Effect of Siwan Sand Therapy on Pulmonary Functions of Rheumatoid Arthritis Patients

Inclusion Criteria: The inclusion criteria were definite RA that fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA * Patients were on their stable doses of anti-rheumatic drugs * Patients with moderate, severe rheumatoid arthritis * they had positive RF and anti-CCP * Both sexes participated in this study * their ages range from 25 to 59 years * body mass index from 25 to 30 * Pain of at least 3 mm on a visual analogue scale (VAS) from 0 mm (no pain) to 10 mm (worst imaginable pain) * Patients with (I) complete functional capacity with ability to carry out all usual duties without handicaps, (II) functional capacity adequate to conduct normal activities despite handicap of discomfort or limited mobility of one or more joints, (III) functional capacity adequate to perform only a few or none of the duties of usual occupation or of self-care - Exclusion Criteria: * uncontrolled arterial hypertension \[systolic blood pressure (SBP) ≥ 180 mm Hg and/or diastolic blood pressure (DBP) ≥ 100 mm Hg\] 32 (Tanaka and Kazumi, 1990). * Uncontrolled diabetes, * Previous renal transplanted patients, * Patients had coronary artery disease including: unstable angina, * Pregnant woman's, * Bleeding disorder, * Largely or wholly incapacitated with patient bedridden or wheel chair bound, permitting little or no self-care.