Balneotherapy of patients with rheumatoid arthritis (RA) has been done empirically from ancient times. As a matter of fact, the pain and stiffness are significantly relieved by bathing in a hot spring. The mechanism of action, however, remains still unclear in some points. The authors have pointed out some of the mechanisms, by which RA patients were influenced from spring water bathing.
1) Vascular dilatation. Gas containing hot springs, such as CO₂ spring or H₂ S spring, have vasodilating action on peripheral blood vessels, which increases the blood circulation, resulting in the acceleration of metabolism and the improvement of pain and stiffness.
2) Stimulation on the adrenocortical hormon secretion. Urinary 17-KS excretion increased significantly after serial bathing in hot spring water, especially in sulfur containing spring water, indicating the stimulatory effect on the adrenocortical function.
3) Stimulation on the sympathetic nerve. Plasma norepinephrin levels were elevated during the bathing either in a hot spring or in a cold spring water, although the elevation was much higher in a cold spring water. This may suggest the stimulatory effect of spring water bathing on the sympathetic nerve function.
4) The effect on plasma prostaglandin levels. Plasma prostaglandin levels were concentrated into around the mean level after 3 weeks of serial bathing in a hot spring water.
5) The effect on plasma cyclic AMP levels. Plasma cyclic AMP levels were elevated significantly after 1 week of serial bathing in a cold spring water, but returned to the initial levels after 3 weeks of the serial bathing.
6) The effect on plasma neuropeptide levels. Plasma beta-endorphin levels were lower in RA patients and they were insignificantly elevated by the bathing in a hot spring water. Both the leucine-encephalin and methionine-encephalin levels were unchanged by the bathing, although the initial levels were both within normal ranges in RA patients.
7) The effect on connective tissue metabolism. Urinary excretion of the total hydroxyproline was higher in RA patients, and it was decreased after the bathing in a hot spring water containing sulfur. Serum monoamine oxidase activities, on the other hand, was lower in RA patients, and they were elevated after the bathing in hot spring waters.
8) The effect on the autonomic nerve function. Abnormality of the autonomic nerve function indicated by the coefficient of variance of R-R intervals in EKG was much more found in RA patients than in healthy controls, and it was improved significantly after 4 weeks of serial kinetic bathing in a simple hot spring water.
In spite of the above mentioned beneficial effects on RA patients, bathing in either hot or cold spring water has shown no effect on the inflammatory activity of RA, but only shown ameliorating effects on the pain and stiffness, just like an effect of non-steroidal anti-inflammatory drugs. It should be recommended, therefore, to use hot spring water not only for relieving pain and stiffness, but also for positive rehabilitation exercise.

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Bathing and UV-irradiation have become one of the common treatments for psoriasis because of 1) higher therapeutic potency and 2) lesser frequency and severity of side effects inevitably associated with systemic treatments for the fundamentally benign disease. We, therefore, investigated possible combination of topical ointment with the bathing and UV-irradiation in order to evaluate the best therapeutic efficacy of the treatment of some skin diseases, including psoriasis. In addition, we showed the clinical effect of PUVA-bath on the management of the patients with atopic dermatitis.

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