Balneotherapy (Mud-Bath Therapy) with a Peloid Enriched with Rosmarinic Acid Enhances Clinical Outcomes and Innate Immune Benefits in Elderly Patients with Osteoarthritis: A Pilot Study

Osteoarthritis (OA) is a common chronic condition that causes pain and disability, particularly in the elderly, resulting in significant limitations on mobility and overall quality of life. Balneotherapy using peloids (mud therapy) is an effective, non-pharmacological treatment for OA that improves symptoms and function. This pilot study aimed to assess whether a controlled-matured peloid, supplemented with rosmarinic acid (RosA), could enhance clinical outcomes, functional status, and immune response in OA patients. The study involved 42 elderly OA patients (mean age 70), comparing a 10-day balneotherapy cycle using either a RosA-fortified or non-fortified peloid. The effects on pain (Visual Analogue Scale), functional status (WOMAC, knee flexion/extension), quality of life (EUROQOL), and innate immune response (neutrophil phagocytic and microbicidal activity) were evaluated. Both treatments resulted in significant improvements in pain (by approximately 60%), function, and quality of life, but the RosA-fortified peloid led to greater benefits, particularly in the anxiety/depression dimension of the EUROQOL questionnaire and in enhancing neutrophil immune responsiveness. These findings suggest that RosA supplementation may further improve the therapeutic effects of mud therapy for OA management.