###### Abstract  
Hand osteoarthritis (HOA) represents a common presentation of osteoarthritis, significantly affecting patients' quality of life and daily activities. The 2018 EULAR recommendations underline the importance of a multidisciplinary approach, combining non-pharmacological and pharmacological treatments. Yet, the role of baleotherapy (BT) in the HOA therapeutic regimen remains unclear. This review seeks to bridge the gap by exploring recent randomized controlled trials (RCTs) that investigate the potential benefits of BT as a complementary intervention for managing HOA. This scoping review investigates original research articles published between January 2003 and August 2023 through a comprehensive search across MEDLINE (PubMed), Google Scholar, and Web of Science. The findings from this scoping review contribute to the growing corpus of evidence indicating that BT, particularly when employing specific methods like mud packs and mineral-rich baths, presents a promising role in reducing pain and enhancing functionality and quality of life, particularly in the initial phases of the condition. These findings highlight the potential therapeutic efficacy of BT interventions and support their inclusion as a complementary approach in managing HOA and preventing its progression. However, further research and the undertaking of larger-scale trials are imperative to validate these preliminary findings.  
osteoarthritis; rehabilitation; complementary medicine; spa therapy +
Footnote †: journal: Medical Radiology (ISMH), 38056 Levioc Terme, Italy
features (e.g., central erosions, joint space narrowing, collapse of the subchondral bone, and subchondral sclerosis) [4, 5, 7].  
HOA can significantly impact quality of life and cause disability, leading to reduced participation in social and work activities [8, 9]. Despite its high prevalence and impact, HOA has garnered less attention compared to other joint localizations affected by OA, such as knee or hip OA [10, 11, 12, 13].  
According to the 2018 update of the European League Against Rheumatism (EULAR) recommendations, the optimal management of HOA usually involves a multidisciplinary approach, combining both non-pharmacological and pharmacological treatments [14]. For the non-pharmacological strategies, this guideline did not provide any specific guidance regarding the inclusion of balneotherapy (BT) as a supplementary component in the treatment regimen for HOA, primarily due to the scarcity of available literature on the topic. However, previous literature has suggested the effectiveness of BT in OA, and although limited, also in HOA [13, 15, 16, 17].  
Indeed, BT--a therapeutic approach that involves the utilization of natural mineral-rich waters for their potential health benefits through various methods, such as immersing the body in these mineral waters or applying mud to the skin--has previously been demonstrated to regulate immune imbalance, promote relaxation, alleviate pain, improve circulation, and address various health conditions, including musculoskeletal disorders and HOA [13, 15, 16, 17].  
Therefore, the aim of this scoping review is to comprehensively explore and summarize the existing randomized controlled trials (RCTs) published in recent years to provide insights into the potential benefits of BT as a complementary intervention in managing HOA. Furthermore, this scoping review aims to identify gaps in the current research landscape, in order to focus on specific topics that should deserve attention in the forthcoming studies.