Efficacy Of Thermotherapy For Rheumatoid Arthritis: A Meta-Analysis

Abstract

Thermotherapy is a commonly used modality in treating rheumatoid arthritis (RA). Superficial moist-heat fomentations (hot packs) at different temperatures, cryotherapy (ice packs), paraffin wax baths and faradic baths have been used as different thermotherapy modalities. This meta-analysis included randomized (RCT) and controlled clinical trials (CCT), case-control and cohort studies of thermotherapy compared with control (no treatment) or active therapy (head-to-head studies). All the included studies (n=7) in this review were identified as RCTs. The results of this meta-analysis of thermotherapy for RA found that there was no significant effect for hot and ice-pack applications and faradic baths on objective measures of disease activity, including joint swelling, pain, medication intake, range of motion (ROM), grip strength, hand function or patient preference, compared with control (no treatment) or active therapy. However, there were positive results for paraffin wax baths combined with exercises for arthritic hands on objective measures of ROM, pinch function, grip function, pain on non-resisted motion compared with control (no treatment) after 4 consecutive weeks of treatment. Exercise alone, however, for arthritic hands yielded better improvement than wax baths combined with exercises for pain on non-resisted motion. There is no significant difference between wax and therapeutic ultrasound, or between wax and faradic bath combined with ultrasound for all the outcomes measured after 1, 2 or 3 week(s). The reviewers concluded that thermotherapy can be used as a palliative therapy, or as an adjunct therapy combined with exercises for RA patients, especially wax baths in the treatment of arthritic hands. These conclusions are limited by methodological considerations, such as the poor quality of trials.