リウマチ性疾患の温泉治療に関する臨床的研究

第1報 リウマチ患者の尿中17KS排泄に及ぼす温泉浴クールの影響

抄録

The author studied the significance of the hot-spring bathing treatment upon rheumatic disease. Excreted urinary 17KS was measured for this purpose and Nomin-no-yu (sulfur spring) and thermal water of the University Hospital (sulfated spring), were employed. The results were as follows:
1) Compared with healthy persons, the value of excreted urinary 17KS of rheumatoid arthritis patients was low. Dividing rheumatoid arthritis patients into two groups, namely, those suffering from less than a year and those more than a year, it was found that no difference was observable in the values of urinary 17KS secretion between the former group and healthy persons and that the value was low in the latter group. Therefore it was postulated that the pituitary adrenocortical function might be impaired due to the prolonged process of rheumatic disease.
2) Hot-spring bathing treatment increased excreted urinary 17KS in rheumatoid arthritis patients. The increase in urinary 17KS excretion reached a maximum 7 days after the initiation of the treatment. After this it gradually decreased, though the increase was still observable 14 days after the initiation. It might be due to the difference in properties between Nomin-no-yu and thermal water of the University Hospital that the increase in excreted urinary 17KS was higher and the duration of the increase was longer in the former than the latter. It seems that the incerase was mainly due to vitalization of the pituitary adrenocortical function by nonspecific stimulation, because the difference was observed in individual reactions against synthetic stimulating action of hot-spring bathing.
3) The increase in excreted urinary 17KS caused by hot-spring bathing was less in rheumatoid arthritis patients than in healthy persons, In a very few cases of rheumatoid arthritis, hardly any increase could be observed; there were some cases in which a decrease in excreted urinary 17KS was observed. An inference can be made from the findings mentioned above that the pituitary adrenocortical function is generally deteriorated in rheumatoid arthritis patients.
4) Hot-spring bathing will increase excreted urinary 17KS in rheumatoid arthritis patients, if it is used in combination with aspirin therapy in which a large quantity of aspirin is used. Where this combined therapy was successful, a pronounced increase in excreted urinary 17KS was observed in rheumatoid arthritis patients. However, where the combined therapy was unsuccessful, the number of cases in which the increase was observed was almost equal to that in which the decrease was observed. These findings suggest that balneotherapy and aspirin therapy work mutually in the therapeutic treatment of rheumatic diseases.
5) In those cases of rheumatoid arthritis where hot-spring bathing was used in combination with prednisolone, excreted urinary 17KS decreased temporarily, but it tended to increase again a few days after the discontinuance of administration of prednisolone. There are many cases where a reduction in the amount of prednisolone to be administered will cause the appearance of reactivation symptom of rheumatoid arthritis, but it is anticipated that hot-spring bathing can prevent it to some extent, judging from the changes in excreted urinary 17KS caused by balneotherapy. Further examination is needed for any definite conclusion.