The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial. Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response Therapy With Mud Compresses for Knee Osteoarthritis: Comparison of Natural Mud Preparations With Mineral-Depleted Mud The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study
 Mud-bath therapy and oral glucosamine sulfate in patients with knee osteoarthritis: a randomized, controlled, crossover study. Spa therapy for gonarthrosis: a prospective study Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial Circulating levels of adiponectin, resistin, and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis Treatment and Prevention of (Early) Osteoarthritis Using Articular Cartilage Repair—Fact or Fiction? A Systematic Review OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Acute treatment of schizophrenia Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. Effects of mud pack treatment on skin microcirculation. Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area.
OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel . R and omized into 2 groups , Group 1 received a combination of mineral baths and mud packs , and Group 2 had tap water baths only . Both groups had a significant but temporary improvement in Ritchie index . Group 1 showed a significant improvement in grip strength . No improvement was noticed in morning stiffness , 15 meter walk time and laboratory variables of disease activity in either group . Twelve patients with osteoarthritis ( OA ) received 2 weeks of treatment with mineral baths and mud packs . Statistically significant improvement for a period of 6 months was noticed in night pain , pain on passive motion , tenderness on palpation and in the index of severity of OA of the knee OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis . DESIGN This study was design ed as a prospect i ve , r and omized-controlled , and single-blinded clinical trial . Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were r and omly assigned into two groups and were treated with mature mud packs ( n 15 ) or hot packs ( n=12 ) . Patients were evaluated for pain [ based on the visual analog scale ( VAS ) ] , function ( WOMAC , 6 min walking distance ) , quality of life [ Short Form-36 ( SF-36 ) ] , and serum levels of tumor necrosis factor-alpha ( TNF-α ) , interleukin-6 ( IL-6 ) , and insulin-like growth factor-1 ( IGF-1 ) at baseline , post-treatment , and 3 and 6~months after treatment . RESULTS The mud pack group shows a significant improvement in VAS , pain , stifness , and physical function domains of WOMAC . The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack . For a 6 min walking distance  , mud pack shows significant improvement , and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment . Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment . Significant improvements are found for the social function , vitality/energy , physical role disability , and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment . A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline , and the difference is significant between groups 3 months after the treatment . CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis Several authors have demonstrated the pivotal role of proinflammatory cytokines in inducing progressive cartilage degradation and secondary inflammation of the synovial membrane in osteoarthritis ( OA ) . It has recently been established that tumor necrosis factor (TNF)-alpha plays a well-defined role in the pathophysiology of inflammatory joint diseases and that binding to circulating soluble TNF-alpha receptors can inactivate it . We investigated the influence of mud pack treatment , which is able to diminish TNF-alpha serum values , on specific TNF receptor ( sTNF-R ) levels . Thirty-six patients with OA were enrolled and r and omized into two groups . Group A underwent mud pack treatment and group B underwent thermal bath treatment .  A group of 20 healthy untreated subjects was used as a control . Blood sample s were collected at baseline and after treatment , and assays of sTNF-R55 and sTNF-R75 were performed in both groups . We found small changes in sTNF-Rs serum values but these were not statistically significant . sTNF-R55 serum values decreased by 0.4 % after the therapy in group A , while in group B the decrease was -17.7 % . sTNF-R75 was reduced by -21.17 % in group A and by -10.6 % in group B. In conclusion , through its thermic and ant/inflammatory activity mud pack treatment shows complex interaction with the most common factors of inflammatory and cartilage degradation . Our results suggest that the thermic component of this natural treatment is mainly involved in modulating inflammatory reaction and cartilage damage through binding of the circulating TNF , which controls the activation of the cells responsible for the production of proinflammatory cytokines BACKGROUND Balneotherapy is one of the most commonly used non-pharmacological approaches for osteoarthritis ( OA ) . Recent data indicate that some biomarkers could be useful to predict OA progression and to assess therapeutic response . OBJECTIVES To evaluate the effects of mud-bath therapy on serum biomarkers in patients with knee OA . METHODS The study group comprised 103 patients with primary symptomatic bilateral knee OA who were r and omly assigned to receive a  cycle of mud-bath therapy over a period of 2 weeks or to continue their st and ard therapy alone . Clinical and biochemical parameters were assessed at baseline and after 2 weeks . Clinical assessment s included global pain score on a visual analogue scale ( VAS ) and the Western Ontario and McMaster Universities Index ( WOMAC ) subscores for knee OA . Cartilage oligomeric matrix protein ( COMP ) , C-terminal cross-linked telopeptide type II collagen ( CTX-II ) , myeloperoxidase ( MPO ) and high sensitivity C-reactive protein ( hsCRP ) serum levels were assessed by ELISA . RESULTS At the end of mud-bath therapy we observed a statistically significant improvement in VAS and WOMAC subscores . Serum levels of COMP , MPO and hsCRP did not show any significant modification in either group , while a significant increase ( P < 0.001 ) in CTX-II serum levels was observed in the mud-bath group after the treatment . CONCLUSIONS A cycle of mud-bath therapy added to the usual treatment had a beneficial effect on pain and function in patients with knee OA . The evaluation of serum biomarkers showed a significant increase of CTX-II only , perhaps due to an increase of cartilage turnover induced by thermal stress OBJECTIVE To analyze the effects of mud therapy on perceived pain , Health Related Quality of Life ( HRQL ) and drug use in patients diagnosed with knee osteoarthritis . MATERIAL AND METHODS A prospect i ve , controlled clinical trial . The sample ( n=147 ) was divided into an experimental group ( EG ) of 61 subjects ( 69.13 ± 5,60 years ) who received 11 consecutive sessions of peloids in the knee/s affected by the process described and a control group ( CG ) of 60 subjects ( 73.08 ± 8,90 years ) who continued routine drug treatment . The sample was assessed before and after intervention using the SF-36 , Visual Analogue Scale and changes in drug use , setting a significance level of P ≤ .05 . RESULTS After the intervention , there were statistically significant differences ( P<.05 ) in all parameters analyzed between EG and CG , reduced drug use in the EG versus no change in the CG . The general health , bodily pain and perceived pain are those that show major changes between the two groups . CONCLUSIONS Mud therapy in patients diagnosed with knee osteoarthritis attains immediate effects on perceived pain and HRQOL , reducing the consumption of specific drugs . Studies are needed to evaluate the scientific evidence from the effects of such intervention The purpose of the present investigation was to evaluate whether an anti-inflammatory effect together with an improvement of the regulation of the interaction between the inflammatory and stress responses underlies the clinical benefits of pelotherapy in osteoarthritis ( OA ) patients . This study evaluated the effects of a 10-day cycle of pelotherapy at the spa centre ‘ El Raposo ’ ( Spain ) in a group of 21 OA patients diagnosed with primary knee OA . Clinical assessment s included pain intensity using a visual analog scale ; pain , stiffness and physical function using the Western Ontario and McMaster Universities Arthritis Index ; and health-related quality of life using the EuroQol-5D question naire . Serum inflammatory cytokine levels ( IL-1β , TNF-α , IL-8 , IL-6 , IL-10 and TGF-β ) were evaluated using the Bio-Plex ® Luminex ® system . Circulating neuroendocrine-stress biomarkers , such as cortisol and extracellular 72 kDa heat shock protein ( eHsp72 ) , were measured by ELISA . After the cycle of mud therapy , OA patients improved the knee flexion angle and OA-related pain , stiffness and physical function , and they reported a better health-related quality of life . Serum concentrations of IL-1β , TNF-α , IL-8 , IL-6 and TGF-β , as well as eHsp72 , were markedly decreased . Besides , systemic levels of cortisol increased significantly . These results confirm that the clinical benefits of mud therapy may well be mediated , at least in part , by its systemic anti-inflammatory effects and neuroendocrine-immune regulation in OA patients . Thus , mud therapy could be an effective alternative treatment in the management of OA Mud pack therapy is an alternative mode of treatment for rheumatic diseases . It is based on the application of heated mud packs to the entire body or to specific areas , such as over joints . The aim of the current study was to evaluate the efficacy of treatment with mud compresses at patients ’ homes for osteoarthritis of the knee . Fifty-eight patients with osteoarthritis of the knee were enrolled in a prospect i ve , double-blinded , controlled study . Forty patients were treated with natural mineral-rich mud compresses and 18 patients were treated with mineral-depleted mud compresses . Mud compresses were applied 5 times each week during 3 weeks for a total of 15 treatments . Patients were assessed at baseline , at completion of the 3-week treatment period , and twice after the conclusion of the treatment period — after 1 month and after 3 months . The main outcome measures were the Lequesne Index of severity of knee osteoarthritis , patient self- assessment of pain , and severity of knee pain on a visual analog scale . A reduction of 20 % or more in the pain scores was considered clinical ly significant . In the group treated with natural mud compresses , a significant reduction in knee pain was observed at all assessment s. Similarly , improvement in the Lequesne Index was seen at the end of therapy and a month after treatment . In the control group , given mineral-depleted mud compresses , no significant change in knee pain was seen at any assessment . Improvement in the Lequesne Index was seen 1 and 3 months after completion of the therapy , but not at the end of therapy . Seventy-two percent of the patients in the treatment group had an improvement of > 20 % in self- assessment of knee pain , compared with 33 % in the control group ( p = 0.005).The data suggest that treatment with mud compresses , but only in their natural form , temporarily relieves pain in patients with osteoarthritis of the knees . We believe that treatment with mud compresses might augment conventional medical therapy in these patients The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased OBJECTIVES To evaluate the efficacy and safety of combined treatment of mud-bath therapy and glucosamine crystalline sulfate ( GlcN-S ) in patients with knee osteoarthritis ( OA ) . METHODS This study was a r and omised , controlled , crossover investigation . Patients were r and omly assigned ( 1:1 ) by the investigators to two groups , named group 1 and 2 . Group 1 included twenty-three patients receiving oral GlcN-S treatment from the beginning of the study  ( T0 ) to the end of the 3rd month of treatment ( T3 ) and a combined treatment of both mud-bath therapy and GlcN-S from T3 to the end of the study at six months ( T6 ) . Group 2 included twenty-two patients receiving a combined treatment of both mud-bath therapy and GlcN-S from T0 to T3 and that discontinued mud-bath therapy , receiving GlcN-S treatment alone , from T3 to T6 . Primary endpoints of the study consisted of evaluating OA severity and activity at baseline and at follow-up visits . RESULTS All 45 patients , eligible for the study , completed the period of the crossover . In group 1 , no significant difference was shown in the comparison from T0 to T3 , while from T3 to T6 most variables were significantly improved . In group 2 , instead , the comparison between T0 and T3 showed a significant difference in different parameters . When comparing T3 and T6 , despite an improvement of all the variables , no significant difference was shown . CONCLUSIONS The association of GlcN-S and mud-bath therapy has a positive and safe role in improving pain , function and quality of life in knee OA patients The objective of this study was to evaluate the effect of spa therapy on clinical parameters of patients with gonarthrosis . Patients with gonarthrosis ( n=33 ) underwent a 2-week spa therapy using three treatment regimes and a 20-week follow-up as follows : group I ( n=11 ) had mineral water baths and hot native mineral mud packs , group II ( n=12 ) had mineral water baths and rinsed mineral-free mud packs and group III ( n=10 ) had tap water baths and mineral-free mud packs . The patients and the assessing rheumatologist were blinded to the difference in the treatment protocol s. A significant improvement in the index of severity of the knee ( ISK ) , as well as night pain scores , was achieved in group I. Improvement in physical findings and a reduction in pain ratings on a visual analogue scale ( VAS ) did not reach statistical significance . Analgesic consumption was significantly decreased in both groups I and III for up to 12 weeks . Global improvement assessed by patients and physician was observed in all three groups up to 16 weeks but persisted to the end of the follow-up period in group I only . Patients with gonarthrosis seemed to benefit from spa therapy under all three regimes . However , for two parameters ( night pain and ISK ) the combination of mineral water baths and mud packs ( group I ) appeared to be superior We have previously shown that thermal mud therapy is able to influence chondrocyte activity of osteoarthrosic patients by modulating the production of serum cytokines , such as interleukin 1 , and this was related to the presence of an anti-inflammatory principle in mature thermal mud . Mud therapy influences many biochemical processes of the body , independently of the thermic stimulation alone and the present paper documents specific increases of insulin growth factor 1 and decreases of tumor necrosis factor alpha in serum of osteoarthrosic patients after 12 days of mud pack application Mud-bath therapy plays a primary role in the treatment and prevention of  osteoarthritis  that has been recognised since antiquity . Numerous studies have demonstrated its clinical benefits and its effects on inflammatory mediators ( interleukins ) , the immune system , cenesthesic factors ( endorphins ) , and the diencephalic – pituitary – adrenal axis . This study was conducted to assess the efficacy of mud-bath therapy with mineral water from the Sillene Spring at Italy ’s Chianciano Spa in patients with osteoarthritis of the knee . Patients ( n = 61 ) were divided into two groups . Group A underwent three cycles of mud-based spa therapy over a year ’s time , whereas group B did not . Clinical conditions , visual analogue scale pain ratings , and Lequesne indexes of the two groups were compared . We also compared these same parameters in the patients of the two groups that were following the therapy with drugs and in the patients of the group A before and after spa treatment . The percentage of patients with no symptoms or mild symptoms was higher in group A than in group B. Within group A , this percentage was higher after treatment than before spa therapy . Even in the comparison between the patients of the two groups that were following the therapy with drug , the results was that in group A the percentage of patients with no symptoms or mild symptoms was higher than in group B. Statistical analyses based on various tests revealed that almost all these differences were highly significant . No adverse effects were observed in any of the patients in group A. In conclusion , the mud-bath therapy performed at Chianciano Spa with Sillene Spring water remarkably improved the clinical conditions of patients with knee arthritis and significantly reduces the frequency and severity of symptoms and the disability they cause The objective of this prospect i ve parallel r and omized single-blind study was to assess that a cycle of mud-bath therapy ( MBT ) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis ( OA ) . Patients with symptomatic primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : one group received a cycle of MBT at spa center of Chianciano Terme ( Italy )  in addition to the usual treatment , and one group continued their regular care routine alone .  Clinical assessment s were performed 7 days before enrollment ( screening visit ) , at the time of enrollment ( basal time ) , after 2 weeks , and after 3 , 6 , 9 , and 12 months after the beginning of the study . All assessment s were conducted by two research ers blinded to treatment allocation . The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) subscore for physical function ( W-TPFS ) .  Of the 235 patients screened , 103 met the inclusion criteria : 53 patients were included in the MBT group and 50 in the control group . In the group of patients treated with MBT , we observed a statistically significant ( p < 0.001 ) reduction of VAS and W-TPFS score at the end of the treatment ; this improvement was significant ( p < 0.05 ) also at 3 months of follow-up . The control group did not show significant differences between baseline time and all other times . The differences between one group were significant for both primary parameters already from the 15th day and persisted up to the 9th month . This beneficial effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of MBT seemed to be good , with light and transitory side effects . Our results confirm that a cycle of MBT added to usual treatment provides a beneficial effect on the painful symptoms and functional capacities in patients with knee OA that lasts over time . Mud-bath therapy can represent a useful backup to pharmacologic treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Adipocytokines , including adiponectin , resistin , and visfatin may play an important role in the pathophysiology of osteoarthritis ( OA ) .  Spa therapy is one of the most commonly used non-pharmacological approaches for OA , but its mechanisms of action are not completely known . The aim of the present study was to assess whether a cycle of mud-bath therapy ( MBT ) influences the serum levels of adiponectin , resistin , and visfatin in patients with knee OA . As part of a prospect i ve r and omized , single blind-controlled trial evaluating the efficacy of MBT in knee OA , we included in this study 95 out patients . One group ( n = 49 ) received a cycle of MBT at the spa center of Chianciano Terme ( Italy ) in addition to the usual treatment , and one group ( control group ; n = 46 )  continued their regular care routine alone . Patients were assessed at basal time and at the end of the study ( 15 days ) for clinical and biochemical parameters . Clinical assessment s included spontaneous pain on a visual analog scale ( VAS ) score and the Western Ontario and McMaster Universities index ( WOMAC ) subscores for knee OA evaluated as total pain score ( W-TPS ) , total stiffness score ( W-TSS ) , and total physical function score ( W-TPFS ) . Adiponectin , resistin and visfatin serum levels were assessed by enzyme immunoassay methods . At the end of the mud-bath therapy , serum adiponectin levels showed a significant decrease ( p < 0.001 ) , while no significant modifications were found in the control group at day 15 . Serum resistin showed a significant decrease ( p < 0.0001 ) in the MBT group at the end of the study and a significant increase in the control patients ( p < 0.001 ) . No significant modifications of visfatin were found in MBT . Furthermore , we tested the relationships between demographic and clinical parameters and adipocytokine concentrations measured in the MBT group at basal and at the end of the study . In conclusion , the present study shows that a cycle of MBT can modify serum levels of adiponectin and resistin but not the circulating levels of visfatin . In view of the recent evidence s about the involvement of adiponectin and resistin in the pathogenesis and progression of OA , the decrease of these adipokines after mud-bath therapy may play a protective role in the course of the disease . However , it remains to be clarified which of the mechanisms of action of MBT may have determined the changes in serum levels of adiponectin and resistin that we observed Early osteoarthritis ( OA ) is increasingly being recognized in patients who wish to remain active while not accepting the limitations of conservative treatment or joint replacement . The aim of this systematic review was to evaluate the existing evidence for treatment of patients with early OA using articular cartilage repair techniques . A systematic search was performed in EMBASE , MEDLINE , and the Cochrane collaboration . Articles were screened for relevance and appraised for quality . Nine articles of generally low method ological quality ( mean Coleman score 58 ) including a total of 502 patients ( mean age range = 36 - 57 years ) could be included . In the reports , both radiological and clinical criteria for early OA were applied . Of all patients included in this review , 75 % were treated with autologous chondrocyte implantation . Good short-term clinical outcome up to 9 years was shown . Failure rates varied from 8 % to 27.3 % . The conversion to total knee arthroplasty rate was 2.5 % to 6.5 % . Although a ( r and omized controlled ) trial in this patient category with long-term follow-up is needed , the literature suggests autologous chondrocyte implantation could provide good short- to mid-term clinical outcome and delay the need for total knee arthroplasty . The use of st and ardized criteria for early OA and implementation of ( r and omized ) trials with long-term follow-up may allow for further expansion of the research field in articular cartilage repair to the challenging population with ( early ) OA OBJECTIVES To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis ( OA ) or following joint replacement . METHODS An international , multidisciplinary expert advisory group was established to guide the study . Potential tests for consideration in the recommended set were identified via a survey of selected experts and through a systematic review of the measurement properties for performance-based tests . A multi-phase , consensus-based approach was used to prioritize and select performance-based tests by applying decision analysis methodology ( 1000Minds software ) via online decision surveys . The recommended tests were chosen based on available measurement-property evidence , feasibility of the tests , scoring methods and expert consensus . RESULTS Consensus incorporated the opinions of 138 experienced clinicians and research ers from 16 countries . The five tests recommended by the advisory group and endorsed by Osteoarthritis Research Society International ( OARSI ) were the  30-s chair-st and test , 40 m fast-paced walk test , a stair-climb test , timed up- and -go test and 6-min walk test . The first three were recommended as the minimal core set of performance-based tests for hip or knee OA . CONCLUSION The OARSI recommended set of performance-based tests of physical function represents the tests of typical activities relevant to individuals diagnosed with hip or knee OA and following joint replacements . These tests are complementary to patient-reported measures and are recommended as prospect i ve outcome measures in future OA research and to assist decision-making in clinical practice . Further research should be directed to exp and ing the measurement-property evidence of the recommended tests These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry ( WFSBP ) . The goal during the development of these guidelines was to review systematic ally all available evidence pertaining to the treatment of schizophrenia , and to reach a consensus on a series of practice recommendations that are clinical ly and scientifically meaningful based on the available evidence . These guidelines are intended for use by all physicians seeing and treating people with schizophrenia . The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia , as well as from meta-analyses , review s and r and omised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE data base and Cochrane Library . The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence ( A – D ) . This first part of the guidelines covers disease definition , classification , epidemiology and course of schizophrenia , as well as the management of the acute phase treatment . These guidelines are primarily concerned with the biological treatment ( including antipsychotic medication , other pharmacological treatment options , electroconvulsive therapy , adjunctive and novel therapeutic strategies ) of adults suffering from schizophrenia OBJECTIVE To develop clinical practice guidelines for the use of foot orthotics ( FO ) in the treatment of knee and hip osteoarthritis . METHOD The SOFMER ( French Physical Medicine and Rehabilitation Society ) methodology , associating a systematic review of the literature , input from every day clinical practice and external review by a multidisciplinary expert committee , was used . The selected analysis criteria were  pain , disability , medications used and X-ray evolution of osteoarthritis .  The recommendations are classified according to the level of proof in Grade A , B or C according to the French National Agency for Health Accreditation and Evaluation ( NAHAE ) . RESULTS In medial knee osteoarthritis , foot pronation orthotics -- when there are no contraindications -- can be proposed for their symptomatic impact , especially in the decrease of NSAIDs consumption ( Grade B ) . To this day , there is no evidence of a structural or functional impact on osteoarthritis ( Grade B ) . Outside of this specific clinical framework , there is no vali date d indication for prescribing foot orthotics in the treatment of knee or hip OA ( Grade C ) . CONCLUSION It is necessary to have further r and omized controlled trials to better define the indication of Foot orthotics ( severity of knee OA , genu varum ) , test the efficacy of other orthoses such as cushioning FO . The long-term side effects , mainly on the external femorotibial compartment could also be assessed . A medical and economical assessment of FO prescriptions is also quite necessary OBJECTIVES The objective of this study was to conduct a laser-Doppler flowmetry investigation of skin microcirculation changes induced by mud pack therapy . The magnitude of the changes , potential remote effects , and potential influence of mud pack thickness were studied . METHODS Twenty female spa therapy patients aged 28 - 67 years ( median , 51 years ) participated in the study . The reason for spa therapy was lower limb venous insufficiency in 14 patients and osteoarthritis in six patients , none of whom had involvement of the shoulders .  Mud pack treatment was associated with a significant elevation in skin temperature , by 1.8 + /- 0.2 and 1.0 + /- 0.2 degrees C with the 30- and 15-mm packs , respectively ( P < 0.001 for both comparisons ; nonsignificant difference between the two packs ) . Skin blood flow increased significantly , by 619 + /- 82 and 410 + /- 124 mV with the 30- and 15-mm packs , respectively ( P < 0.0001 for both comparisons ; nonsignificant difference between the two packs ) . The vasomotion score increased markedly on the treated side , by 16.7 + /- 2.8 and 13.0 + /- 1.6 with the 30- and 15-mm packs , respectively ( P < 0.005 for both comparisons ; no significant difference between the two packs ) . Furthermore , low-frequency vasomotion waves of a type not described previously were recorded . The microcirculatory changes lasted longer than did the temperature increase . No significant changes were noted in the other shoulder or in central body temperature . RESULTS The patients were volunteers receiving spa therapy and free of diabetes mellitus , vasoactive drug treatment , and inflammatory shoulder disease .  Two mud packs , 15 and 30 mm in thickness , respectively , were applied at an interval of 48 h , at the same time of day in a given patient , and at a distance from other spa treatments . The packs were centered on the deltopectoral groove . The side and order of application of the two packs were determined at r and om . Superficial skin blood flow was measured by laser-Doppler flowmetry ( Perimed PF4001 , wavelength 82 nm ) and recorded by the Perisoft computer program with a 3-s time constant downstream from a broadb and filter ( 12 MHz ) . CONCLUSION These results suggest that the vascular changes induced by mud pack therapy are not fully explained by vasodilation in response to local temperature elevation . Further studies are in order to identify the other mechanisms involved The efficacy of balneotherapy in fibromyalgia syndrome ( FS ) has been well demonstrated , while controlled studies using mud packs are lacking . We performed a r and omized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients , who are poor responders to pharmacological therapy . Eighty patients with primary FS , according to ACR criteria , were r and omly allocated to two groups : 40 were su bmi tted to a cycle of 12 mud packs and thermal baths  , and 40 were considered as controls .  At baseline , after thermal treatment and after 16 weeks , patients were evaluated by FIQ , tender points count , VAS for “ minor ” symptoms , AIMS 1 and HAQ . Control patients were assessed at the same time periods . A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed . Mud packs were well tolerated and no drop-outs were recorded . Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS OBJECTIVE To assess the incidence of Total Joint Replacement ( TJR ) during the long-term follow-up of patients with knee osteoarthritis ( OA ) formerly receiving treatment with glucosamine sulphate or placebo .  METHODS Knee OA patients participating in two previous r and omised , placebo-controlled , double-blind , 3-year trials of glucosamine sulphate and receiving treatment for at least 12 months , were systematic ally contacted to participate in a long-term follow-up retrospective assessment of the incidence of total knee replacement . RESULTS Out of 340 patients with at least 12 months of treatment , 275 ( i.e. , 81 % ) could be retrieved and interviewed for the present evaluation : 131 formerly on placebo and 144 on glucosamine sulphate .  There were no differences in baseline disease characteristics between groups or with the patients lost to follow-up . The mean duration of follow-up was approximately 5 years after trial termination and treatment discontinuation , making up a total of 2178 patient-years of observation ( including treatment and follow-up ) . Total knee replacement had occurred in over twice as many patients from the placebo group , 19/131 ( 14.5 % ) , than in those formerly receiving glucosamine sulphate , 9/144 ( 6.3 % ) ( P=0.024 , chi-square test ) , with a Relative Risk that was therefore 0.43 ( 95 % confidence interval ( CI ) : 0.20 - 0.92 ) , i.e. , a 57 % decrease compared with placebo . The Kaplan Meier/Log-Rank test survival analysis confirmed a significantly decreased ( P=0.026 ) cumulative incidence of total knee replacements in patients who had received glucosamine sulphate . A pharmacoeconomic analysis in a subgroup of subjects suggested that patients formerly on glucosamine sulphate had recurred to less symptomatic medications and use of other health re sources than those from the placebo group during the last year of follow-up . CONCLUSIONS Treatment of knee OA with glucosamine sulphate for at least 12 months and up to 3 years may prevent TJR in an average follow-up of 5 years after drug discontinuation Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel . The patients were divided into four groups of 10 . Group I was treated with daily mud packs , group II with daily hot sulphur baths , group III with a combination of mud packs and hot sulphur baths , and group IV served as a control group . The patients were assessed by a rheumatologist who was blinded to the treatment modalities . Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices . Improvement in the control group was minor in comparison and not statistically significant . No significant improvement was observed in any of the laboratory variables measured . Except for three mild cases of thermal reaction there were no side effects
CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA .
OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA .