy of water therapy for disease activity, functional capacity, spinal mobility, and pain in patients with ankylosing spondylitis. METHODS PubMed, Ovid, web of science, Cochrane library, Physiotherapy Evidence Database, CNKI, VIP, Wan Fang, and Open Grey were searched for randomized controlled trials that investigated the effects of water therapy on patients with ankylosing spondylitis. Two researchers independently screened the literature databases and then assessed methodological qualities using the Physiotherapy Evidence Database scale and extracted data. Outcomes included were disease activity, functional capacity, spinal mobility, and pain. RESULTS A total of eight studies (n = 383) met the inclusion criteria. Analysis demonstrated that water therapy had a significant effect on disease activity and pain, but not on spinal mobility, or functional capacity in patients with ankylosing spondylitis. CONCLUSION Water therapy can benefit patients with ankylosing spondylitis by reducing disease activity and alleviating pain. More well-designed randomized controlled trials are needed to confirm the results.IMPLICATIONS FOR REHABILITATIONWater therapy can reduce disease activity and pain in patients with ankylosing spondylitis, but cannot improve functional capacity or spinal mobility.Due to its analgesic effect both during and after treatment, water therapy remains an alternative for patients with ankylosing spondylitis when land-based therapy is not well tolerated.
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Affiliation(s)
- Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Sanjon EP, Maier A, Hinrichs A, Kraft G, Drossel B, Fournier C. A combined experimental and theoretical study of radon solubility in fat and water. Sci Rep 2019; 9:10768. [PMID: 31341228 PMCID: PMC6656752 DOI: 10.1038/s41598-019-47236-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/01/2019] [Indexed: 11/26/2022] Open
Abstract
Radon is a radioactive noble gas that can enter the human body, thus increasing the risk of lung cancer. But it is also used for treatment of various ailments, most notably rheumatoid arthritis. The accumulation of radon differs between tissues, with particularly high concentrations in fat tissue. To understand the underlying mechanisms, a combination of γ-spectroscopy and molecular dynamics simulations were performed, to study the accumulation of radon gas in contact with several liquids (water, fatty acids). The solubilities, specific for a defined radon activity concentration, are in good agreement and differ by two orders of magnitude between water and fat, caused by radon disrupting the hydrogen bond network of water. In contrast, the energy cost of introducing radon atoms into fat is low due to the dispersive interaction between radon and fat, which is a non-polar solvent. This correlation was also explicitly demonstrated in our simulations by changing the polarization of the solvent.
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Affiliation(s)
- Elvira P Sanjon
- Institut für Festkörperphysik, Technische Universität Darmstadt, Hochschulstr. 6, 64289, Darmstadt, Germany
| | - Andreas Maier
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics division, Planckstr. 1, 64291, Darmstadt, Germany.
| | - Annika Hinrichs
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics division, Planckstr. 1, 64291, Darmstadt, Germany
- Goethe Universität Frankfurt, Max-von-Laue-Str. 1, 60438, Frankfurt, Germany
| | - Gerhard Kraft
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics division, Planckstr. 1, 64291, Darmstadt, Germany
| | - Barbara Drossel
- Institut für Festkörperphysik, Technische Universität Darmstadt, Hochschulstr. 6, 64289, Darmstadt, Germany
| | - Claudia Fournier
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics division, Planckstr. 1, 64291, Darmstadt, Germany
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Braun J, Baraliakos X, Kiltz U, Krüger K, Burmester GR, Wassenberg S, Thomas MH. Disease Activity Cutoff Values in Initiating Tumor Necrosis Factor Inhibitor Therapy in Ankylosing Spondylitis: A German GO-NICE Study Subanalysis. J Rheumatol 2019; 47:35-41. [PMID: 30877206 DOI: 10.3899/jrheum.181040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE International recommendations for the management of axial spondyloarthritis including ankylosing spondylitis (AS) recommend a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) level of disease activity of ≥ 4 to initiate treatment with biologics. We aimed to evaluate the level of disease activity used to initiate tumor necrosis factor inhibitor (TNFi) treatment and the level of responses to treatment based on different BASDAI cutoffs. METHODS This is a posthoc analysis of the noninterventional, prospective, GO-NICE study in the subgroup of biologic-naive AS treated with golimumab (GOL) 50 mg subcutaneously once monthly. RESULTS Of the 244 biologic-naive AS patients at baseline, 70.5% had a BASDAI ≥ 4 (Group 1), 14.3% had 2.8 to < 4 (Group 2), and 15.2% had even < 2.8 (Group 3). A total of 134 patients (54.9%) completed the 24-month observational period. The mean BASDAI in Groups 1, 2, and 3 was initially 5.9 ± 1.3, 3.4 ± 0.4, and 2.0 ± 0.8, decreased to 2.2 ± 2.0, 1.9 ± 1.2, and 1.0 ± 1.2 within 3 months (all p < 0.0001 vs baseline), and decreased significantly to 2.2 ± 1.7, 1.9 ± 1.7, and 1.4 ± 1.0 at Month 24 (all p < 0.005), respectively. BASDAI 50% improvement was noted in 68.8%, 44.8%, and 45.2% of patients at Month 3, and in 84.9%, 61.9%, and 55.0% at Month 24. CONCLUSION TNFi treatment was initiated in almost a third of AS patients with lower disease activity states as assessed by BASDAI cutoff of ≥ 4. Patients with a BASDAI between 2.8 and < 4 appeared to benefit significantly from GOL treatment, while patients with BASDAI < 2.8 did not. This finding should lead to a reevaluation of the established BASDAI cutoff of ≥ 4.
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Affiliation(s)
- Jürgen Braun
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany. .,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer. .,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH.
| | - Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Uta Kiltz
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Klaus Krüger
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Gerd R Burmester
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Siegfried Wassenberg
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Matthias H Thomas
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
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Maier A, Papenfuß F, Schmitt M, Fournier C, Kraft G. Inhomogeneous distribution of radon in different types of tissue in the human body. BIO WEB OF CONFERENCES 2019. [DOI: 10.1051/bioconf/20191403001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cozzi F, Ciprian L, Carrara M, Galozzi P, Zanatta E, Scanu A, Sfriso P, Punzi L. Balneotherapy in chronic inflammatory rheumatic diseases-a narrative review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:2065-2071. [PMID: 30276474 DOI: 10.1007/s00484-018-1618-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
Since ancient time, thermal baths and mudpacks have been used as treatments for rheumatic diseases and other musculoskeletal complaints. Despite basic researches suggest an anti-inflammatory effect of spa therapy, there is no consensus about the benefits of balneotherapy in patients with chronic inflammatory rheumatic diseases. The aim of this review is to summarize the currently available information on clinical effects of balneotherapy in these diseases. We did a literature search for articles considering the randomized controlled trials (RCTs) published until today. Although many selected studies do not have an elevated methodological quality, data from these RCTs support a beneficial effect of spa therapy. Balneotherapy highly improves the clinical course of the disease in patients with predominant axial involvement, such as with ankylosing and enteropathic spondylitis; the effects are less favorable in patients with predominant peripheral articular inflammation, such as rheumatoid arthritis. Good results have been observed in patients with psoriatic arthritis, but only few RCTs have been conducted on this disease. Spa therapy appears safe, and adverse events have been reported only in a few patients.
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Affiliation(s)
- Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Luca Ciprian
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Gunay SM, Keser I, Bicer ZT. The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 2018; 31:337-346. [PMID: 28946534 DOI: 10.3233/bmr-169755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) can cause severe functional disorders that lead to loss of balance. OBJECTIVE The aim of this study was to investigate the effects of balance and postural stability exercises on spa based rehabilitation programme in AS subjects. METHODS Twenty-one participants were randomized to the study (n= 11) and control groups (n= 10). Patients balance and stability were assessed with the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, Single Leg Stance Test (SLST) and Functional Reach Test (FRT). AS spesicied measures were used for assessing to other parameters. The treatment plan for both groups consisted of conventional transcutaneous electrical nerve stimulation (TENS), spa and land-based exercises 5 days per week for 3 weeks. The study group performed exercises based on postural stability and balance with routine physiotherapy practice in thermal water and in exercise room. RESULTS The TUG, SLST and FUT scores were significantly increased in the study group. In both groups, the BASMI, BASFI, BASDAI and ASQoL scores decreased significantly by the end of the treatment period (p< 0.05). CONCLUSIONS In AS rehabilitation, performing balance and stability exercises in addition to spa based routine approaches can increase the duration of maintaining balance and can improve the benefits of physiotherapy.
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Affiliation(s)
- Selim M Gunay
- Physiotherapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Ilke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Zemzem T Bicer
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Uludag University, Bursa, Turkey
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Kojima S, Thukimoto M, Cuttler JM, Inoguchi K, Ootaki T, Shimura N, Koga H, Murata A. Recovery From Rheumatoid Arthritis Following 15 Months of Therapy With Low Doses of Ionizing Radiation: A Case Report. Dose Response 2018; 16:1559325818784719. [PMID: 30013458 PMCID: PMC6043934 DOI: 10.1177/1559325818784719] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 12/20/2022] Open
Abstract
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that occurs commonly in old people. Hot spring radon therapy is widely practiced in Central Europe and Japan for relief from the painful symptoms. The usual duration of a spa treatment is a week or two, and the relief is temporary. This article reports on the near-complete recovery of a patient who had been suffering from RA for 10 years. The patient received 15 months of low-dose radon and γ-radiation therapy in a room that reproduced the conditions of a radon spa. The daily 40-minute exposure in the therapy room was supplemented by ten 6-minute radio-nebulizer treatments. The inflammation markers C-reactive protein and matrix metalloproteinase 3 declined strongly to the normal level of 0.07 mg/dL and the near-normal level of 48.9 ng/mL, respectively. After the patient's return to good health, the frequency of the visits was reduced to twice each month. The patient's protection systems appear to have adapted to stimulated conditions, sufficiently to sustain the recovery from RA. Such a long-term course of treatments and follow-up maintenance could be carried out in any hospital that has these low-dose radiation therapy rooms. The therapy could be scheduled to suit patient availability.
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Affiliation(s)
- Shuji Kojima
- Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS), Noda-shi, Chiba, Japan
| | - Mitsutoshi Thukimoto
- Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS), Noda-shi, Chiba, Japan
| | | | | | | | - Noriko Shimura
- Faculty of Pharmaceutical Sciences, Ohu University, Koriyama, Japan
| | - Hironobu Koga
- Lead and Company Co, Ltd, Minami-ku, Yokohama, Japan
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Karagülle M, Kardeş S, Dişçi R, Karagülle MZ. Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:195-205. [PMID: 28884308 DOI: 10.1007/s00484-017-1441-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36-37 °C for 20 min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2 weeks) and 3 and 6 months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p = 0.010) and with a trend in favor of spa group in patient global assessment (p = 0.058), function (p = 0.092), and disease activity (p = 0.098) at 3 months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p = 0.006) and patient (p = 0.020) and physician global (p = 0.011) assessments, and a trend toward improvements in pain (p = 0.069) and swollen joints (p = 0.070) at 6 months. A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects may last for 6 months.
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Affiliation(s)
- Mine Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey.
| | - Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
| | - Rian Dişçi
- Department of Biostatistics, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Müfit Zeki Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
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42
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Long-term efficacy of spa therapy in patients with rheumatoid arthritis. Rheumatol Int 2018; 38:353-362. [PMID: 29327104 DOI: 10.1007/s00296-017-3926-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022]
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Karagülle M, Kardeş S, Karagülle MZ. Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1945-1956. [PMID: 28560466 DOI: 10.1007/s00484-017-1384-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 05/28/2023]
Abstract
The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis (p = 0.063) and rheumatoid arthritis (p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis (p = 0.068), rheumatoid arthritis (p = 0.111), and rotator cuff tendinitis (p = 0.078) subgroups. In daily clinical practice, spa therapy is prescribed and practiced mainly for osteoarthritis, then fibromyalgia, lumbar/cervical disc herniation, and nonspecific low back pain; and less for ankylosing spondylitis, rheumatoid arthritis, and rotator cuff tendinitis. The study results suggest that real-life spa therapy may be effective in a variety of rheumatic and musculoskeletal diseases by improving pain and function.
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Affiliation(s)
- Mine Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey.
- Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi, Fatih/Capa, 34093, İstanbul, Turkey.
| | - Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Müfit Zeki Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
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Cucu A, Shreder K, Kraft D, Rühle PF, Klein G, Thiel G, Frey B, Gaipl US, Fournier C. Decrease of Markers Related to Bone Erosion in Serum of Patients with Musculoskeletal Disorders after Serial Low-Dose Radon Spa Therapy. Front Immunol 2017; 8:882. [PMID: 28791026 PMCID: PMC5524779 DOI: 10.3389/fimmu.2017.00882] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/11/2017] [Indexed: 12/29/2022] Open
Abstract
Musculoskeletal disorders (MSDs) are the most frequent cause of disability in Europe. Reduced mobility and quality of life of the patients are often associated with pain due to chronic inflammation. The inflammatory process, accompanied by a destruction of the cartilage and bone tissue, is discussed as a result of (A) the infiltration of immune cells into the joints, (B) an altered homeostasis of the joint cavity (synovium) with a critical role of bone remodeling cells, and (C) release of inflammatory factors including adipokines in the arthritic joint. In addition to the classical medication, low-dose radiation therapy using photons or radon spa treatments has shown to reduce pain and improve the mobility of the patients. However, the cellular and molecular mechanisms of anti-inflammatory effects of radon are yet poorly understood. We analyzed blood and serum samples from 32 patients, suffering from MSDs, who had been treated in the radon spa in Bad Steben (Germany). Before and after therapy, we measured the levels of markers related to bone metabolism (collagen fragments type-1, cartilage oligomeric matrix protein, receptor activator of NFκB ligand, and osteoprotegerin) in the serum of patients. In addition, adipokines related to inflammation (visfatin, leptin, resistin, and adiponectin) were analyzed. Some of these factors are known to correlate with disease activity. Since T cells play an important role in the progression of the disease, we further analyzed in blood samples the frequency of pro- and anti-inflammatory T cell subpopulations (CD4+IL17+ T cells and CD4+FoxP3+ regulatory T cells). Overall, we found a decrease of collagen fragments (CTX-I), indicating decreased bone resorption, presumably by osteoclasts, in the serum of MSD patients. We also observed reduced levels of visfatin and a consistent trend toward an increase of regulatory T cells in the peripheral blood, both indicating attenuation of inflammation. However, key proteins of bone metabolism were unchanged on a systemic level, suggesting that these factors act locally after radon spa therapy of patients with MSDs.
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Affiliation(s)
- Aljona Cucu
- GSI Helmholtz Center for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | - Kateryna Shreder
- GSI Helmholtz Center for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | - Daniela Kraft
- GSI Helmholtz Center for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | - Paul Friedrich Rühle
- Department of Radiation Oncology, Universitätklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gerhart Klein
- Association for Spa Research and Medical Practice for Cardiology, Bad Steben, Germany
| | - Gerhard Thiel
- Membrane Biophysics Group, Department of Biology, Technical University Darmstadt, Darmstadt, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Fournier
- GSI Helmholtz Center for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
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Karagülle M, Kardeş S, Karagülle O, Dişçi R, Avcı A, Durak İ, Karagülle MZ. Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:169-180. [PMID: 27324882 DOI: 10.1007/s00484-016-1201-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
Oxidative stress has been shown to play a contributory role in the pathogenesis of rheumatoid arthritis (RA). Recent studies have provided evidence for antioxidant properties of spa therapy. The purpose of this study is to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy. In this investigator-blind randomized controlled trial, we randomly assigned 50 patients in a 1:1 ratio to spa therapy plus standard drug treatment (spa group) or standard drug treatment alone (control group). Spa group followed a 2-week course of spa therapy regimen consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36-37 °C for 20 min every day except Sunday. All clinical and biochemical parameters were assessed at baseline and after spa therapy (2 weeks). The clinical parameters were pain intensity, patient global assessment, physician global assessment, Health Assessment Questionnaire disability index (HAQ-DI), Disease Activity Score for 28-joints based on erythrocyte sedimentation rate (DAS28-4[ESR]). Oxidative status parameters were malondialdehyde (MDA), nonenzymatic superoxide radical scavenger activity (NSSA), antioxidant potential (AOP), and superoxide dismutase (SOD). The NSSA levels were increased significantly in the spa group (p = 0.003) but not in the control group (p = 0.509); and there was a trend in favor of spa therapy for improvements in NSSA levels compared to control (p = 0.091). Significant clinical improvement was found in the spa group compared to the control in terms of patient global assessment (p = 0.011), physician global assessment (p = 0.043), function (HAQ-DI) (p = 0.037), disease activity (DAS28-4[ESR]) (0.044) and swollen joint count (0.009), and a trend toward improvement in pain scores (0.057). Spa therapy with saline balneotherapy exerts antioxidant effect in patients with RA as reflected by the increase in NSSA levels after spa therapy; whether this antioxidant effect contributes to the clinical improvements observed remains to be verified.
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Affiliation(s)
- Mine Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey.
| | - Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
| | | | - Rian Dişçi
- Department of Biostatistics, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Aslıhan Avcı
- Department of Biochemistry, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İlker Durak
- Department of Biochemistry, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Müfit Zeki Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey
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Forestier R, Erol-Forestier FB, Francon A. Current role for spa therapy in rheumatology. Joint Bone Spine 2017; 84:9-13. [DOI: 10.1016/j.jbspin.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 01/15/2023]
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Lim HJ, Lee MS, Lim HS. Exercise, Pain, Perceived Family Support, and Quality of Life in Korean Patients with Ankylosing Spondylitis. Psychol Rep 2016; 96:3-8. [PMID: 15825897 DOI: 10.2466/pr0.96.1.3-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Relations of habitual exercise and pain, perceived family support, and the quality of life in patients with functional class II for ankylosing spondylitis were explored. In a cross-sectional study perceived pain, family support, and quality of life were compared for 30 patients (23 women and 7 men whose mean age was 28.3 yr. ± 8.6 yr.) practicing exercise regularly and for 38 sedentary patients (31 women and 7 men whose mean age was 27.2 ± 6.7 yr.). Exercising patients reported significantly lower pain, greater perceived family support, and increased quality of life than their sedentary peers. Pain ratings were significantly negatively correlated with the quality of life in both groups ( r = −.26 in exercisers and r = −.50 in sedentary patients) and control group's perceived family support was significantly correlated .44 with quality of life. These results encourage further study of the associations of habitual exercise with perceived pain, family support, and quality of life.
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Affiliation(s)
- Hyun-Ja Lim
- Department of Nursing, Chodang University, Muan
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The impact of serial radon and hyperthermia exposure in a therapeutic adit on pivotal cytokines of bone metabolism in rheumatoid arthritis and osteoarthritis. Clin Rheumatol 2016; 35:2783-2788. [DOI: 10.1007/s10067-016-3236-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
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49
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López-Medina C, Schiotis RE, Font-Ugalde P, Castro-Villegas MC, Calvo-Gutiérrez J, Ortega-Castro R, Jiménez-Gasco R, Escudero-Contreras A, Collantes-Estévez E. Assessment of Fatigue in Spondyloarthritis and Its Association with Disease Activity. J Rheumatol 2016; 43:751-7. [DOI: 10.3899/jrheum.150832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 01/28/2023]
Abstract
Objective.To evaluate fatigue in patients with spondyloarthritis (SpA) and to define its association with disease-related factors and patients’ features.Methods.A cross-sectional multicenter study which includes 2251 patients with SpA selected from the national Spondyloarthropathies Registry (the Spanish Society of Rheumatology; REGISPONSER) Spanish cohort. The primary outcome was the assessment of fatigue performed with the first item of the Bath Ankylosing Spondyloarthritis Disease Activity Index followed by the study of its relation with different factors organized into 4 groups: sociodemographics, emotional, disease-related, and disease activity. Univariate logistic regressions, multivariate logistic regression, and multiple linear regressions were performed to relate fatigue with the studied covariates.Results.Mean fatigue score in all patients with SpA was 4.3 ± 2.9, with statistically significant differences between different SpA types. In univariate logistic regressions, significant differences were seen for many variables included in the 4 groups. Multivariate logistic regression showed that high fatigue score was related with sex (female), emotional component, the Ankylosing Spondylitis Quality of Life score, stiffness, and high levels of 2 visual analog scale items (vertebral pain in the last week and patient’s global assessment of disease activity). The multivariate linear regression showed that fatigue was mainly explained by disease-related factors and disease activity (54.1%), but sex and emotional status may also be involved in 13.5% of the variance.Conclusion.Fatigue is associated with disease-related factors and mostly with SpA activity. However, the emotional component and sex may contribute to the onset of fatigue.
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Activation of Antioxidative Functions by Radon Inhalation Enhances the Mitigation Effects of Pregabalin on Chronic Constriction Injury-Induced Neuropathic Pain in Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2016:9853692. [PMID: 26798431 PMCID: PMC4699081 DOI: 10.1155/2016/9853692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 12/15/2022]
Abstract
Radon inhalation brings pain relief for chronic constriction injury- (CCI-) induced neuropathic pain in mice due to the activation of antioxidative functions, which is different from the mechanism of the pregabalin effect. In this study, we assessed whether a combination of radon inhalation and pregabalin administration is more effective against neuropathic pain than radon or pregabalin only. Mice were treated with inhaled radon at a concentration of 1,000 Bq/m(3) for 24 hours and pregabalin administration after CCI surgery. In mice treated with pregabalin at a dose of 3 mg/kg weight, the 50% paw withdrawal threshold of mice treated with pregabalin or radon and pregabalin was significantly increased, suggesting pain relief. The therapeutic effects of radon inhalation or the combined effects of radon and pregabalin (3 mg/kg weight) were almost equivalent to treatment with pregabalin at a dose of 1.4 mg/kg weight or 4.1 mg/kg weight, respectively. Radon inhalation and the combination of radon and pregabalin increased antioxidant associated substances in the paw. The antioxidant substances increased much more in radon inhalation than in pregabalin administration. These findings suggested that the activation of antioxidative functions by radon inhalation enhances the pain relief of pregabalin and that this combined effect is probably an additive effect.
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