Effects of mud-bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound (CEUS)

Authors: Cozzi F (1) , Raffeiner B (1) , Beltrame V (2) , Ciprian L (1) , Coran A (2) , Botsios C (1) , Perissinotto E (3) , Grisan E (4) , Ramonda R (1) , Oliviero F (1) , Stramare R (2) , Punzi L (1)
(1) Rheumatology Unit, Department of Medicine - DIMED, University of Padova (2) Radiology Unit, Department of Medicine, University of Padova (3) Unit of Statistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova (4) Department of Information Engineering, University of Padova
Source: Joint Bone Spine. 2015 Mar;82(2):104-8
DOI: 10.1016/j.jbspin.2014 Publication date: 2015 Mar E-Publication date: Jan. 23, 2015 Availability: abstract Copyright: © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Language: English Countries: Italy Location: Not specified Correspondence address: Franco Cozzi : Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 049 8212190; fax: +39 049 8212191. Email : franco.cozzi@unipd.it


Article abstract


Despite the efficacy of TNF inhibitors, most patients with psoriatic arthritis maintain a residual synovial inflammation. The main aim of the study was to evaluate the effects of mud-bath therapy on clinical picture of PsA patients treated with TNF inhibitors. The secondary outcome was to assess synovial inflammation in hand joints detected by contrast-enhanced ultrasound. Other aims were to verify the risk of arthritis flare and to evaluate the effects of spa treatment on functional ability and on quality of life.


Thirty-six patients with psoriatic arthritis, treated in the last 6 months with TNF inhibitors, were enrolled. After 1:1 randomisation, 18 patients (group A) underwent mud-bath therapy (12 mudpacks and 12 thermal baths), maintaining treatment with TNF inhibitors; 18 patients (group B) continued pharmacological therapy alone. CRP, PASI, DAS28, swollen and tender joint count, VAS pain, HAQ and SF-36 were evaluated at baseline (T0) and after 45 days (T1). Synovial inflammation detected by contrast-enhanced ultrasound, analysed by a software system, was also assessed.


A significant improvement in PASI (P<0.005), DAS28 (P<0.05), swollen joint count and tender joint count (P<0.001), and HAQ (P<0.001) between T0 and T1 was observed in group A. No patient underwent a flare-up of arthritis. Ultrasound videos demonstrated a significant appearance delay (P<0.05) and faster washout (P<0.02) of contrast dye in group A patients with respect to group B.


These data suggest a decrease of residual synovial inflammation and a beneficial clinical effect of spa therapy in psoriatic arthritis patients treated with TNF inhibitors.

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