Exploratory data analysis on the effects of non pharmacological treatment for knee osteoarthritis

Authors: Ceccarelli F (1) , Perricone C (1) , Alessandri C (1) , Modesti M (1) , Iagnocco A (1) , Croia C (1) , Di Franco M (1) , Valesini G (1)
(1) Dipartimento di Clinica e Terapia Medica, Sezione di Reumatologia, Sapienza Università di Roma, Policlinico Umberto I
Source: Clin Exp Rheumatol. 2010 Mar-Apr;28(2):250-3
DOI: Not specified Publication date: 2010 Mar E-Publication date: May 13, 2010 Availability: full text Copyright: © Clinical and Experimental Rheumatology 2010
Language: English Countries: Italy Location: Tivoli Terme Spa Correspondence address: Prof. Guido Valesini,
Dipartimento Di Clinica e Terapia Medica, Reumatologia, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy.
E-mail: guido.valesini@uniroma1.it


Article abstract


Osteoarthritis (OA) is a chronic rheumatic disease characterized by progressive cartilage destruction mediated by cytokines and other molecules. Chondrocyte activity and metabolism have attracted interest as targets of drug intervention, and spa-therapy can influence the serum levels of several cytokines. We investigated the effects of spa-therapy on clinical and ultrasonographic (US) findings and serum levels of cartilage oligomeric matrix protein (COMP) and several cytokines, chemokines, and growth factors in a prospective cohort of patients with symptomatic knee OA.


Patients (n=53) with primary symptomatic knee OA were treated for 12 consecutive days with locally applied mud-packs. Assessments were made at baseline, immediately after completion of the treatment cycle, and 6 and 12 months after completion of treatment. They included visual analogue scale (VAS) ratings of pain, the Lequesne algofunctional index for knee OA, and US with calculation of a semiquantitative score that expressed the severity of the local inflammatory process. Serum levels of 27 cytokines (including interferon--inducible protein-10 [IP-10]), chemokines, and growth factors were measured with multiplex bead-based immunoassays, and COMP levels were determined by ELISA.


US scores, VAS pain ratings, and Lequesne indexes indicated significant improvement after spa-therapy and at the 6- and 12-month follow-ups. Serum IP-10 levels also dropped significantly (p=0.0035), and this reduction was positively correlated with improvement of the Lequesne index (p=0.031).


In patients with knee OA, spa-therapy can modulate serum levels of proinflammatory cytokines/chemokines and produce improvements in joint pain and function that persists for up to 1 year.

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