Effects of mud-bath therapy in psoriatic arthritis patients treated with TNF inhibitors. Clinical evaluation and assessment of synovial inflammation by contrast-enhanced ultrasound (CEUS)

Authors: Cozzi F , Raffeiner B , Beltrame V , Ciprian L , Coran A , Botsios C , Perissinotto E , Grisan E , Ramonda R , Oliviero F , Stramare R , Punzi L

Affiliations:

Source: Joint Bone Spine. 2015 Mar;82(2):104-8

DOI: 10.1016/j.jbspin.2014 Publication date: 2015 Mar E-Publication date: Jan. 23, 2015 Availability: abstract Copyright: © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Language: English Countries: Italy Location: Not specified Correspondence address: Franco Cozzi : Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 049 8212190; fax: +39 049 8212191. Email : franco.cozzi@unipd.it

Keywords

Article abstract

OBJECTIVES:

Despite the efficacy of TNF inhibitors, most patients with psoriatic arthritis maintain a residual synovial inflammation. The main aim of the study was to evaluate the effects of mud-bath therapy on clinical picture of PsA patients treated with TNF inhibitors. The secondary outcome was to assess synovial inflammation in hand joints detected by contrast-enhanced ultrasound. Other aims were to verify the risk of arthritis flare and to evaluate the effects of spa treatment on functional ability and on quality of life.

METHODS:

Thirty-six patients with psoriatic arthritis, treated in the last 6 months with TNF inhibitors, were enrolled. After 1:1 randomisation, 18 patients (group A) underwent mud-bath therapy (12 mudpacks and 12 thermal baths), maintaining treatment with TNF inhibitors; 18 patients (group B) continued pharmacological therapy alone. CRP, PASI, DAS28, swollen and tender joint count, VAS pain, HAQ and SF-36 were evaluated at baseline (T0) and after 45 days (T1). Synovial inflammation detected by contrast-enhanced ultrasound, analysed by a software system, was also assessed.

RESULTS:

A significant improvement in PASI (P<0.005), DAS28 (P<0.05), swollen joint count and tender joint count (P<0.001), and HAQ (P<0.001) between T0 and T1 was observed in group A. No patient underwent a flare-up of arthritis. Ultrasound videos demonstrated a significant appearance delay (P<0.05) and faster washout (P<0.02) of contrast dye in group A patients with respect to group B.

CONCLUSIONS:

These data suggest a decrease of residual synovial inflammation and a beneficial clinical effect of spa therapy in psoriatic arthritis patients treated with TNF inhibitors.

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