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Re: About the fourth EULAR recommendation for hand osteoarthritis.

Dear Editor, W Zhang and al. in their fourth recommendation for hand osteoarthritis consider that their proposition is based on expert opinion alone. In France, and probably other European country, spa therapy (with hot mud, water or cloud) is often used for treating hand osteoarthritis. A French spa centre supported two randomised clinical trial: One showed positive and equivalent effect between two different types of mud and thermal cloud [1] (which remain unpublished but is cited in the review of E Maheu et al[2]). The other shows superiority of thermal cloud application on topical NSAI (ibuprofen) [3]. Even if they have some methodological limitation, we propose that these two trials (in French language) could be analysed by ESCISIT, in future recommendations, for determining if level of evidence could be improved by their conclusion.

References

[1] Collin JF, Constant F, Herbeth B. Evaluation of comparative efficacy of mud and Berthollet on hand osteoarthritis [evaluation de l’efficacité compare de la boue et du Berthollet sur l’arthrose des mains]. Journée pratique s”hydrologie thérapeutique, MEDEC 1993.

[2] Trèves R, Maheu E, Dreiser RL. Clinical trials in hand osteoarthritis. Critical review.[les essais thérapeutiques dans l’arthrose digitale, revue critique] Rev Rhum 1995, 62:119S-128S.