Malliou (2025) Therapeutic properties of thermal water in rheumatic diseases A narrative review

Thermal Water Therapy in Rheumatic Diseases: Healing Through Nature

Introduction: Renewed Interest in Thermal Therapies

Thermal water therapy, also known as balneotherapy, is gaining recognition as a non-pharmacological treatment option for managing rheumatic diseases. Historically rooted in natural healing traditions, it is now supported by a growing body of scientific literature. This narrative review by Malliou and Salamaliki (2025) evaluates the therapeutic effects of thermal water on conditions like osteoarthritis, rheumatoid arthritis, fibromyalgia, and axial spondyloarthritis.

Mechanisms of Action

The therapeutic impact of thermal water is attributed to mechanical, thermal, and chemical stimuli. Immersion in mineral-rich hot water reduces inflammation, improves circulation, relaxes muscles, and triggers neuroendocrine responses. Elements like sulfur and hydrogen sulfide show anti-inflammatory and antioxidant effects. Studies have also indicated changes in biomarkers such as cortisol, leptin, and adiponectin, suggesting broader metabolic impacts.

Clinical Benefits Across Conditions

Evidence suggests that thermal water therapy improves:

Pain levels and mobility in osteoarthritis (OA) and rheumatoid arthritis (RA)
Quality of life (QoL) and functionality in fibromyalgia and chronic low back pain
Sleep quality and fatigue in axial spondyloarthritis (AxSpA)

Results from randomized controlled trials (RCTs) and observational studies show that benefits can persist for up to six months post-treatment, especially when combined with mud therapy or physiotherapy.

Research Gaps and Limitations

Despite promising results, challenges include heterogeneity in study designs, small sample sizes, and lack of double-blind RCTs. More standardized, large-scale studies are needed to confirm long-term efficacy and mechanisms.

Conclusion

Thermal water therapy holds substantial promise as a safe, cost-effective, and accessible complementary treatment for rheumatic diseases. As evidence continues to grow, it may soon become a more integrated part of multidisciplinary pain and rehabilitation programs.