Thermotherapy (heat treatment) for treating rheumatoid arthritis

Thermotherapy is a commonly used modality in treating rheumatoid arthritis (RA). Thermotherapy modalities include superficial moist heat fomentations (hot packs) at different temperatures, cryotherapy (ice packs), paraffin wax baths and faradic baths. All studies included in this review (n=7) are randomized controlled trials (RCT).

This review found there were no significant effects for hot and ice packs 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 to control (no treatment) or active therapy. However, there were positive results for paraffin wax baths alone for arthritic hands on objective measures of ROM, pinch function, grip strength, pain on non-resisted motion, stiffness compared to control (no treatment) after four consecutive weeks of treatment.

There is no significant difference between wax and therapeutic ultrasound or between wax and faradic bath combined with ultrasound for any of the outcomes measures. The reviewers concluded that thermotherapy can be used as a palliative therapy or as an adjunct therapy combined with exercises for RA patients. Wax baths appear especially helpful in the treatment of arthritic hands. These conclusions are limited by methodological considerations such as the poor quality of trials.

Authors' conclusions: 

Superficial moist heat and cryotherapy can be used as palliative therapy. Paraffin wax baths combined with exercises can be recommended for beneficial short-term effects for arthritic hands. These conclusions are limited by methodological considerations such as the poor quality of trials.

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Background: 

Thermotherapy is often used as adjunct in the treatment of rheumatoid arthritis (RA) by rehabilitation specialists.

Objectives: 

To evaluate the effectiveness of different thermotherapy applications on objective and subjective measures of disease activity in patients with RA.

Search strategy: 

We searched MEDLINE, EMBASE, Pedro, Current Contents, Sports Discus and CINAHL up to and including September 2001. The Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registers. Hand searching was conducted on all retrieved articles for additional articles.

Selection criteria: 

Comparative controlled studies, such as randomized controlled trials, controlled clinical trials, cohort studies or case/control studies, of thermotherapy compared to control or active interventions in patients with RA were eligible. No language restrictions were applied. Abstracts were accepted.

Data collection and analysis: 

Two independent reviewers identified potential articles from the literature search (VR, LB). These reviewers extracted data using pre-defined extraction forms. Consensus was reached on all data extraction. Quality was assessed by two reviewers using a 5 point scale that measured the quality of randomization, double-blinding and description of withdrawals.

Main results: 

Seven studies (n=328 participants) met the inclusion criteria. The results of this systematic review of thermotherapy for RA found that there was no significant effect of hot and ice packs applications (Ivey 1994), cryotherapy (Rembe 1970) and faradic baths (Hawkes 1986) on objective measures of disease activity including joint swelling, pain, medication intake, range of motion (ROM), grip strength, hand function compared to a control (no treatment) or active therapy.

There is no significant difference between wax and therapeutic ultrasound as well as between wax and faradic bath combined to ultrasound for all the outcomes measured after one, two or three week(s) of treatment (Hawkes 1986). There was no difference in patient preference for all types of thermotherapy. No harmful effects of thermotherapy were reported.

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