Balneotherapy for rheumatoid arthritis.

BACKGROUND: Balneotherapy (spa therapy or mineral baths) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain, improve joint motion and as a consequence to relieve patients' suffering and make them feel well. In this update we included one extra study. OBJECTIVES: To assess the effectiveness of balneotherapy for rheumatoid arthritis. SEARCH STRATEGY: We searched the following databases up to October 2006: CENTRAL (Issue 3, 2006), PubMed, CINAHL, the database from the Cochrane 'Rehabilitation and Related Therapies' Field and Pedro. We also performed reference checking and personal communications with authors to retrieve eligible studies. SELECTION CRITERIA: Randomised controlled trials comparing balneotherapy with any other intervention or with no intervention. Included patients were all suffering from definite or classical rheumatoid arthritis as defined by the American Rheumatism Association Criteria or by the criteria of Steinbrocker. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be among the main outcome measures. DATA COLLECTION AND ANALYSIS: Two authors independently assessed quality and extracted data. Disagreements were solved by consensus. MAIN RESULTS: One extra study is included in this update. Now seven trials (412 patients) were included in this review. Most trials reported positive findings on their main outcomes, but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. None of the trials performed an intention-to-treat analysis and only two performed a comparison of effects between groups. Pooling of the data was not performed because of heterogeneity of the studies, multiple outcome measurements, and the overall poor data presentation. We found a significant benefit of mineral baths compared to Cyclosporine A at eight weeks on pain in one study (RR=2.4; 95%CI: 1.4,3.8).Overall there is insufficient evidence that balneotherapy is more effective than no treatment, that one type of bath is more effective than another, or that one type of bath is more effective than mudpacks, exercises or relaxation therapy. AUTHORS' CONCLUSIONS: Silver level evidence was found for one study in favour of mineral baths compared to drug treatment at eight weeks. Insufficient evidence was found for all other comparisons. However the scientific evidence is insufficient because of poor methodological quality. Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws, an answer about the apparent effectiveness of balneotherapy cannot be provided at this moment.