C. F. Roques

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Transcript of C. F. Roques

  • Pr CF ROQUES LATRILLE MD ISMH General Secretary AFRETH Scientific Committee President (Paris) Institute of Thermalism President (Dax)
    • Cares to the tourists
      • First aid +++
      • Primary cares GP
    • Care to the migrant returning home for holidays
      • Secondary cares (recourse advices +++)
    • Cares using natural therapeutic resources
      • Climatotherapy
      • Thalassotherapy
      • Medical Balneotherapy (medical cares delivered in thermo-mineral resorts)
    • High technology cares delivered to better costs
      • Dental cares
      • Medical Assessment
      • Cardiac surgery
      • Grafts,
    • 104 resorts, 1200 mineral springs, 500 doctors
    • 2009 : 493 153 persons
      • 9 073 807 days for medical treatment(Social Security pays)
      • 490 889 days for wellness
    • Female : 64 % ; male : 36 %
    • Age : above 60 : 65 % - under 16 : 7 %
    • Aetiology : Rheumatic conditions = 72 %
    • Gross product of spa resorts : 1 Billion
    • Social security involvement (thermal cares + doctors fees) : 290 Millions
    • Employed persons : 110 000
    • Made of
      • Hydrothermal cares
      • Complementary cares (medical, paramedical, patient education, )
      • Resort stay
        • Climate
        • Rest
        • Social interactions
        • Adapted physical activities,
    • With Consequences on
      • Care delivery
      • Scientific investigation,
    • Medical benefit assessment ++++
    • Preclinic investigation ++
    • Safety studies +
    • Specificity of thermo-mineral products ++
    • Medico-economics +
    • Other topics +
    • Data from papers published in english speaking journals with impact factor
    • Rheumatic conditions
    • ENT conditions
    • Metabolic diseases
    • Heart & vessels
    • Skin diseases
    • Gynaecological disorders
    • Stress related disorders
    • Ageing
    • Other topics
    • A very prevalent condition : in France about 160 000 patients in SPA resorts are treated for KOA
    • Balneotherapy reduces pain and improves functional abilities (RCT)
      • Balint Clin. Rheumatol., 2007, 26 , 890 ;
      • Evcik Joint Bone Spine , 2007, 74 , 60 ;
      • Cantarini, Rheumatol. Int., 2007, 27 , 523 ;
      • Karaglle M, Clin. Rheumatol., 2007, 26 , 2063 ;
      • Vaht, Compl. Ther. Clin. Pract., 2008, 14 , 60 ;
      • Odabasi , J Alt Compl Med , 2008;14:559 ;
      • Sherman , Isr Med Asoc J, 2009;11:88 ;
      • Fioravant i, Am J Phys Med Rehabil. 2010;89:125 ;
      • Fraioli , Rheumatol Int. 2010 Epub
      • Kilioglu , Rheumatol Int. 2010;30:739 ;
      • Forestier , Ann Rheum Dis. 2010;69:660 ;
      • Cecarelli , Clin Exp Rheumatol, 2010;28:250
    • Balneotherapy acts on cellular mechanisms
      • Action on pro-inflammatory cytokines damaging cartilage Ceccarelli , Clin Exp Rheumatol. 2010;28:250 :
      • Action on leptine and adiponectin, Fioravanti , Rheumatol Int. 2010; epub
      • Antioxidative, anti-inflammatory, cartilage protection of SULFUR: Benedetti , Clin Biochem, 2010, epub )
      • Potentializes chondroprotective drugs : Caraglia , Exp. Mol. Med., 2005, 37 , 476
      • Action on inflammation markers and anti-oxidative status: Olah , Int J Biometeorol. 2010;54:249
    • Topics made with thermal muds are efficient
      • Mahboob , J Alt Compl Med.2009;11:1239
    • Reviews : Balneotherapy : useful in OA of lower limb
      • Forestier , Joint Bone Spine, 2008;
      • Falagas , Int J Clin Pract, 2009; 63:1068
      • Harzy , Clin Rheumatol. 2009;28:501
    • Meta-analysis : Silver evidence concerning the beneficial effects of mineral baths compared to no treatment; methodological quality of the trials was poor.
      • Verhagen , J. Rheumatol., 2008, 35 , 1118-1123
    • Beneficial on painful chronic spinal conditions
      • Balogh . Forsch. Komplementarmed. Klass. Naturheilkd., 2005, 12 , 196-201 (Low back pain)
      • Olah, Rheumatol Int ., 2008, 28 , 749-756 2008)(low back and neck pain)
      • Kulisch , J Rehab Med.2009;41:73 (low back pain)
      • Beneficial effect on intensity of chronic back pain of balneotherapy and spa therapy .
        • Pittler Rheumatology , 2008, 45, 880 (meta-analysis)
    • Efficiency in Rheumatoid Arthritis
      • Codish, Rheumatol. Int., 2005, 25 , 49
      • Franke, Rheumatol. Int ., 2007, 27 , 703
    • Ankylosing Spondylitis
      • Codish, Isr. Med. Assoc. J. , 2005, 7 , 443
      • Yurkturan, Rheumatol. Int ., 2007, 27 , 703
      • Cozzi, Joint Bone Spine , 2007, 74 , 436
      • and people accept to pay: Boonen, Ann. Rheum. Dis., 2005, 64 , 1650
    • Biological actions
      • H2S reduces IL6 in Fibroblats Like Synoviocytes in RA. Kloesch , Cell Biol Int. 2010;34:477
      • Increase in TGF beta in AS: Shehata, Wien Klin. Wochenschr ., 2006, 118 ,266 )
    • Clinical effects : improvement of pain and function
      • Dnmez, Rheumatol. Int ., 2005, 26 , 168
      • Zijlstra, Rheumatology , 2005 , 44 , 539-546
      • Fioravanti, Rheumatol. Int ., 2007, 27 , 1157
      • for an acceptable cost (Zijlstra, Rheumatology , 2007, 46 , 1454
      • De Andrade , Rheumatol. Int, 2008;29:147
      • Tomas-Carus , J Rehabil Med, 2008;40:248
      • Tomas-Carus , Rheumatology, 2009;48:1147
      • Improvement of respiratory symptoms : Kesiktas, J Back Musculoskelet Rehabil. 2011;24 :57
      • Biological actions : decrease in IL1, LTB4, PGE2 : Ardi, Rheumatol. Int ., 2007, 27 , 441
      • EVIDENCE
      • * strong Mc Veigh (review), Rheumatol Int, 2008;29:119
      • * moderate Langhorst (meta-analysis) (SMD pain : -1.27 et QOL : -1.16), Rheumatology, 2009;48:1155
      • Recommendations : EULAR B
    • Improvement of sinusal mucoses after surgery (SH, Fe, As water ): reduction of mucoses infiltration by eosinophilic cells (Staffieri, Am J Otolaryngol , 2008;29:223 )
    • Recovery of epithelial cells (junction sites recovery)(NaCl, Br, I water)Fenu , Journal of Alternative and Complementary Medicine, 2010: 341
    • Sulphurous water inhalation is helpful in Upper Air Tract Chronic Infections.Salami , Int J Pediatr Otorhinolaryngol, 2008;72:1717
    • Overweight and obesity reeduction
      • Reduction of 5% of body weight (4kg)(Hanh, 2011, under press )
    • Intestine motility speed increased
      • Gasbarrini, World J. Gastroenterol ., 2006, 12 , 2556
    • Reduction of post-prandial lipaemia, serum and chylomicrons triacylglycerols
      • Schoppen, Br. J. Nutr ., 2005 , 94 , 582
    • Augmentation of insulin