• mud-bath therapy
• Fibromyalgia
• balneotherapy
• Proteomics

Fibromyalgia (FM) is a chronic non-inflammatory musculoskeletal disorder characterized by a variety of symptoms related to pain. A wide range of other unspecific symptoms may characterize the disease including fatigue, sleep disturbances, mood disorders, morning stiffness, anxiety, depression, cognitive dysfunction (e.g., memory problems, concentration difficulties, diminished mental clarity), irritable bowel and bladder syndrome, sexual dysfunction and sicca symptoms. In the last decade, many attempts have been carried out for the research of specific biomarkers in FM, but, at present, there are no specific markers, the diagnosis is basically clinical. The complexity of the disease means that there isn’t a therapeutic treatment standards and this is demonstrated by the fact that pharmacological treatments are often applied in combination with non-pharmacological treatments. Among non-pharmacological interventions the most used there is the spa therapy, which includes hydrotherapy, balneotherapy, physiotherapy, mud-pack therapy and exercise.
In the present work, to study the effects of both balneotherapy and mud-bath therapy treatments in patients affected by FM, we used rheumatological, psychiatric, biochemical and proteomic approach.
Forty-one FM patients (39 F, 2 M), who fulfilled the American College of Rheumatology criteria received 2-week thermal therapy program comprising therapy once daily for 6 days/week. Twenty-one patients received mud-bath treatment, while the other twenty balneotherapy. Pain, symptoms, and quality of life were assessed. Oxytocin, brain-derived neurotrophic factor (BDNF), ATP and serotonin transporter levels during therapy were assayed by commercial kits. Comparative whole saliva proteomic analysis was performed using a combination of 2-D and nano-LC-ESI-MS/MS spectrometry techniques. The Elisa kit was performed to validate different expression of transaldolase, phosphoglicerate mutase1 and zinc alpha-2-glycoprotein1 proteins. We observed reduction in pain, FIQ values and improvement of SF36 in both groups of patients treated with mud-bath or balneotherapy. The improvement of the outcome measures occurred with different timing and duration in the two spa treatments. A significant decrease of neuropeptide concentrations was observed either after balneo-theraphy or mud-bath therapy when assayed after twelve weeks, while no significant change of oxytocin levels was detected. Significant differences were observed for PGAM1 and zinc-alpha 2 glycoprotein protein expression.
Our results showed that the thermal treatment might have a beneficial effect on the specific symptoms of the disease. In particular, while balneotherapy gives results that in most patients occur after the end of the treatment but which are no longer noticeable after 3 months, the mud-bath treatment gives more lasting results.