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Medical research

Systemic lupus erythematosus (SLE) and possibilities of spa treatment

SLE is an inflammatory rheumatic disease primarily affecting women between 20 and 50 years of age. It affects various tissues and organs and is chronic. Its characteristic diagnosis is via a cytology examination – LE tests and the confirmation of LE cell presence, with a positive test in the case of SLE ranging between 80% and 100%.
The cause of the disease is not known, although most probably it is due to several factors, such as hereditary predisposition, an inadequate immune reaction to elements of one’s own tissues, certain virus infections, an increased concentration of venereal hormones and a long-term administration of certain medications, e.g. Hydralazine, Procainamide, and Hydantoin derivatives.
Clinical course of the disease: the disease usually begins slowly, in stages, often starting with slightly higher temperatures or irregular waves of fever, overall weakness, fatigue and weight loss. Symptoms vary greatly; skin symptoms in particular are frequent: the acute phase of the disease is typical for localised butterfly-shaped exanthema, or possibly an erythema on the whole body, as well as joint pains, pain in several joints, or episodic inflammations of one or several joints. These, together with morning stiffness of joints, are the most frequent initial signs of SLE. An acute joint inflammation may affect any joint, but most often and typically it affects small joints in the hands, wrists and knees. In approximately three quarters of patients, the disease develops into a chronic, long-term joint inflammation, poly-arthritis. The disease may affect the lungs (pneumonitis, pleuritis), heart (pericarditis, endocarditis), digestive system (inflammations of intestines, pancreas, liver), kidneys (lupus nephritis), spleen, which is usually enlarged, lymphatic system, with enlarged lymphatic nodes usually in the armpit area and under the jaws, as well as the central nervous system, including psychoses and depressions. Organs may be affected individually or in combination, and the disease is characteristic of a chronic and long-term course, during which acute attacks vary with repeated spontaneous remissions. Therefore, any treatment has to include the treatment of acute phases as well as the treatment of a chronic and progressive disease.
In recent years, we have seen significant progress in the treatment of SLE, which involves not only treatments by non-steroid anti-rheumatics and corticoids, but also the administration of substances to suppress immune functions, which have produced successful results with the disease.
Spa treatment as such is contraindicated, but in case of certain less serious and stabilised patients we allow for a so-called modified treatment. It needs to be emphasised that any stimulating treatment procedure that burdens the body's overall condition is contraindicated in all cases, as well as mud packs and all forms of phototherapy. In such cases, Health Spa Piešťany prescribes an isometric bath 2 times per week at most, and physical therapy to maintain the flexibility of affected joints. However, the procedure needs to be conducted more carefully compared to other inflammatory rheumatic diseases. In case of greater muscle weakness, isometric traction is used with less than maximum force. Electroanalgesia is used to treat pain.

Dr. Tomáš Lulovič, M.D.

Monitoring indicators of the effectiveness of the spa treatment in a group of patients with II – III stage coxarthrosis

Summary

Coxarthrosis is the most common degenerative disease of the hip joint with subsequent cartilage damage, which is caused by many biological and biomechanical factors. The disease is manifested by alternating painful and pain-free states with a functional limitation of motion in the affected joint. Due to the pain, the patient tries not to use the affected limbwhich leads to a change in body posture, a curvature of the spine in the waist and the rotation of the pelvis. Part of the therapy is also the spa treatment, rehabilitation and balneology procedures, which helps improve more than just joint mobility.

Objective: To determine the effects of the complex spa therapy in patients with II - III stage coxarthrosis.

Characteristics of the research file and the methods used: The research was conducted between March to May 2010, with patients who underwent a complete spa treatment in the spa facilities at Balnea Grand Splendid in Slovak Health Spa Piešťany, Inc.
After the prior consent of the selected patients, the examined group consisted of 27 respondents with an average length of treatment of 20 days. For data collection, we used a standardized questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and ARTROTEST (angle measurements with special protractors). The evaluation consisted of a comparison of data from respondents at the beginning and the end of the treatment, using an arithmetic average and the Student t test.

The results confirmed a statistically significant relief of the intensity of the pain (WOMAC = 2.48 vs = 1.92, t test p <0.01), statistically significant relief of rigidity (WOMAC = 2.79 vs = 2.11, p <0.01) and improvement of the  functional disability (WOMAC = 2.46 vs = 1.97, p <0.01). Through assessment of the Artrotest in a measurement of angles before and after the treatment was recorded, in addition to extension (0%), improvement in flexion by 7.17%, abduction by 14.38%, adduction by 14.96%, intra-rotation by 10.19% and extra-rotation by 17.99%.

Conclusion: With patients who underwent treatment at our facility with a duration of 20 days, we recorded a reduction in their pain intensity, a relief of rigidity and an improvement in the independence of their everyday life activities. A complex spa therapy programme has a legitimate place in hip treatments, which was also confirmed by our study.

Dr. Makovník Pavel, M.D., and team

 

The current view of rehabilitation procedures in the treatment of cerebral palsy in 2003

Summary

Cerebral palsy, as a complex of multiple pathological symptoms, represents a multi-specialisation problem and requires a comprehensive approach to treatment. A very important moment in the continuing process of rehabilitation and education is to establish a proper relationship with the affected child and his/her family.

The disorder permanently changes the social and economic situation of the child´s family. A chronically ill child’s quality of life highly depends on the degree of satisfaction within the family. Family stability is considered to be a relevant test of the individual personal maturity of both partners. Spa therapy is a very important component to the treatment.
 
We attempted to reflect these aspects in the questionnaire-based comparative study, focusing on the families of affected children.
The study was carried out on patients with cerebral palsy who were treated at the children´s spa facility Zelený Strom (Green Tree), Slovenské liečebné kúpele a.s. Piešťany in 2003.

The objective of the study was to provide an overview of literary resources with respect to our knowledge and to perform an analysis of comprehensive rehabilitation in cerebral palsy. The author also utilised her many years of experience in the field.

The second part of the work was based on the questionnaire survey, including 128 patients aged 3-15. A standardised questionnaire was completed by the patient´s parents. The questionnaire consisted of 26 questions and was split into two parts.

The general part contained information on the parents’ education and employment, housing and family status. In the special part, the study focused on the details of the disorder and on comprehensive rehabilitation care for children with cerebral palsy.

The results of the study emphasize the need for an early diagnosis of the disorder, cooperation between the family and the professional staff, and the importance of repeated spa treatment.

Dr.Boldišová Oľga, M.D.


Authors: Team of doctors, co-editor Dr.Boldišová Oľga, M.D., Acta rheumatologica et balneologica Pistiniana, 2010


Linking hyperthermic procedures (as part of a spa treatment) to physical therapy, observations, statistical analysis

Summary

Baseline: Hyperthermic procedures are a part of the spa treatment and represent a suitable preparation for physical therapy. The literature offers insufficient information on the assessment of the impact that the sequence of these procedures has on the overall effect of the spa treatment.  Patients: 31 patients with an average age of 70.6 years with knee arthrosis were divided into two subgroups during their 3-week spa treatment at SLK Piešťany. In the study group (14 patients), the sequence of hyperthermic procedures and physical exercise was strictly complied with. In the control subgroup (17 patients), this sequence was not complied with. Methods: At the beginning and end of the spa treatment, both groups were assessed for the following parameters: pain using visual analogue scale (VAS) in mm, Lequesn´s functional index and the knee range of motion measured by a goniometer. Results: Compliance with the sequence of hyperthermic procedures and physical therapy did not have an unequivocal impact on the treatment results. In both subgroups, the VAS was reduced; in the basic set it was from 55.9 ± 16.9 to 31.1 ± 15.2, and in the control group it was from 56.2 ± 16.2 to 31.4 ± 15.9 (p=0.49). The total number of points of the Lequesn´s functional index was reduced in the basic set from 8.4 ± 2.6 to 5.4 ± 2.2, and in the control group from 9.1 ± 3.3 to 6.5 ± 2.9 (p=0.33). The range of motion was slightly improved in both sets. However, the changes are not significant. Conclusion: The fact that the sequence of the procedures has no significant effect on the result of the spa treatment enables the acceptance of the current practice in our spa facilities, where, due to organizational and technical reasons, it is necessary to schedule the procedures according to the availability of individual workplaces in the morning hours.

Dr. Soňa ŽLNAYOVÁ, M.D., PhD.

An evaluation of the effects of complex spa balneotherapy in patients with osteoarthritis of the knee and hip.

Summary

Purpose: To evaluate the effects of complex spa balneotherapy in patients with osteoarthritis of the knee and hip.
Materials and methods: The clinical study in 40 patients with clinically-symptomatic osteoarthritis of the hip and knee joints according to Kellgren and Lawrence, 1963, treated in Slovak Health Spa Piešťany,a.s., during a median 19 days,  where joint pain, stiffness and function were evaluated using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC).
Results: Complex balneotherapy confirmed a statistically significant decrease in pain intensity (VAS :67.12 vs. 34.50, Womac: 15.35 vs. 8.9 , p<0.001), a decrease in joint stiffness (WOMAC : 5.02 vs. 3.20, p  < 0.001) an improvement in articular function  (WOMAC:  49.30, to 31.40, p<0.001) and also an improvement in the general WOMAC score (from 69.7 to 43.6)
Conclusions: Complex spa balneotherapy lasting  21 days led to pain relief, a decrease in joint stiffness and an improvement in articular function for patients with osteoarthritis  of the knee and hip.

Dr. Zimanová Tamara, M.D.


Study of Piešťany Peloid (Mud) and Thermal Water Biological Effects

Bratislava – Piešťany 1996
Department of Biochemical Technology, School of Chemical Technology, Slovak Technical University, Bratislava
Research Institute of Rheumatic Diseases, Piešťany
Responsible Compilers:  Prof. Ján Fuska, DrSc., Dr. Jozef Rovenský, M.D., DrSc.
Cooperating Compilers:  Bohumil Proksa, DrSc., Mária Šturdíková, CSc., Mária Stančíková, CSc., Karol Švík, CSc.

A study of the biological effects of the mud and thermal water from Piešťany
Bratislava, 1997
Department of Biochemical Technology, Faculty of Chemical Technology, Slovak University of Technology, Bratislava
Research Institute of Rheumatic Diseases, Piešťany
Principal investigators: Prof. Ján Fuska, DrSc., Dr. Jozef Rovenský, M.D., DrSc.
Co-investigators: Bohumil Proksa, DrSc.,  Mária Šturdíková. CSc., Mária Stančíková, CSc., Karol Švík, CSc.

A Research on the Factors Participating in the Effects of Natural Healing Sources Applied in Piešťany Spa
A Study of Thermal Mud Characteristics Used in Balneological Facilities of Piešťany Spa 

Bratislava – Piešťany 2000
Research Institute of Rheumatic Diseases, Piešťany
Head Complilor: Dr. Jozef Rovenský, M.D., DrSc.
Deputy Head Compilor: Prof.  Ján Fuska, DrSc.
Cooperating Compilors: Mária Stančíková, CSc.,  Bohumil Proksa, DrSc., Karol Švík, CSc., Mgr. Richard Ištok, Dr. Svätoslav Hluchý, CSc., SPÚ Nitra
Consultants: Dr. Mária Tóthová, M.D., SLK, Dr. Ružena Čunčíková, M.D., SLK

An evaluation of the overall effect of spa treatments in patients with clinically symptomatic osteoarthritis in weight-carrying joints
Rybár, I., Zimanová, T., Vajcík, J., Vlčková, V., Jurča, J.
Research Institute of Rheumatic Diseases, Piešťany
Director: Dr. Jozef Rovenský, M.D., DrSc.
Health Spa Piešťany
Director General: I. Drábek

Theoretical and Experimental Studies of Piešťany Mud and River Sediment Microbial Community
Bratislava 1999
Department of Biochemical Technology School of Chemical Technology, Slovak Technical University, Bratislava
Responsible Compiler: Mária Šturdíková, PhD.
Cooperating Compilers: Katarína Mináriková

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