Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases. This is one of the oldest treatment modalities still recommended, due to the therapeutic benefits of water, including the reduction of edema, pain relief and reduction of the load on joints affected by arthritis. Although the term balneotherapy has a different meaning from hydrotherapy, both terms are accepted for all forms of water treatment. Balneotherapy includes immersion baths with ordinary water (from the tap), medicinal mineral waters (crenotherapy) and artificial mineral waters with the addition of dissolved gases, chemical or organic substances. Crenotherapy is the use of the properties of mineral waters and associated gases for therapeutic purposes, especially rheumatological ones.
Despite its high prevalence, osteoarthritis lacks effective therapies. Spa treatments are known to cure ailments and have proven effective in managing various ailments, especially musculoskeletal disorders. However, the therapeutic role of sulfur baths in osteoarthritis, with regard to hemorheological indices, has not been extensively studied. Previous studies have reported that sulfur baths reduce joint pain, firmness, and swelling, especially those that result from increased excretion of sodium in the urine. Balneotherapy can stimulate diuretic mechanisms in the kidneys and improve joint mobility and gait efficiency. In a recent study published in Scientific Reportsresearchers evaluated the health benefits of balneotherapy on the rheological properties of the blood of osteoarthritis patients.
The study included 48 patients, 24 males and 24 females, aged between 60 and 80 years, divided into two groups: intervention (n=35; 18 males and 17 females)) and control (n=13). The intervention group did the sulfur water therapy daily during their three-week stay at the Solec Zdrój Health Resort in Poland. The team evaluated the morphological, biochemical, coagulation and rheological changes in the blood. Morphological parameters studied were complete blood count, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet concentration (PLT), platelet distribution width (PDW), and differential white blood cell counts.
Biochemical and coagulation parameters included high sensitivity C-reactive protein (hs-CRP), fibrinogen, international normalized ratio (INR), prothrombin time (PT), and activated partial thromboplastin time (APTT). Rheological parameters included erythrocyte aggregation amplitude (AMP), total red blood cell aggregation half-life (T1/2), aggregation index (AI), and elongation index (EI). After sulfur balneotherapy, white blood cell counts, especially neutrophil counts, were significantly reduced in the intervention group, indicating that balneotherapy may have a positive impact on chronic low-grade inflammation. Elongation indices of erythrocytes were significantly greater after balneotherapy in shear stresses such as 8.2, 16, 31 and 60 Pa.
Hemoglobin levels, mean corpuscular hemoglobin (MCH), mean platelet volume (MPV), and neutrophil concentration (NEU) were significantly altered after balneotherapy. In contrast, the levels of biochemical and coagulation parameters, including CRP and fibrinogen, did not differ significantly from baseline values. The time required for a half-maximum change in the aggregation signal (T1/2) was significantly greater after the intervention. In contrast, balneotherapy significantly reduced the degree of erythrocyte clumping as assessed using the clumping index (AI). The significant decrease in hemoglobin count could be relative due to increased thirst after hot spring bathing, which could lead to overhydration, blood pressure fluctuations, and tachycardia.
The precise mechanisms by which sulfur affects hemorheological variables are unknown. However, studies have reported that hydrogen sulfide (H2S) possesses antioxidant properties as it can neutralize oxygen free radicals (ROS) which can remodel vasculature by damaging vascular cells, increasing inflammatory cell recruitment and lipid peroxidation. . Furthermore, H2S can increase the secretion of antioxidant proteins and enzymes through the activation of the transcription factor NRF-2. The positive effects of sulfur on hemorheological parameters may also be linked to endothelial function and the release of nitric oxide, a potent vasodilator with anti-inflammatory effects. Endothelial nitric oxide secretion is regulated by shear stress on blood vessel walls, ascertained based on blood viscosity and flow in their peripheral regions.
So if the popular or empirical experience had its underlying reasons, there is now scientific evidence that supports the usefulness of programmed balneotherapy cycles. One more example to take care of your health even when you’re on vacation. Or even take a vacation to take care of yourself and think about health in terms of present and future prevention. Either way, it’s about health.
- By Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Scientific publications
Teleglow A, Seremak J et al. Sci Reports 2023; 13(1):7
Tenti S et al. Int J Biometeorol. 2020; 64(9):1561-1569.
Kovács C et al. Int J Biometeorol. 2016; 60(11):1675-80.
Branco M et al. Eur J Phys Rehabil Med. 2016; 52(4):422.
Kovács C et al. Clin Rheumatol. 2012; 31(10):1437-42.