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Systemic lupus erythematosus /SLE/ and possibilities of a spa treatment
SLE is an inflammatory rheumatic disease affecting mostly women between 20 and 50 years of age. It affects various tissues and organs and its course is chronic. Characteristic diagnosis is via a cytology examination – LE tests and confirmation of LE cell phenomenon, with test positivity in case of SLE ranging between 80% and 100%.
The cause of the disease is not known, most probably it is due to several factors such as hereditary predisposition, inadequate immune reaction to elements of one’s own tissues, certain virus infections, increased concentration of venereal hormones and long-term administration of certain medications /e.g. Hydralazine, Procainamide, Hydantoin derivatives/.
Clinical course of the disease: the disease usually begins in grades and slowly, it often starts with slightly higher temperatures or irregular waves of fever, overall weakness, fatigue and losing of weight. Symptoms vary greatly; frequent are in particular skin symptoms /the acute phase of disease is typical for localised butterfly-shaped exanthema, possibly an erythema on the whole body/, as well as joint pains /pain in several joints, 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 of 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 lungs /pneumonitis, pleuritis/, heart /pericarditis, endocarditis/, digestive system /inflammations of intestines, pancreas, liver/, kidneys /lupus nephritis/, spleen that is usually enlarged, lymphatic system /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 by having a chronic and long-term course during which acute attacks vary with repeated spontaneous remissions. Therefore, any treatment has to include treatment of acute phases as well as treatment of chronic and mostly progressing disease.
In the recent years we have seen significant progress in SLE treatment, which involves not only treatments by non-steroid antirheumatics and corticoids, but also administration of substances to suppress immune functions, which have successful impacts on the disease.
Spa treatment as such is contraindicated, but in case of certain less serious and stabilised patients we allow for the so-called modified treatment. It needs to be emphasised that in all cases any stimulating treatment procedure that would burden the overall regulation is contraindicated, as well as mud packs and all forms of photo-therapy. In such cases Health Spa Piešťany prescribes an isometric bath maximally 2 times per week and movement treatments to maintain flexibility of affected joints. However, the procedure needs to be more careful compared to other inflammatory rheumatic diseases. In case of a greater muscle weakness, isometric traction is used with submaximal force. Electroanalgesis is used to influence pain.
MUDr. Tomáš Lulovič
Monitoring indicators of the effectiveness of the spa treatment in a group of patients with coxarthrosis of the II – III stage
Coxarthrosis is the most common degenerative disease of the hip joint with subsequent wear of cartilage, which is caused by many biological and biomechanical factors. The disease is manifested by alternating painful and painless states with a functional limitation of motion in the affected joint. Due to the pain the patient tries not to use the affected limb so intensive what causes change of the static, the 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 help not only to improve the joint mobility.
Objective: To determine the effects of the complex spa therapy in patients with coxarthrosis of the II - III stage.Characteristics of the research file and the methods used: The research was conducted since March to May 2010 with patients who underwent complete spa treatment in the spa facilities Balnea Grand Splendid in the 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, Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and ARTROTEST (angle measurements with special protractors). The evaluation consisted of comparison of data from respondents at the beginning and the end of the treatment, using arithmetic average and the Student t test.Results have confirmed a statistically significant relief of the pain intensity (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 measurement of angles before and after the treatment were recorded, in addition to extension (0%), improvement in flexion by 7,17%, abduction by 14,38%, adduction by 14,96%, intrarotation by 10,19% and extrarotation by 17,99%.
Conclusion: With patients who underwent treatment at our facility with duration of 20 days we recorded reduction in their pain intensity, relief of rigidity and improvement of their independence in everyday life activities. A complex spa therapy has its legitimate place in the treatment of hip, which has also been confirmed by our study.
MUDr. Makovník Pavel and team
Current view of rehabilitation procedures in the treatment of cerebral palsy in 2003
Cerebral palsy, as a complex of multiple pathological symptoms, represents a multi-specialization 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 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 the analysis of comprehensive rehabilitation in cerebral palsy. The author also implemented her many years of experience in the field.
The second part of the work was based on the questionnaire survey, including 128 patients ages 3-15. A standardized questionnaire was completed by 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, I 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 early diagnosis of the disorder, cooperation between the family and the professional staff and the importance of repeated spa treatment.
Authors: Team of doctors, co-editor MUDr.Boldišová Oľga Acta rheumatologica et balneologica Pistiniana 2010
Linking hyperthermic procedures (as part of spa treatment) to physical exercise treatment, observations, statistical analysis
Baseline: Hyperthermic procedures are part of the spa treatment and represent a suitable preparation for physical exercise therapy. Literature offers insufficient information on the assessment of the impact 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 exercise 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, 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 spat 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 from the morning hours.
MUDr. Soňa ŽLNAYOVÁ, PhD.
The evaluation of effects of the complex spa balneotherapy in patients with the osteoarthritis of the knee and hip.
Purpose: To evaluate effects of complex spa balneotherapy in patients with osteoarthritis of the knee and hip.
Materials and methods: The clinical study in 40 patiens with clinically symptomatic osteoarthritis of hip and knee joint according to Kellgren and Lawrence, 1963, treated in Slovak Health Spa Piešťany,a.s., during median 19 days, were evaluated joint pain, stiffness and function using visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC).
Results: Complex balneotherapy confirmed a statiscitally significant decraese in pain intensity ( VAS :67,12 vs 34,50, Womac:15,35 vs 8,9 , p<0,001 ), a degrease of joint stiffness ( WOMAC : 5,02 vs 3,20, p < 0,001 ) an improvement of articular function (WOMAC: 49,30, to 31,40, p<0,001 ) and also improvement of general WOMAC score ( from 69,7 to 43,6)
Conclusions: Complex spa balneotherapy lasting 21 days led in patients with osteoarthritis of the knee and hip to pain relief, decrease of joint stiffness and improvement of articular function .
MUDr. Zimanová Tamara
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. Ing. Ján Fuska, DrSc., Prof. MUDr. Jozef Rovenský, DrSc.
Cooperating Compilers: Ing. Bohumil Proksa, DrSc., Ing. Mária Šturdíková, CSc., Ing. Mária Stančíková, CSc., Ing. Karol Švík, CSc.
Study of biological effects of the mud and thermal water from Piešťany
Department of Biochemical Technology, Faculty of Chemical Technology, Slovak University of Technology, Bratislava
Research Institute of Rheumatic Diseases, Piešťany
Principal investigators: prof. Ing. Ján Fuska, DrSc., Prof. MUDr. Jozef Rovenský, DrSc.
Co-investigators: Ing. Bohumil Proksa, DrSc., Ing. Mária Šturdíková. CSc., Ing. Mária Stančíková, CSc., Ing. Karol Švík, CSc.
Research of Factors Participating in the Effect of Natural Healing Sources Applied in Piešťany Spa
Study of Thermal Mud Characteristics Used in Balneological Facilities of Piešťany Spa
Bratislava – Piešťany 2000
Research Institute of Rheumatic Diseases Piešťany
Head Complilor: Prof. MUDr. Jozef Rovenský, DrSc.
Deputy Head Compilor: Prof. Ing. Ján Fuska, DrSc.
Cooperating Compilors: Ing. Mária Stančíková, CSc., Ing. Bohumil Proksa, DrSc., Ing. Karol Švík, CSc., Mgr. Richard Ištok, Doc. Ing. Svätoslav Hluchý, CSc., SPÚ Nitra
Consultants: MUDr. Mária Tóthová, SLK, MUDr. Ružena Čunčíková, SLK
Evaluation of the overall effect of the spa treatment in patients with clinically symptomatic osteoarthritis of weight-carrying joints
Rybár, I., Zimanová, T., Vajcík, J., Vlčková, V., Jurča, J.
Research Institute of Rheumatic Diseases, Piešťany
Director: prof. MUDr. Jozef Rovenský, DrSc.
Health Spa Piešťany
Director General: Ing. I. Drábek
Theoretical and Experimental Studies of Piešťany Mud and River Sediment Microbial Community
Department of Biochemical Technology School of Chemical Technology, Slovak Technical University, Bratislava
Responsible Compilor: Ing. Mária Šturdíková, PhD.
Cooperating Compilors: Ing. Katarína Mináriková