**2. Conclusions**

188 Hyperthermia

Franke et. al demonstrated an intermediate to long term pain reduction in patients suffering from rheumatoid arthritis during a nine month follow-up after combined RnHT. This randomized, double-blinded study included 134 patients and compared the efficacy of balneotherapeutic regimen applied at 37° C either with or without 222Rn. Although both groups showed a beneficial effect immediately after therapy, the radon group predominated significantly at the three and six months follow up. Similar results were obtained concerning cut-down in NSAID and corticosteroid intake [22]. Consistent with these findings, a previous study including 60 patients with rheumatoid arthritis clearly demonstrated pain reduction and functional improvement of affected joints after a typical regimen of thermal water baths. However, patients receiving 222Rn thermal water showed a significantly

Van Tubergen et al. investigated in course of a randomized, controlled study the efficacy of speleotherapeutically applied RnHT combined with a complex rehabilitation program including gymnastics, hydro – and sport therapy. 120 patients suffering from ankylosing spondylitis were enrolled in the study and randomized in two treatment and one control group. Whereas the control group maintained its regular physiotherapeutic program at home, the intervention groups received the complex rehabilitation program either concomitantly with hyperthermia treatment in form of sauna regimen or concomitantly with speleotherapeutic combined RnHT. Bath Ankylosing Spondylitis Functional Index (BASFI), quality of life assessment score, pain score on a visual analogue scale and duration of morning stiffness were taken together to a Pooled Index of Change (PIC) as primary endpoint. Immediately after therapy both intervention groups showed a 20 to 30% improvement in contrast to the control group that remained unaffected. In the six to nine

In line with these results, Lind-Albrecht demonstrated a significant long-term pain reduction, improved mobility of the spine and reduced drug intake of patients with ankylosing spondylitis receiving a rehabilitation program combined with speleotherapeutic RnHT compared to those, who exclusively received the rehabilitation program [26, 27].

According to two double-blinded randomized studies by Pratzel et al., an intermediate-term pain reduction could be achieved by serially applied thermal water baths with or without 222Rn in patients with non-inflammatory cervical syndrome and degenerative disorders of spine or joints, respectively. Immediately after therapy both treatment groups benefitted from an elevated threshold of pressure-provoked pain in the paravertebral muscles. A sustainable and significant pain reduction lasting until the two and four months follow-up

A recent prospective study including 222 patients suffering from non-inflammatory, degenerative rheumatoid disorders investigated the sustainability of beneficial effects achieved by serially applied 222Rn containing thermal water baths. Compared to baseline levels, pain score and functional restriction of affected joints were significantly reduced up to twelve or six months, respectively. The fraction of patients with sickness absence was

significantly reduced within one year after versus one year prior to therapy [30].

pronounced effect on the analyzed parameters [23].

months follow up only the 222Rn group significantly prevailed [24, 25].

could be demonstrated only in the 222Rn group [28, 29].

Numerous studies have demonstrated a sustaining beneficial effect of combined low-dose RnHT when serially applied either by speleotherapy or balneotherapy to patients suffering from inflammatory or non-inflammatory degenerative disorders of the musculo-skeletalsystem. Of note, the most dominant effect is recognized several months rather than immediately after therapy. Combined RnHT represents a cost effective method that alleviates pain and, thus, allows reducing drug intake which, in turn, may contribute to the prevention of adverse events caused by NSAIDs and glucocorticoids. As mentioned above, radionuclide-based therapy has been employed in the management of rheumatic disorders for decades. However, the poor benefit-risk ratio led to severe limitations or complete discontinuation in clinical use. RnHT poses doses to the patients which are in magnitude 10- 5 lower in respect to the bone dose compared to 224Radiumchloride-injection regimens. However, further studies are necessary to evaluate potential risks of low-dose RnHT. Although some studies implicate a beneficial effect of hyperthermia therapy for rheumatic diseases, combined RnHT turned out to be more effective than sauna or balneotherapy at an ambient temperature of 37° C lacking 222Rn. As combined RnHT may also exert beneficial effects in other disease entities, further studies are necessary to prove its place among the current treatment options.

Effects of Low-Dose Radon Therapy Applied Under Hyperthermic

Conditions (RnHT) on Inflammatory and Non-Inflammatory Degenerative Disease Conditions 191

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