Cryotherapy in inflammatory rheumatic diseases: a systematic review

Abstract

The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.

Keywords::

• cryotherapy
• cytokines
• DAS28
• enzymes
• pain VAS

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Molecular pathways targeted by cryotherapy (proinflammatory cytokines, VEGF, cartilage-degrading enzymes) suggest interesting anti-inflammatory properties in rheumatic inflammatory diseases, which should be further investigated.

• Cryotherapy could be an interesting adjunct therapy in these diseases with a better safety profile as compared with corticosteroids and NSAIDs.

• By pooling six studies, we show that chronic local cryotherapy and WBC significantly reduce pain visual analogic scale and 28-joint disease activity score in rheumatoid arthritis (within-group effect size). However, methodological issues and a lack of control groups prevent from calculating any between-group effect size.

Notes