Comparative Effects of Cold and Warm Pelotherapy on Disease Activity and Function in Ankylosing Spondylitis: A Prospective Study

IntroductionAnkylosing spondylitis (AS) is a chronic inflammatory rheumatic disease associated with pain, functional impairment, and progressive limitation of spinal mobility.Balneotherapy and pelotherapy (PT) are frequently incorporated into multimodal rehabilitation programs; however, evidence regarding the potential influence of peloid temperature on clinical outcomes remains limited.The present study aimed to compare the short-term effects of cold and warm PT on disease activity, functional status, and spinal mobility in patients with AS. MethodsA total of 63 patients undergoing a two-week multimodal rehabilitation program were included and allocated to cold PT (n = 26) or warm PT (n = 37).Clinical outcomes were assessed at admission and discharge using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Ankylosing Spondylitis Disease Activity Score based on erythrocyte sedimentation rate (ASDAS-ESR). ResultsNo statistically significant differences between the cold and warm PT groups were identified at admission or discharge for any of the evaluated clinical parameters.Nevertheless, significant within-group improvements were observed in BASDAI, BASFI, and ASDAS-ESR in both treatment groups.BASDAI decreased significantly in the cold and warm PT groups (both p < 0.001), as did ASDAS-ESR (both p < 0.001), while BASFI also improved significantly (p = 0.014 and p < 0.001, respectively).In contrast, BASMI did not change significantly in either group.No treatment-related adverse events were reported. ConclusionsThese findings indicate that both cold and warm PT, when incorporated into a multimodal rehabilitation program, are associated with short-term improvements in disease activity and functional status in patients with AS.No significant between-group differences were detected; however, the study was not powered to establish equivalence between the two procedures, while the limited change in spinal mobility may reflect the lower responsiveness of structural and mobility-related parameters to short-term rehabilitation.Larger controlled studies with longer follow-up are warranted to determine whether peloid temperature independently influences therapeutic outcomes.