Serial Mud Packs Induce Anti-inflammatory Effects in Knee Osteoarthritis – A Randomized, Prospective Clinical Study

Abstract

Abstract Background Mud bath and pack have been used to treat musculoskeletal disorders since ancient times. However, the actual mechanisms of action of mud therapy on the inflammatory processes are complex and still not clarified. Methods Therefore, the clinical effects of serial mud packs in patients with knee osteoarthritis were investigated on the molecular level. A total of 52 patients were recruited from an in-patient rheumatology clinic. The participants were randomized in 2 groups: the intervention group (IG, n=26) underwent 9 mud packs in 21 days and a standardized multimodal physical therapy in an in-patient setting, whereas the control group (CG, n=26) only received the multimodal physical therapy. Primary outcome parameters were changes in the serum levels of interleukin(IL)-1ß and IL-10. Secondary outcome parameters were changes of the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Western Ontario and Mc Master Universities Arthritis (WOMAC) index and pain (visual analog scale - VAS). Results The IG presented after the serial mud packs significantly decreased pro-inflammatory IL-1ß levels and significantly increased anti-inflammatory IL-10 levels, whereas the CG showed no changes of the 2 cytokines. CRP and ESR remained within in the normal range in both groups without significant changes. Furthermore, the IG presented a significant decrease of the WOMAC index and pain (VAS). Conclusions The results suggest an additive anti-inflammatory effect of serial mud packs within a multimodal physical therapy concept in patients with knee osteoarthritis and could explain the beneficial clinical effects.