Low-temperature sulphurous peloids and sulphurous mineral water in active rheumatoid arthritis at the Banja Koviljača Spa (Serbia): a prospective controlled clinical study

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which symptoms such as pain and functional limitations can persist despite pharmacological control. Balneotherapy and pelotherapy are widely used as complementary, non-pharmacological interventions, although clinical evidence remains heterogeneous. To evaluate the clinical effects of a combined balneotherapy protocol consisting of local application of low-temperature sulphurous peloids followed by partial baths in natural sulphurous mineral water, added to a standard rehabilitation program in patients with active rheumatoid arthritis (RA). Seventy patients with active RA were included. The balneotherapy group (n = 35) received local applications of sulphurous peloids (24 °C, 20 min) followed by partial baths in sulphurous mineral water (30 °C, 15 min) for 21 daily sessions. The standard group (n = 35) received four-cell galvanic baths. Both groups received identical physiotherapy and a low-frequency electromagnetic field (5 mT, 25 Hz, 30 min). Primary outcome was change in Disease Activity Score 28 (DAS28). Secondary outcomes included pain, morning stiffness, joint counts, erythrocyte sedimentation rate (ESR), and change in concomitant analgesic medication. The balneotherapy group showed a significantly greater reduction in DAS28 (6.17 ± 0.84 to 4.65 ± 0.78) than the standard group (6.00 ± 0.80 to 5.41 ± 0.92; p < 0.001). Between-group analyses also favored balneotherapy for pain reduction in hands and knees, decreases in tender and swollen joint counts, greater ESR reduction, and a more favorable pattern of analgesic dose reduction (77.1% vs. 20.0%; p < 0.001). No serious adverse events were reported. Adjunctive low-temperature sulphurous peloids plus partial baths in sulphurous mineral water were associated with greater short-term improvement in disease activity, inflammatory markers, pain, and functional outcomes than conventional thermal therapy in active RA.