We found silver level evidence ( www.cochranemsk.org ) concerning the beneficial effects of mineral baths compared to no treatment .
Of all other balneological treatments no clear effects were found .
BACKGROUND Balneotherapy ( or spa therapy , mineral baths ) for patients with arthritis is one of the oldest forms of therapy .
One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients ' suffering and make them feel well .
In this up date we included one extra study .
OBJECTIVES To assess the effectiveness of  balneotherapy  for patients with osteoarthritis ( OA ) .
Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial.
OBJECTIVE To determine the efficacy of combined spa-exercise therapy in addition to st and ard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis ( AS ) . METHODS A total of 120 Dutch out patients with AS were r and omly allocated into 3 groups of 40 patients each . Group 1 ( mean age 48 + /- 10 years ; male : female ratio 25:15 ) was treated in a spa resort in Bad Hofgastein , Austria ; group 2 ( mean age 49 + /- 9 years ; male : female ratio 28:12 ) in a spa resort in Arcen , The Netherl and s. The control group ( mean age 48 + /- 10 years ; male : female ratio 34:6 ) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks . St and ardized spa-exercise therapy of 3 weeks duration consisted of group physical exercises , walking , correction therapy ( lying supine on a bed ) , hydrotherapy , sports , and visits to either the Gasteiner Heilstollen ( Austria ) or sauna ( Netherl and s ) . After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks . Primary outcomes were functional ability , patient 's global well-being , pain , and duration of morning stiffness , aggregated in a pooled index of change ( PIC ) . RESULTS Analysis of variance showed a statistically significant time-effect ( P < 0.001 ) and time-by-treatment interaction ( P = 0.004 ) , indicating that the 3 groups differed over time with respect to the course of the PIC . Four weeks after start of spa-exercise therapy , the mean difference in PIC between group 1 and controls was 0.49 ( 95 % confidence interval [ CI ] 0.16 - 0.82 , P = 0.004 ) and between group 2 and controls was 0.46 ( 95 % CI 0.15 - 0.78 , P = 0.005 ) . At 16 weeks , the difference between group 1 and controls was 0.63 ( 95 % CI 0.23 - 1.02 , P = 0.002 ) and between group 2 and controls was 0.34 ( 95 % CI--0.05 - 0.73 ; P = 0.086 ) . At 28 and 40 weeks , more improvement was found for group 1 compared with controls ( P = 0.012 and P = 0.062 , respectively ) but not for group 2 compared with controls . CONCLUSION In patients with AS , a 3-week course of combined spa-exercise therapy , in addition to drug treatment and weekly group physical therapy alone , provides beneficial effects . These beneficial effects may last for at least 40 weeks
We found silver level evidence ( www.cochranemsk.org ) concerning the beneficial effects of mineral baths compared to no treatment .
Of all other balneological treatments no clear effects were found .
BACKGROUND Balneotherapy ( or spa therapy , mineral baths ) for patients with arthritis is one of the oldest forms of therapy .
One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients ' suffering and make them feel well .
In this up date we included one extra study .
OBJECTIVES To assess the effectiveness of  balneotherapy  for patients with osteoarthritis ( OA ) .