Criteria for balneotherapy have not been established in rheumatoid arthritis (RA) so far. The body temperature, or erythrocyte sedimentation rate (ESR) is still inconclusive as the standard. We found that urinary hydroxyproline (Hy-pro) may be one of the standards for balneotherapy of RA patient.
1. Urinary hydroxyproline
Daily urinary Hy-pro excretion was significantly higher in RA (41.2±23.3mg/day in 20 cases)
than in control subjects (28.2±14.6mg/day in 22 cases).
In 9 RA patients urinary Hy-pro excretion was decreased significantly after bathing in Konya thermal mud at 42°C for 15-20 minutes, while it increased after the bathing in a systemic lupus erythematosus patient.
On the other hand the urinary Hy-pro excretion was not changed essentially in 5 RA patients who did not take the bathing but rehabilitation exercise as shown below.
Effect of hot spring bathing on urinary Hy-pro excretion
Desease NO Urinary Hy-pro (mg/3hrs)
Before After
RA 9 4.2±2.4 2.1±1.1*
SLE 1 0.4 3.8
RA 5§ 2.1±0.4 2.3±0.4
* p<0.05. § they did rehabilitation exercise only.
From the above results it was concluded that urinary Hy-pro excretion was decreased by the balneotherapy in RA patient, suggesting anti-inflammatory action or stabilizing effect on collagen of the balneotherapy in rhematoid process. On the other hand it was considered that the urinary Hy-pro may serve as a standard for balneotherapy of RA. If it increased after a balneotherapy the patient may have no indication of the therapy.
2. Erythrocyte sedimentation rate
Effect of hot spring therapies on ESR was investigated in 114 RA patients. Improvement of ESR was observed in 30% of RA patients with ESR over 100mm/hr and in the patients with abnormal ESR under 59mm/hr the improvement was found in 31%.
It was concluded, therefore, that ESR is not always a standard for balneotherapy of RA.
3. RA with amyloid nephropathy
Renal function was aggravated after thermal bathing in a RA patient with amyloid nephropathy. Balneotherapy, therefore, must be done very carefully in such patient.