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The objective of this study was to test if spa therapy can play a role in the management of severe knee osteoarthritis (OA). Twenty patients with radiologically and clinically severe knee OA were randomly assigned into spa and drug therapy groups. Spa group (n = 10) traveled to a spa town and stayed at a hotel for a 10-day spa therapy course. They followed a balneotherapy regimen including thermal pool baths at 37 degrees C for 20 min two times daily. Drug therapy group (n = 10) stayed at home and followed their individually prescribed drug therapy (NSAIDs and paracetamol). Patients were assessed at baseline (week 0), after spa therapy at 2 weeks (week 2) and during follow-up period at 12 (week 12) and 24 (week 24) weeks by a blinded investigator. Patients assessed with Lequesne algofunctional index (LAFI), pain (visual analogue scale, VAS), patient's and investigator's global evaluation (VAS), ten-stairs stepping up and down time, 15 m walking time and three times squatting up and down time. Significant improvement in pain and LAFI scores were found at week 2, week 12 and week 24 in the spa therapy group compared to baseline. Comparing the two group differences, spa therapy was superior to drug therapy in pain reduction and in physician's global assessment at all time points. This superiority was also found in LAFI scores and patients' global assessments at week 12 and week 24. A 10-day course of spa therapy may be beneficial in short- and medium-term up to 24 weeks by reducing pain and improving functional status and overall well-being in patients with severe knee OA and may be considered as an effective therapeutic tool for such patients in countries like Turkey where it is widely available and (at least partly) reimbursed.

Investigations in healthy persons have shown that drinking mineral water containing HCO(3) has a positive effect on urine supersaturated with calcium oxalate (SS(CaOx)). The present study evaluates in a common setting whether these effects are also relevant in patients with multiepisodic urinary stone formation. A total of 34 patients with evident multiepisodic CaOx-urolithiasis were included in the study. Patients with hyperparathyroidism, renal tubular acidosis, Wilson's disease, Cushing disease, osteoporosis and malignant diseases were excluded. In a cross-over design and double-blinded the patients received 1.5 l of a mineral water with 2.673 mg HCO(3)/l (test water) or the same amount of water with a low mineral content (98 mg HCO(3)/l) (control water) daily for 3 days. During the study period the patients diet was recorded in a protocol, but not standardised. The main target parameter was SS(CaOx )in 24 h urine. In addition, urinary pH and the most important inhibiting and promoting factors were measured in 24 h urine (Ca, Ox, Mg, Cit). Both waters tested led to a highly significant increase in 24 h urine volume without a difference between each other. In the group, drinking the water containing HCO(3) the urinary pH increased significantly and was within a range relevant for metaphylaxis of calcium oxalate stone formation (x=6.73). This change was highly significant compared to the control group. In addition, significantly increased magnesium and citrate concentration were also observed. Supersaturation with calcium oxalate decreased significantly and to a relevant extent; however, there was no difference between the waters tested. As expected, the risk of uric acid precipitation also decreased significantly under bicarbonate water intake. However, an increase of the risk of calcium phosphate stone formation was observed. It is evident that both waters tested are able to lower significantly and to a relevant extent the risk of urinary stone formation in patients with multiepisodic CaOx-urolithiasis. In addition, the bicarbonate water increases the inhibitory factors citrate and magnesium due to its content of HCO(3) and Mg. Thus, it can be recommended for metaphylaxis of calcium oxalate and uric acid urinary stones.

To assess the absorption of magnesium (Mg) from mineral waters of different Mg content in comparison to low mineralized water and a Mg capsule. Materials and Methods: Design: Randomized, controlled, double- blind trial in a crossover design with an additional control with a Mg capsule. Setting: Institute of Balneology and Medical Climatology, Medical School of Hanover, Germany. Subjects: 22 healthy male volunteers aged between 23-46 years. Intervention: After a standardized breakfast, each participant received, in Latin square order, 500 ml of either of two Mg-rich mineral waters (281 or 120 mg/l). As a control condition, a mineral water of low Mg content (8 mg/l) was used. A Mg capsule (Magnesium-Diasporal? 150, Protina, Ismaning, Germany) was used for further comparisons. Results: Changes in serum Mg levels in the first 4 hours after intake differed significantly between the groups (p = 0.030; ANOVA). Mean values differed between the Mg-rich mineral water conditions and the control conditions though did not reach statistical significance (p = 0.055), however, mean values did not differ between the test waters and the capsule (p = 0.338). Conclusion: Magnesium from mineral waters can easily be absorbed and its absorption rate is similar to that from a pharmaceutical Mg preparation.

ZusammenfassungZiel der Studie: Vergleich der Wirkungen zweier verschiedener traditioneller Kurortbehandlungsregimes bei Patienten mit Knieosteoarthritis auf Kniefunktion und Schmerzen. Methodik: Alle Patienten mit nachgewiesener Knieosteoarthritis, die im Badeort Sandikli eine traditionelle Kur (8-tägig) durchführten, wurden um eine Teilnahme an der Studie gebeten. 49 Patienten stimmten der Teilnahme nach entsprechender Aufklärung zu und wurden in die folgenden Behandlungsgruppen eingeteilt: Gruppe I (n = 24) erhielt je ein Thermalwasserbad (39 8C, 20 min) und ein Peloidbad (45 8C, 20 min) pro Tag; Gruppe II (n = 25) erhielt zwei Thermalwasserbäder (39 8C, 20 min) pro Tag. Hauptzielparameter war der Lequesne-Index für Kniebeschwerden. Sekundäre Zielparameter waren Schmerzintensität (VAS), 10-Meter-Gehzeit, Dauer von drei Kniebeugen und Zeit für das Herauf-und Herabgehen von 10 Treppenstufen. Diese Parameter wurden von einem nicht verblindeten Untersucher zu Beginn und am Ende der Therapiephase erhoben. Ergebnisse: In beiden Gruppen fand sich eine signifikante (p < 0,001) Verbesserung des Lequesne-Knie-Index (Gruppe I: 49,3 %; Gruppe II: 31,3 %). Die Verbesserung war in Gruppe I signifikant stärker als in Gruppe II (p < 0,001). Die Schmerzangaben in der VAS verringerten sich in beiden Gruppen (Gruppe I: 37,3; Gruppe II: 30,1 %). Diese Reduktion war in Gruppe I signifikant stärker als in Gruppe II (p = 0,003). Auch die anderen drei Parameter zeigten signifi- AbstractPurpose: To compare the effects of two different traditional spa therapy regimens for knee osteoarthritis (OA) on function and pain. Patients and Methods: Patients with knee osteoarthritis staying in a spa hotel in Sandõklõ Spa for traditional spa therapy (8 days) were asked to be included in the study. Total of 49 patients gave informed consent consisting two groups based on treatment regimens as follows: Group I (n = 24) had a thermal water bath and a peloid bath per day; Group II (n = 25) had two thermal mineral water baths per day. The primary outcome measure was Lequesne's knee severity index. Secondary measures were pain intensity (visual analogue scale), 10 meters walking time, 3 times squatting down and up time and 10 stairs stepping up and down time. An unblinded observer carried out all assessments at the beginning and at the end of the spa therapy. Results: In both groups, improvements were found in Lequesne's Knee Index (49.3 % in group I and 31.3 % in group II, respectively) (p < 0.001) and improvement in group I was significantly higher than group II (p < 0.001). VAS scores for pain reduced in both groups (37.3 % and 30.1 %) and this reduction was significantly higher in group I (p = 0.003). All other 3 measures also showed significant improvements in both groups and again improvements were significantly higher in group I than group II. Conclusions: Both traditional spa therapy regimens could significantly improve the functional status and pain on patients with knee OA Wissenschaftliche Kurzmitteilung 337 Downloaded by: University of Brit...

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