Journal Article Review October 2017

October, 2017:  Do mud packs relieve symptoms of osteoarthritis in the hands?

Aksoy MK et al: The efficacy of peloid therapy in management of hand osteoarthritis: a pilot study. Int J Biometeorol  published online August 4, 2017

Investigators from Turkey report on their results on a prospective, randomized-controlled, single-blind study of 55 patients, age range 35-75 years, who were divided into two groups. All patients had radiographic evidence of hand osteoarthritis (OA) and a score of at least four on a ten-point visual analog scale (VAS). One group received five thirty-minute mud pack treatments for two weeks and instructions for a home exercise program. The mud consisted mainly of clay, which was heated to 47 degrees C and applied to the hands, which were then wrapped in stretch film and then in towels. The control group received only the instructions for home exercises.

The researchers evaluated all subjects before treatment, after two weeks, and again four weeks later. They used a VAS to record pain, the Australian/Canadian Hand Osteoarthritis Index to assess function, the Health Assessment Questionnaire to mark disease activity, and a grip and pinch meters to determine strength.

The groups were statistically identical with respect to mean age, sex distribution, body mass index, disease duration, radiological grade of OA, and baseline determinations of the outcomes measures.

RESULTS: At both two and six weeks, the mudpack group had statistically significantly improved scores for all measured outcomes over the control group.

DISCUSSION: Previous studies have shown that mud applied directly to osteoarthritic knees was more effective than mud packs wrapped in plastic bags, implying that the chemicals in the mud have an effect. Another study showed subjects, whether or not exposed directly to the mud for 15 sessions, 42 degrees C, 20 minutes each) and equal improvement at the end of treatment, although 4 months later those who had been directly exposed to the mud showed improved performance.

The authors cite previous studies that indicate that mud bath therapy reduces inflammatory mediators such as interleukin and tumor necrosis factor and stimulates the production of adrenocortical hormones and endorphins. It also is credited for activating osteoblasts but not for suppressing osteoclastic activity.

COMMENT: The authors acknowledge that this is a pilot study and that they would like to continue investigation with larger sample sizes, various types of mud and application durations, and longer follow-up durations. It would be helpful for them to also compare packaged and unpackaged mud and compare mud to paraffin or warm water. In the meantime, mud would likely be young boys’ hands-down choice with paraffin close behind.