## 3 Results
Post-BT therapy, there were significant enhancements in pain reduction, functional index, health assessment, morning stiffness, and reduced drug consumption. These improvements persisted even after a 6-month follow-up, highlighting the enduring benefits of BT in HOA patients. In terms of tolerability, the BT group reported a 5% occurrence of treatment-related side effects, characterized by mild intensity and minimal disruption to the therapy process. In contrast, the control group exhibited a higher incidence of 9%, primarily manifesting as gastrointestinal side effects. This discrepancy is likely attributed to the increased usage of symptomatic drugs in the control group compared to the BT group [22]. [PERSON] et al. investigated the effects of BT in comparison to bathting in tap water for patients with HOA. In a double-blind RCT, one group comprising 24 participants underwent BT utilizing sulfurous water for 20 min per session, repeated 15 times over a span of 3 weeks, while the control group, consisting of 21 patients, took warm tap water baths. The inclusion criteria comprised a Kellgren and Lawrence radiographic grade of \(\geq\)II in at least two joints. The mineral-rich water employed was spa water from Mezokovsed, belonging to the group of sulfurous waters with a sulfide ion content of 13.2 mg/L. This mineral-rich water also contained notable levels of calcium, magnesium, bicarbonate, and sodium chloride. The results of the study demonstrated that BT using sulfurous water yielded more favorable outcomes in improving the conditions of HOA patients, particularly in terms of pain reduction, when compared to the effects of bathing in warm tap water. No adverse events or negative reactions were reported in either group [23]. [PERSON] et al. conducted a comparative study to assess the efficacy of mud plus bath therapy in comparison to bath therapy alone for patients with both HOA and knee OA. Patients were required to have a Kellgren and Lawrence score of II or III in at least three fingers for HOA in a radiograph performed within the last 6 months, with the majority of patients having a score of II. The mud treatment in the study involved the application of a mud pack prepared using 'Nuova Fonte' water sourced from Terme di Pejo in Peio, Trento, Italy, along with matured clay. The mud pack was applied to affected joints at an initial temperature of 47-50 \({}^{\circ}\)C for 15 min. Meanwhile, bath therapy consisted of immersing the whole body in 'Antica Fonte' water maintained at 35 \({}^{\circ}\)C for 15 min. Both interventions spanned a 12-day period with a break on the 6 th day. The study included 52 patients with HOA. The findings indicated that mud plus bath therapy exhibited greater effectiveness than bath therapy alone in improving clinical outcomes for HOA. No adverse events were reported [24]. [PERSON] et al. conducted a study to investigate the therapeutic and chemical effects of Heviz mud on patients with HOA. The research was conducted at the Covered Bath of Heviz Thermal Lake and St. Andrew Hospital for Rheumatic Diseases. The study enrolled a total of 47 patients with mild-to-moderate HOA, and they were randomly divided into two groups. Group 1 (consisting of 23 patients) received the direct application of Heviz mud on both hands, while Group 2 (comprising 24 patients) received mud on both hands with nylon gloves placed between the mud and the skin. Both groups underwent a series of five 20-min treatment sessions per week for a duration of 3 weeks, with the mud maintained at a constant temperature of 42 \({}^{\circ}\)C. Both the local mud and local mud with nylon gloves induced improvements in the short-term observation. However, the group that received direct mud treatment showed a lasting effect. Indeed, at the week 16 follow-up, the group receiving direct mud treatment exhibited significantly greater improvement in VAS parameters and the count of swollen joints in both hands compared to the nylon glove-mud group. Throughout the study, no adverse effects were observed [25]. [PERSON] et al.