Abstract
Musculoskeletal disorders (MSDs) are the most frequent cause of disability in Europe. Reduced mobility and quality of life of the patients are often associated with pain due to chronic inflammation. The inflammatory process, accompanied by a destruction of the cartilage and bone tissue, is discussed as a result of (A) the infiltration of immune cells into the joints, (B) an altered homeostasis of the joint cavity (synovium) with a critical role of bone remodeling cells, and (C) release of inflammatory factors including adipokines in the arthritic joint. In addition to the classical medication, low-dose radiation therapy using photons or radon spa treatments has shown to reduce pain and improve the mobility of the patients. However, the cellular and molecular mechanisms of anti-inflammatory effects of radon are yet poorly understood. We analyzed blood and serum samples from 32 patients, suffering from MSDs, who had been treated in the radon spa in Bad Steben (Germany). Before and after therapy, we measured the levels of markers related to bone metabolism (collagen fragments type-1, cartilage oligomeric matrix protein, receptor activator of NFκB ligand, and osteoprotegerin) in the serum of patients. In addition, adipokines related to inflammation (visfatin, leptin, resistin, and adiponectin) were analyzed. Some of these factors are known to correlate with disease activity. Since T cells play an important role in the progression of the disease, we further analyzed in blood samples the frequency of pro- and anti-inflammatory T cell subpopulations (CD4+IL17+ T cells and CD4+FoxP3+ regulatory T cells). Overall, we found a decrease of collagen fragments (CTX-I), indicating decreased bone resorption, presumably by osteoclasts, in the serum of MSD patients. We also observed reduced levels of visfatin and a consistent trend toward an increase of regulatory T cells in the peripheral blood, both indicating attenuation of inflammation. However, key proteins of bone metabolism were unchanged on a systemic level, suggesting that these factors act locally after radon spa therapy of patients with MSDs.
Highlights
Musculoskeletal disorders (MSDs) affect large part of the population and can have multiple origins
To elucidate cellular changes leading to the observed clinical benefits from radon exposure, we investigated the serum concentrations of markers related to bone metabolism, prominent inflammatory key players such as adipokines as well as changes in subpopulations of T cells
To assess the effects of radon spa treatment on bone remodeling, we analyzed the levels of collagen fragments type-I (CTX-I), a marker used in clinical dia gnostics, in the serum of MSD patients before and at indicated time points after radon spa treatment (Figure 1A)
Summary
Musculoskeletal disorders (MSDs) affect large part of the population and can have multiple origins. Reduced mobility and quality of life of the patients are often associated with pain due to destructive and inflammatory processes at the respective sites of the body [2, 3]. The disease is elicited by an unbalanced load of bone and cartilage, which in turn is causing attrition, succeeded by a progressive inflammatory process. Inflammation may become chronic and is accompanied by further erosion of cartilage and bone, and with concurrent bone formation (osteophytes) [4]. Even though bone and cartilage destruction occurs in rheumatoid arthritis (RA) too, the pathogenesis of this autoimmune disease is different; in the pathogenesis of RA, inflammation is the trigger and not the consequence of bone and cartilage destruction [5]
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