Clinical efficacy of balneological treatment (hydrotherapy and peloidotherapy) on patients with ankylosing spondylitis and its effects on cytokine levels

Objective: To evaluate the efficacy of balneological treatment (combination of hydrotherapy and peloidotherapy) with clinical scales and to determine the effect on serum IL-6 and TGF-1 levels in patients with Ankylosing Spondylitis. Method: 40 patients diagnosed with AS according to the modified New York Criteria and using anti-TNF drugs were assigned to two groups by randomization. The patients in the treatment group received hydrotherapy (38°C) for 20 minutes and then peloid pack (43°C) was applied to the entire spinal area for 20 minutes in addition to the routine treatments. The same procedure was repeated for 10 sessions. The patients in the control group continued own routine treatment. Patients were evaluated before treatment / 1st day, end of treatment / 12th day and 3rd month with pain (VAS), global assessment patient's and the doctor's (VAS), BATH Ankylosing Spondylitis Disease Activity Index (BASDAI), BATH Ankylosing Spondylitis Functional Index (BASFI), BATH Ankylosing Spondylitis Metrology Index (BASMI). Venous blood samples were taken from all patients for analysis of serum IL-6 and TGF-β1 levels. Results: In the treatment group, statistically significant improvement was observed in pain, patient and doctor's global assessment, BASDAI and BASMI scores at the end of the treatment. It was seen that these significant improvements continued for 3 months except for the BASMI score. In the control group there was significant improvement in BASMI score only in the 3rd month. In the comparison between the groups, significantly superiority was found in favor of the treatment group in all evaluations for BASDAI and BASFI scores and in the 3rd month for doctor's global assessment. Serum IL-6 levels did not show any significant change in both groups. Although TGF-β1 levels increased in the treatment group compared to the baseline, it was not statistically significant. Conclusion: In support of drug therapies, hydrotherapy and peloidotherapy combination treatment has been shown to beneficial effects on pain, disease activity and functional status in patients with ankylosing spondylitis. Keywords: balneological treatment, hydrotherapy, peloidotherapy, ankylosing spondylitis, anti-TNF