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 For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy.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.

A Background for the Management of Osteoarthritic Knee Pain

“…However, its use in chronic conditions is not well studied. It has been determined that local cryotherapy induces a temperature decrease within the joint [58]. The decrease in internal temperature may downregulate mediators of joint inflammation and destruction such as cytokines, cartilage-degrading enzymes and proangiogenic factors.…”

Physical Exercise Combined with Whole-Body Cryotherapy in Evaluating the Level of Lipid Peroxidation Products and Other Oxidant Stress Indicators in Kayakers

“…Such low temperatures are applied uniformly to the entire body surface (whole-body cryotherapy, WBC) or locally and are generated using the vapour of liquid nitrogen or liquid synthetic air [1]. Cryotherapy has been used for many years in sports to treat injuries and prevent overtraining [2, 3], as well as in the treatment of many diseases due to its analgetic, antioedematous, and anti-inflammatory effect [4]. A rapid increase in body temperature after leaving the cryogenic chamber and intensive cutaneous blood flow (tissue overperfusion lasting for several hours) induce the removal of metabolites and inflammation mediators from damaged tissues.…”

Whole-body cryostimulation increases parasympathetic outflow and decreases core body temperature

“…The treatment is based on a relatively short (usually up to 180 s) exposure of the whole body to extremely cold air, in order to achieve considerable cooling of the skin. This is associated with resultant activation of processes that lead to accumulation of heat and counterbalance its loss (Costello et al, 2012a(Costello et al, ,b,c, 2014Banfi et al, 2010;Guillot et al, 2014).…”

“…Moreover, whole-body cryotherapy is very popular as a method of wellness treatment and athletic recovery. Initially introduced in Japan, Germany and Poland, WBC has gained increasing popularity worldwide (Costello et al, 2012bBanfi et al, 2010;Guillot et al, 2014;Lubkowska and Szygula, 2010;Lubkowska and Suska, 2011).…”