Innate/inflammatory bioregulation and clinical effectiveness of whole-body hyperthermia (balneotherapy) in elderly patients with osteoarthritis

Abstract

Objectives: Balneotherapy with mud application (mud therapy) is a common hydrothermal intervention for the treatment and rehabilitation of elderly patients with osteoarthritis, leading to anti-inflammatory effects. The main purpose of this investigation was to study a role for regulatory T cells in these anti-inflammatory effects. The second objective was to assess whether the neutrophil-mediated innate response is affected by these anti-inflammatory effects. Methods: Thirty-six elderly patients with knee osteoarthritis underwent a 10-day cycle of balneotherapy at a spa center. They received daily sessions of whole-body mud therapy at 40-42 C, using mineral-medicinal water and mud. IL-8 and TGF-b serum concentrations, percentage of circulating CD4 þ CD25 þ FOXP3 þ and CD8 þ CD28regulatory T cells, and neutrophil phagocytic capacity were evaluated at baseline and at the end of the intervention. Clinical assessments included knee flexion and extension angle, pain, stiffness, physical function and health-related quality of life. Results: All clinical outcomes significantly improved. Circulating concentrations of IL-8 and TGF-b decreased, which correlated with decreased pain and improved knee flexion, respectively. Percentage of CD4 þ regulatory T cells decreased, whereas CD8 þ regulatory T cells increased. Neutrophil functional capacity increased. Conclusions: Balneotherapy with mud application was effective in the management of osteoarthritis symptoms. The anti-inflammatory effect mediated by cytokines contributed to the improvement in pain and joint function; and changes in the circulating percentage of regulatory T cells seem to be involved in the anti-inflammatory effects. Improvement in neutrophil function after mud therapy reflects an optimal bioregulatory effect on the inflammatory and innate responses.

Natural medicinal resources and their therapeutic applications

“…The results showed that mud therapy significantly improved osteoarthritis-related pain, stiffness, and physical function. It also increased knee flexion and extension angle [11]. Balneotherapy has short-and long-term effects on patients with low back pain-another noninflammatory musculoskeletal disease.…”

“…Osteoarthritis is a degenerative musculoskeletal disease and leading cause of pain, disability, and impaired quality of life [4,10,11]. It affects synovial joints (mainly hips and knees), in which cartilage destruction, subchondral bone remodeling, osteophyte formation, and synovial inflammation are found, thereby leading to joint stiffness [11]. Osteoarthritis usually affects approximately 10% of people over 60 years of age [10].…”

Balneotherapy and human immune function in the era of COVID-19

“…In a psoriasis-like murine model, balneotherapy suppressed lesional IL-23 and IL-17A, cytokines involved in maintaining chronic inflammation (Lee et al 2014). C-reactive protein levels, which rise in response to inflammation, decrease significantly after balneotherapy (Gálvez et al 2018a(Gálvez et al , 2018b.…”

“…Rinaldi et al (2006) demonstrated in vitro that sulphurous mineral water favours the short-term survival of neutrophils, speeding up the resolution of infections and preventing further inflammation. Studies conducted in patients with osteoarthritis who underwent hydrotherapy or mud-bath therapy showed that, after the treatment, neutrophils' circulating and functional capacity increased, reflecting a greater defence capacity against pathogens and thus a potential lower susceptibility to infections (Gálvez et al , 2018a(Gálvez et al , 2018b. Balneotherapy may also contribute to increase cortisol levels in healthy and subhealthy people.…”

“…Regarding the modulation of inflammatory cytokines' activity, mud therapy and balneotherapy can cause a reduction in serum concentrations of pro-inflammatory cytokines TNF-α and IL-1β as well as an increase in anti-inflammatory IGF-1 (Gálvez et al 2018a(Gálvez et al , 2018b. In a psoriasis-like murine model, balneotherapy suppressed lesional IL-23 and IL-17A, cytokines involved in maintaining chronic inflammation (Lee et al 2014).…”