Investigation of Lake Hévíz Mineral Water Balneotherapy and Hévíz Mud Treatment in Murine Osteoarthritis and Rheumatoid Arthritis Models

Abstract

Arthritic diseases are the most frequent causes of chronic pain and disability. Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and progressive structural joint damage. Osteoarthritis is a degenerative process of the articular cartilage associated with hypertrophic changes in the bone. The aim of the present study was to investigate the anti-inflammatory and analgesic effects of Hévíz thermal water and mud in monosodium iodoacetate- (MIA-) (25 mg/ml, 20 μl i.a.) induced osteoarthritis and Complete Freund's adjuvant- (CFA-) (1 mg/ml, 50–50 μl s.c) induced rheumatoid arthritis murine models. The mechanonociceptive threshold of female NMRI mice (n=6– 8 mice/ group) was measured by aesthesiometry, and paw volume was monitored with plethysmometry, knee joint diameter with digital micrometer, and dynamic weight bearing on the hind limbs with a Bioseb instrument. Periarticular bone destruction was assessed by SkyScan 1176 in vivo micro-CT. Inflammatory cytokines were detected by ELISA in plasma samples. Treatments (30 min, every working day) with tap water, sand, and a combined therapy of tap water and sand served as controls. Hévíz medicinal water and combined treatment with water and mud significantly decreased the mechanical hyperalgesia and knee oedema in MIA-induced osteoarthritis model. However, balneotherapy did not influence mechanical hyperalgesia, weight bearing, or oedema formation induced by CFA. Neither medicinal water nor mud treatment ameliorated deep structural damage of the bones or the joints in the animal models. On the basis of the present findings, we conclude that balneotherapy is an effective complementary treatment to reduce the pain sensation and swelling in degenerative joint diseases such as osteoarthritis. Our experimental data are in agreement with the previous human studies that also confirmed antinociceptive and anti-inflammatory effects of thermal water and Hévíz mud treatments.

Effect of balneotherapy in sulfurous water on an in vivo murine model of osteoarthritis

“…Conversely, previous studies observed that H 2 S plays anti-inflammatory effects on fibroblast-like synoviocytes from OA and rheumatoid arthritis patients (Sieghart et al 2015;Kloesch et al 2010;, alleviating, for instance, the inflammatory expression activated by IL-1 in these cells (Sieghart et al 2015). Nevertheless, in agreement with our results, Tékus et al (2018) observed in a chemicalinduced OA that balneotherapy in thermal water rich in H 2 S showed smaller synovial swelling, reduced number of fibroblasts, and less collagen, but there were no statistically significant differences in comparison with control. A possible explanation for the discrepancy between the effect of H 2 S in in vitro and in vivo OA models could reside in the moment that histological analysis of synovium was performed, i.e., last stage of the experimental OA when synovial inflammation is likely into remission and destructive processes are taking place in the joint, so that differences between treated and control conditions in terms of synovitis are already indistinguishable.…”

Mud therapy and rehabilitation - scientific relevance in the last six years (2015 – 2020) Systematic literature review and meta-analysis based on the PRISMA paradigm

“…For instance, rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and progressive structural joint damage. Osteoarthritis is a degenerative process of the articular cartilage associated with hypertrophic changes in the bone (84). The new insights in the pathogenesis of osteoarthritis (OA) reveal the implications of adipocytokines.…”

A comprehensive analysis to understand the mechanism of action of balneotherapy: why, how, and where they can be used? Evidence from in vitro studies performed on human and animal samples

“…To date, just a limited number of controlled animal studies have been carried out in this field. In particular, some authors demonstrated the anti-inflammatory, antinociceptive, antioxidant, and chondroprotective properties of BT, principally reducing cytokines and free radical production, and decreasing the mechanical hyperalgesia and edema in different murine models of arthritis or psoriasis (Abu-al-Basal 2012; Bajgai et al 2017;Britschka et al 2007;Cozzi et al 2004;Tékus et al 2018;Zivná et al 2012). Some aspects of these studies are disputable and could represent a source of bias.…”

“…Indeed, comparisons among the various studies are difficult principally because of the difference in type and length of interventions, and, in certain cases, the combinations of treatment modalities. The problem in working with animals is mainly related to economical problems, to establish a specific model for a particular disease and to find the most suitable application routine of BT or the protocol of mud treatment (Tékus et al 2018). Furthermore, the restraint conditions at which the animals are subjected for the treatments may exert stress reactions that can influence the experimental outcomes (Scheich et al 2017;Tékus et al 2016).…”