A Cochrane review [Abstract] 1 included 9 studies with a total of 579 subjects. The studies examined balneotherapy (natural mineral waters, gases and mudpacks or spa therapy) in people with rheumatoid arthritis (RA). Four out of 9 studies did not contribute to the analysis, as they presented no data.
Mudpacks versus placebo (1 study, n=45 patients with hand RA): There were no statistically significant differences in terms of pain on a 0 to 100-mm visual analogue scale (VAS) (MD 0.50, 95% CI -0.84 to 1.84), improvement (RR 0.96, 95% CI 0.54 to 1.70) or number of swollen joints on a scale from 0 to 28 (MD 0.60, 95% CI -0.90 to 2.10). There was a reduction in the number of tender joints on a scale from 0 to 28 (MD -4.60, 95% CI -8.72 to -0.48; 16% absolute difference). Information about physical ability and adverse events was not reported in the study.
Additional radon in carbon dioxide baths (2 studies, n=194): There were no statistically significant differences between groups for all outcomes at 3-month follow-up. There was some benefit of additional radon at 6 months in terms of pain frequency (RR 0.6, 95% CI 0.4 to 0.9; 31% reduction; improvement in one or more points (categories) on a 4-point scale) and 9.6% reduction in pain intensity on a 0 to 100-mm VAS (MD 9.6 mm, 95% CI 1.6 to 17.6). There also was some benefit in one study (n=60) in terms of improvement in one or more categories based on a 4-point scale (RR 2.3, 95% CI 1.1 to 4.7; 30% absolute difference). Information about physical disability, tender and swollen joints and adverse events was not reported in the studies.
Balneotherapy (seated immersion) versus hydrotherapy (exercises in water), land exercises or relaxation therapy (1 study, n=148): There was no statistically significant differences in pain on the McGill Questionnaire or in physical disability between balneotherapy and the other interventions. Improvement, tender joints, swollen joints and adverse events were not reported in the study.
Mineral baths (balneotherapy) versus Cyclosporin A (1 study, n=57): There was no statistically significant differences in pain intensity on a 0 to 100-mm VAS (MD 9.64, 95% CI -1.66 to 20.94) at 8 weeks. There was some benefit of balneotherapy in overall improvement on a 5-point scale at 8 weeks of 54% (RR 2.35, 95% CI 1.44 to 3.83). There were no statistically significant differences in the number of swollen joints, but some benefit of Cyclosporin A in the number of tender joints (MD 8.9, 95% CI 3.8 to 14). Physical disability, withdrawals due to adverse events and serious adverse events were not reported.
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), by indirectness (differences between the outcomes of interest and those reported: many patient-important outcomes not reported, such as self assessed function, quality of life, adverse effects), and by imprecise results (few patients and outcome events).
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