We have previously reported that a depressive mental state of the patients with rheumatoid arthritis (RA) could be improved by rehabilitation exercise and hot spring bathing. These patients noticed that their muscle stiffness decreased and that they also felt mentally refreshed. In this study, the changes in the serum inflammatory cytokine levels after rehabilitation exercise and hot spring bathing in the RA patients with an active disease were evaluated and increased levels of interleukin 6 (IL-6) were found to decrease to the nearly half of the pre exercise levels. The decreases in the IL-6 levels were not attributed to the circadian rhythm and they also did not correlate with the serum cortisole levels. Next, we chose RA patients with active disease who had not been treated with any corticosteroids or exercise therapy. After exercise, the patients tended to complain of aggravated muscle stiffness and joint pain as well as discomfort. Their IL-6 levels did not show any decrease, but instead a moderate increase was observed. IL-1 receptor antagonist (IL-1ra) showed normal levels before exercise, and they did not change substantially after the exercise. As a result, when patients with active disease achieved a decrease in muscle stiffness and also felt refreshed, then their serum IL-6 levels also decreased. Such exercise therapy should be initiated when the patients' complaints have improved owning to sufficient bed rest and small doses of corticosteroids.

The effect of Artificial CO₂-bathing was compared with that of placebo bathing on patients with rheumatoid arthritis (RA). A large tablet containing sodium bicarbonate and citric acid, which is called Bub, was used to make CO₂ gas as it dissolves in water bath. A placebo tablet, which is quite same in the appearance, has the substrate only and makes no gas. So the trial was performed by single blind method.
Forty two RA patients (definite or classical) were tested by single bathing and other 40 RA patients, by serial bathing of 30 days (once a day). After a single bathing grip strength of the patients increased significantly in both groups, but more significantly in Bub group (p<0.01 vs p<0.05). The joint tenderness also reduced significantly after a single bathing in both groups, almost equally. However plasma β endorphin levels were little changed after single bathing in both groups.
By serial bathing of 30 days, Lansbury's activity index, ADL score, and pain score were all changed insignificantly in each group. However Bub group showed a tendency to improve in the 3 parameters, whereas placebo group did a tendency to deteriorate.
From the above results it was considered that artificial CO₂-bathing may exert more beneficial effects on RA patients, as compared with plain water bathing.

The effect of octylphthalide (OP) bathing was compared with placebo bathing on patients with rheumatoid arthritis (RA).
A liquid containing octylphthalide was dissolved in water of 40°C at a concentration of 10ppm. A liquid which has quite similar appearance and perfume to the above was used as a placebo. Double blind controlled study tests were performed.
Twenty patients (10 for OP bathing and 10 for placebo bathing) were tested by single bathing, 33 other patients (16 patients for OP bathing and 17 for placebo bathing), by serial bathing for 30 days (once a day).
After a single bathing, while grip strengths, tender joints scores, and 20m walking time improved significantly in the OP bathing group, only tender joint scores and 20m walking time improved significantly in the placebo bathing group.
After serial bathing for 30 days, tender joint scores improved significantly in the OP bathing group, but no improvement was observed in the placebo bathing group. The above results suggest that OP bathing may be beneficial for RA patients, but further study may be needed.