Zeki Karagulle

We very recently published clinical studies evaluating spa and balneological therapies in elderly population and patients with musculoskeletal conditions such as osteoarthritis and rheumatoid arthritis. We additionally have conducted a clinical study to assess clinical effects of spa therapy as well as to verify the effects on the oxidant/antioxidant status in patients with RA. And finally we conducted an in-vitro study to determine anti-inflammatory and angiogenic properties of thermal mineral waters in human keratinocyte cells. With the aim to evaluate the short-term effects of spa therapy we retrospectively analyzed the records of a cohort of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were undertaken a spa therapy course in Turkey spa resorts. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knees. This improvement was clinically important in majority of the patients.

Under real-life clinical practice circumstances, in a larger population of patients with a wide range of rheumatic and musculoskeletal diseases who were prescribed spa therapy, we found that spa therapy may be effective in osteoarthritis, fibromyalgia, lumbar/cervical disc herniation, and nonspecific low back pain; and less for ankylosing spondylitis, rheumatoid arthritis, and rotator cuff tendinitis by improving pain and function.
We newly online published a crossover randomized controlled trial testing the therapeutic efficacy of spa therapy adjunct to pharmacotherapy in  heumatoid arthritis (RA) patients. We showed that a 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional diseasemodifying antirheumatic drugs. These beneficial effects may last for 6 months. As an earlier phase of above mentioned study our purpose was to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy. In this investigator-blind randomized
controlled trial we found that spa therapy with saline balneotherapy exerts antioxidant effect in patients with RA as reflected by the increase in nonenzymatic superoxide radical scavenger activity (NSSA) levels after spa therapy; whether this antioxidant effect contributes to the clinical improvements observed remains to be verified.

We have presented an in-vitro study in 42. ISMH World Congress in Moscow last June. In this study, we tested four different thermal waters with known chemical composition at the cellular level to determine their anti-inflammatory and angiogenic properties by measuring gene expressions of TNF-α, IL-1α and VEGF by RT-qPCR analysis in human keratinocyte cells in vitro. All four tested thermal waters decreased the expression of IL-1α when compared with untreated control cells. On the other hand, significant downregulation of TNF-α has been found only with two of four thermal waters and all waters showed downregulation of the gene expression of VEGF significantly. These findings add insight on the underlying mechanisms of the therapeutic benefit of balneotherapy observed in inflammatory skin and rheumatic diseases.

Il Dr. Karagülle è professore di medicina e direttore del Dipartimento di ecologia medica e idroclimatologia presso la facoltà di medicina dell’Università di Istanbul.
Oltre a dirigere programmi di istruzione e formazione universitari e post-universitari, il Prof. Karagülle ha pubblicato articoli di ricerca e ha scritto e curato libri sui benefici della terapia termale, della balneoterapia e del ricorso alla medicina termale. Karagülle è presidente della Turkish Medical Medicine and Balneology Association ed è stato presidente della International Society of Medical Hydrology and Climatology (ISMH). Essendo un noto esperto in balneologia e medicina termale, idrologia ecologica e climatologia, ha partecipato a numerosi simposi, tavole rotonde e workshop e ha organizzato congressi e riunioni.