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Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis

  • University of Twente Faculty Behavioural Management and Social Sciences

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To study the effects of infrared (IR) Sauna, a form of total-body hyperthermia in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients were treated for a 4-week period with a series of eight IR treatments. Seventeen RA patients and 17 AS patients were studied. IR was well tolerated, and no adverse effects were reported, no exacerbation of disease. Pain and stiffness decreased clinically, and improvements were statistically significant (p < 0.05 and p < 0.001 in RA and AS patients, respectively) during an IR session. Fatigue also decreased. Both RA and AS patients felt comfortable on average during and especially after treatment. In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.
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Infrared sauna in patients with rheumatoid arthritis
and ankylosing spondylitis
A pilot study showing good tolerance, short-term improvement of pain and stiffness,
and a trend towards long-term beneficial effects
Fredrikus G. J. Oosterveld & Johannes J. Rasker &
Mark Floors & Robert Landkroon & Bob van Rennes &
Jan Zwijnenberg & Mart A. F. J. van de Laar &
Gerard J. Koel
Received: 31 March 2008 / Revised: 1 July 2008 /Accepted: 11 July 2008 / Published online: 7 August 2008
The Author(s) 2008
Abstract To study the effects of infrared (IR) Sauna, a
form of total-body hyperthermia in patients with rheuma-
toid arthritis (RA) and ankylosing spondylitis (AS) patients
were treated for a 4-week period with a series of eight IR
treatments. Seventeen RA patients and 17 AS patients were
studied. IR was well tolerated, and no adverse effects were
reported, no exacerbation of disease. Pain and stiffness
decreased clinically, and improvements were statistically
significant (p<0.05 and p<0.001 in RA and AS patients,
respectively) during an IR session. Fatigue also decreased.
Both RA and AS patients felt comfortable on average
during and especially after treatment. In the RA and AS
patients, pain, stiffness, and fatigue also showed clinical
improvements during the 4-week treatment period, but
these did not reach statistical significance. No relevant
changes in disease activity scores were found, indicating no
exacerbation of disease activity. In conclusion, infrared
treatment has statistically significant short-term beneficial
effects and clinically relevant period effects during treat-
ment in RA and AS patients without enhancing disease
activity. IR has good tolerability and no adverse effects.
Keywords Ankylosing spondylitis
Infrared sauna
Physical therapy modalities
Rheumatoid arthritis
Since Hippocratic times, heat treatment has been popular
among people with rheumatic disorders. The evidence for
their application is still weak, despite the fact that several
studies investigating the effects of heat in rheumatic
diseases have been conducted [1, 2]. Superficial heat can
be used in rheumatoid arthritis and low back pain as a
palliative therapy and can be recommended for beneficial
short-term effects, but these recommendations are limited
by methodological considerations such as the poor quality
of trials [3, 4].
Finnish saunas, a well-known form of total-body heating,
showed good clinical effects for rheumatic patients [5, 6].
The so-called whole-body hyperthermia has also been
widely used during the last century, especially in Germany
and Eastern European countries and was known as fever
treatment [7]. Although beneficial effects of total-body
hyperthermia have been reported [8 , 9], controlled studies
have not been performed, and the method is not often used
in Western Europe.
During the past 10 years, a new modality for whole-body
hyperthermia, named infrared (IR) sauna, has become
Clin Rheumatol (2009) 28:2934
DOI 10.1007/s10067-008-0977-y
F. G. J. Oosterveld (*)
M. Floors
R. Landkroon
B. van Rennes
J. Zwijnenberg
G. J. Koel
Expertise Center Health, Social Care and Technology,
Saxion University of Applied Sciences,
P.O. Box 70.000, 7500 KB Enschede, The Netherlands
J. J. Rasker
M. A. F. J. van de Laar
Department of Communication Studies, Faculty of Behavioral
Sciences and Philosophy, University Twente,
Enschede, The Netherlands
M. A. F. J. van de Laar
Department of Rheumatology, Medisch Spectrum Twente,
Enschede, The Netherlands
available in the Europe. It is a compact and user-friendly IR
whole-body hyperthermia. Personal experiences of rheu-
matoid arthritis (RA) and ankylosing spondylitis (AS)
patients in our out-patients clinic appeared to be promising.
They experienced less pain and imp roved physical func-
tioning. Despite the theoretical possibility of negative
effects on disease activity, in our clinical series, no
aggravation of inflammation activity was seen.
The new IR cabin differs from the traditional Scandinavian
saunas. The heating effect of a high ambient temperature is
comparable, but due to the addition of infrared radiation, some
heat penetrates maximally up to 4 mm into the superficial skin
[10]. As this might result in different physiological responses
compared to the Finn ish sauna, we first studied the
physiological effects of infrared whole-body treatment in
healthy subjects before starting clinical trials in rheumatic
patients [11]. Fifteen healthy subjects were exposed to total-
body heat treatment in an infrared cabin at three different
intensities (40°C, 55°C, and 70°C). Mean skin surface
temperature (2.6°C, 6.8, and 9.1°C, respectively), core
temperature (0.4°C, 0.5°C, and 0.6°C, respectively), and
heart rate (+14, +37, and +58 beats per minute, respectively)
increased significantly. Significant loss of bodyweight after
treatment was also found (0.1, 0.3, and 0.4 kg, respectively).
In general, a small decrease of systolic and diastolic blood
pressure was shown.
The purpose of this study was to determine whether
these previously found physiological changes would also
provide beneficial effects in patients w ith rheumatic
disorders. The more explicit research questions, therefore,
1. What is the effect of IR sauna on body functions and
structures, such as pain, stiffness, and fatigue (primary
2. What is the effect of IR on physical activities and
(social) participation (secondary outcomes)?
3. Are there any side effects regarding c omfort and
tolerance during treatment and disease activity (tertiary
Patients and methods
Inclusion criteria People with RA according to the revised
American Rheumatism Association [12 ]orwithAS
according to the New York [13] criteria between 18 and
70 years of age and only patients with chronic disease that
had been stable for at least 3 months without change in
medication were included.
Exclusion criteria Patients with a change of treatment
during 3 months prior to the start of the study; patients
with signs of acute inflammatory activity (morning stiffness
lasting longer than 1 h or more than three joints actively
inflamed) as judged by the consulting rheumatologist (heat
treatment may aggravate clinical signs and inflammatory
activity in an acute phase of the di sease); patients
permanently wheelchair-bound or bedridden; patients with
the following comorbidities: heart disease, skin disease,
malignancy, asthmatic bronchitis, or psychiatric disorders
are excluded.
Patients were recruited consecutively from the rheuma-
tology out-patients clinic (JJR) in a general district hospital
in Enschede, The Netherlands.
After oral and written information about the study and
the possible clinical effects of IR whole-body hyperthermia,
patients were invited to participate. Informed consent was
obtained from all patients, according to the Declaration of
Treatment The patients were treated in the Health Company
Infrared Cabin (kindly made available by The Health
Company, P.O. Box 321, 2400 AH Alphen a/d Rijn, the
Netherlands), which was 130×90×190 cm in size. The
temperature in the cabin can be adjusted from normal
ambient room temperature up to 90°C. The patients were
seated in the infrared cabin, which has six heating sources;
three at the back, two in front besides the entrance, and one
under the bench behind the lower legs of the patients. The
infrared used has a long wavelength between 5,000 and
1,000,000 nm.
The patients were treated for a perio d of 4 weeks, twice
weekly, with eight IR sessions in the IR cabin (30 min at an
ambient temperature of 55°C). According to the manufac-
turers recommendation, before treatment, a preheating time
of the IR whole-body hyperthermia equipment of 15 min was
used. During the whole study period , the dosages of
nonsteroidal anti-inflammatory drugs and disease-modifying
antirheumatic drugs were not changed; treatments with
physiotherapy, when applied, were not changed, and no
corticosteroid injectio n was given
Measurements Clinical measurements were performed
4 weeks before the start, at the start, and at the end of the
4-week period of IR treatments and 4 weeks after the end of
the treatment series; all four assessments were at the same
time of the day and executed by a trained physiotherapist
unaware of the study protocol. The pretreatment period
without IR sauna was meant as a control and the 4 weeks
after treat ment as follow-up.
The patients perceptions of pain [14], stiffness [15], and
fatigue [
1618] were measured on a 100-mm visual analog
scale and were considered as primary outcomes.
Secondary outcomes for the RA patients were: Escola
Paulista de Medicina Range of Motion (EPM-ROM scale)
30 Clin Rheumatol (2009) 28:2934
[19] and activities and participation scales of the Dutch
Arthritis Impact Measurement Scales (DUTCH-AIMS)
[20]. For AS patients, Bath Ankylosing Spondylitis Global
Score [21], the Bath Ankylosing Spondylitis Metrology
Index (BASMI, a ROM-index) [22], and the Bath Anky-
losing Spondylitis Functional Index [23] were used. To
evaluate possible effects on the disease activity (improve-
ment or exacerbation) for RA patients, the Disease Activity
Score using 28 joints (DAS 28) [24] was calculated, and for
AS pat ients, the Bath Ankylosing Spondylitis Disease
Activity Index (BASDAI) [25] and the erythrocyte sedi-
mentation rate (ESR) after 1 h were assessed. The DAS 28,
BASDAI, and ESR were considered as tertiary outcomes.
These measurements are fairly routine in clinical research
and have been proven to be valid, reliable, and of good
sensitivity to change [1425].
Short-term effects Directly before and after the first IR
treatment, the primary outcomes were registered to measure
the immediate effect of IR on pain, stiffness, and fatigue.
Besides that, during and after the first treatment, well-being
(as tertiary outcome) was recorded on a five-point Likert scale
(very uncomfortable, uncomfortable, neutral, comfortable,
and very comfortable). Well-being was measured at 15 and
30 min after the start of the treatment (patient still in the cabin)
and 30 min after the end of treatment (patient out of cabin).
Statistics The continuous data were checked for normality .
This was done with the descriptive statistics explore command
in Social Package for Social Sciences (SPSS) 14.0 [26]by
making histograms, scatter graphs, normality plots, normal
curves, and carrying out normality tests (Kolmogorov
Smirnov and ShapiroWilk). Continuous data were statisti-
cally analyzed by means of repeated measure analysis with
Bonferroni correction within SPSS 14.0. Results are
expressed as mean and SEM (Standard Error of Mean).
For nonparametric data (well-being on an ordinal Likert
scale), Wilcoxon signed-rank test for related samples was
applied. Level of significance (α) was chosen at 0.05.
Ethics The ethical committee of the Hospital Medisch
Spectrum Twente, Enschede, The Netherlands approved
the study design.
Patient characteristics Of 37 patients approached, one
declined (could not participate due to nonmedical reasons)
and 36 were enrolled into the study. A total of 18 patients
with rheumatoid arthritis and 18 patients with ankylosing
spondylitis entered the study with mean age of 47 and
44 years, respectively (Table 1).
One RA and one AS pa tient dropped ou t in the
pretreatment period due to exacerbation of RA and acute
lumbar nerve root compression, respectively, and could not be
measured for follow-up. Therefore, the mean group results of
17 RA and 17 AS patients are presented. Functional capacity
of RA patients according to Steinbröcker classification [27]is
shown in Table 2.
Immediate effects of IR whole-body hyperthermia Pain and
stiffness significantly decreased clinically (p<0.05 and p<
0.001 in RA and AS patients, respectively) during an IR
session (Table 3). Fatigue also improved, but this did not
reach statistical significance.
Delayed effects during and 4 weeks after treatment on
primary outcomes In RA patients, pain, stiffness, and
fatigue showed slight improvements during the 4-week
treatment period; stiffness a lmost reached statistical signif-
icance: p=0.06 (Table 4). In the AS patients, stiffness
improved after the treatment, but this did not reach
statistical significance (
p=0.30); otherwise, small or no
effect were seen during the treatment and post-treatment
periods (Table 4).
Table 1 Patient characteristics
RA patients AS patients
Gender 3 male, 15 female 13 male, 5 female
Age 47 SD 13 (2670) 44 SD 10 (2357)
Disease duration 13 SD 10 (329) 21 SD 10 (440)
Mean in years, SD (minimummaximum)
RA Rheumatoid arthritis, AS ankylosing spondylitis
Table 2 Steinbröcker classification of rheumatoid arthritis patients
Stage Number of patients
II 8
IV 1
Table 3 Immediate effects of IR sauna treatment
Pain Stiffness Fatigue
Before After Before After Before After
RA 25 (5) 15 (5)* 25 (5) 12 (3)* 35 (7) 30 (7)
AS 26 (4) 11 (3)** 40 (6) 16 (4)** 37 (6) 28 (6)
VAS, 0100 mm; mean (SEM)
IR infrared, RA rheumatoid arthritis, AS ankylosing spondylitis
*p<0.05, **p<0.001
Clin Rheumatol (2009) 28:2934 31
Delayed effects during and 4 weeks after treatment on
secondary outcomes Over the 12-week study period, no
statistically significant change was found on secondary
clinical and f unctional variables, such as ROM and
DUTCH-AIMS for RA patients (Table 5)andBath
Ankylosing Spondylitis scores for AS patients (Table 5).
However, there is a clear clinical improvement of RA
patients on the physical, affective, and symptom scales of
the DUTCH-AIMS. The effect persisted during the post-
treatment phase on the physical and affective scales.
Well-being during and after treatment (tertiary outcomes)
The RA patients felt comfortable during and after the
treatment session. Especially after treatment, 59% felt
comfortable and many felt even very comfortable (29.4%;
Table 6). There was no statistically significant difference in
well-being as measured at the three instances. The AS
patients felt less comfortable during the treatment but after
half an hour, almost all of them felt (very) comfortable
(Table 6). The perceived well-being 30 min after treatment
in AS patients showed better statistically significance
compared to the other two measurement points (p<0.01).
Influence on disease activity No relevant change in disease
activity measurem ents as reflected by DAS 28 in RA
patients and BASDAI and ESR in AS patients was found,
indicating no unwanted exacerbation of disease during or
after IR treatment, and no other side effect was reported (for
example fainting and headache; Table 5).
In all patients, a clinically relevant improvement was seen
during the IR sauna treatment with pain and stiffness
decreasing 5 to 24 points on the VAS. Pain reduced
approximately 40% and 60% and stiffness approximately
50% and 60% for patients with RA and AS, respectively
(Table 3). All patients felt well during and after IR
treatment, and 30 min after the end of treatment, 88.2%
of patients felt comfortable or very comfortable
(Table 6).
In RA patients, a clinically relevant improvement is seen
during the 4 -week treatment period compared to the
Table 4 Outcome primary effect variables 4 weeks before IR sauna,
at start and end of the 4-week treatment period and 4 weeks after
Pretreatment Start
End of
RA patients
Pain 30 (5) 29 (6) 24 (5) 27 (4)
Stiffness 28 (6) 27 (5) 17 (5)* 23 (5)
Fatigue 37 (6) 36 (6) 33 (6) 39 (7)
AS patients
Pain 26 (6) 26 (4) 30 (5) 27 (6)
Stiffness 40 (7) 38 (6) 32 (7) 31 (7)
Fatigue 34 (7) 37 (7) 35 (7) 30 (7)
VAS, 0100 mm; mean (SEM)
IR Infrared, RA rheumatoid arthritis, AS ankylosing spondylitis
Table 5 Outcome secondary and tertiary effect variables 4 weeks before IR sauna, at start, and end of the 4-week treatment period and 4 weeks
after treatment
Pretreatment Start treatment End of treatment Post-treatment
RA patients
EPM-ROM 6.2 (0.6) 5.6 (0.6) 5.8 (0.7) 5.6 (0.6)
AIMS physical 2.3 (0.4) 2.6 (0.6) 1.6 (0.4) 1.7 (0.4)
AIMS affective 2.9 (0.3) 3.1 (0.5) 2.2 (0.3) 2.3 (0.4)
AIMS symptoms 4.0 (0.5) 4.0 (0.5) 3.3 (0.5) 3.9 (0.5)
AIMS social 4.3 (0.4) 3.8 (0.4) 3.7 (0.4) 4.2 (0.5)
DAS 28 3.96 (0.30) 3.74 (0.34) 3.58 (0.31) 3.63 (0.32)
AS patients
BASGS (last week) 3.4 (0.7) 3.1 (0.7) 2.9 (0.7) 3.2 (0.8)
BASGS (26 weeks) 3.9 (0.7) 3.5 (0.7) 3.7 (0.8) 4.1 (0.8)
BASMI 2.0 (0.5) 2.4 (0.5) 2.2 (0.5) 2.3 (0.5)
BASFI 3.3 (0.6) 3.2 (0.6) 3.2 (0.6) 3.1 (0.6)
BASDAI 3.4 (0.5) 3.4 (0.6) 3.4 (0.6) 3.2 (0.6)
ESR 17 (3) 16 (4) 14 (2) 15 (3)
Mean (Standard error of the mean); low scores are better scores
IR Infrared, RA rheumatoid arthritis, AS ankylosing spondylitis, EPM-ROM Escola Paulista de Medicina Range of Motion score, AIMS Arthritis
Impact Measurement Scales, DAS 28 Disease Activity Score, BASG Bath Ankylosing Spondylitis Global Score, BASMI Bath Ankylosing
Spondylitis Metrology Index, BASFI Bath Ankylosing Spondylitis Functional Index, BASDAI Bath Ankylosing Spondylitis Disease Activity
Index, ESR erythrocyte sedimentation rate
32 Clin Rheumatol (2009) 28:2934
pretreatment period, regarding pain and stiffness dim inish-
ing 510 points on the VAS, while during the previous
nontreatment period , t here was n o noticeable change
(Table 4). During the post-treatment period, these effects
were lost. These effects are less obvious in AS patients
(Table 4).
In RA patients, the physical, affective, and symptoms
scales of the DUTCH-AIMS showed a trend of improve-
ment during treatment, persisting during the post-treatment
phase on the physical and affective scale (Table 5). It is not
surprising that no relevant change was seen on the social
scale because it cannot be expected that this period would
have any influence on the relationship of a patient with
family, friends, and relatives as measured on the social
In the AS patients group, there are no changes on BAS
global scores and functional index over time (Table 5).
Apparently, IR whole-body hyperthermia does not have
major effects on these domains.
No relevant change on EPM-ROM and BASMI in RA
and AS patients, respectively, were found, so IR treatment
does not seem to have any direct effect on the overall range
of motion (Table 5). Probably, the impaired ROM in non-
acutely inflamed joints, as was the case in our series, is
mainly due to irreversible change in these joints, such as
erosions and cartilage damage in RA patients and calcifi-
cation of joint ligaments or bony outgrowth in AS patients.
Therefore, no majo r imp rovement could have been
expected without adequate additional exercises.
The effect of IR whole-body hyperthermia upon local
joint inflammation or disease activity is not clear. The
findings of earlier studies were controversial [9, 2833],
and many studies have poor or no optimal quality as
summarized in the COCHRANE study [3]. For that reason,
we have monitored disease activity as reflected by DAS 28
in RA patients and BASDAI and ESR in AS patients. No
relevant change in these disease activity measurements was
found, indicating no unwanted side effects of IR treatment
(Table 5). This does not exclude that some individual cases
may experience increased complaints during or after
From this study, it appears that IR whole-body hyper-
thermia has direct beneficial effects. Although in the long-
term, there is a tenden cy toward improvement of clinical
symptoms of RA and AS patients, there is no sufficient
evidence that the short-term effect will last for several days
or weeks. Therefore, further controlled clinical studies with
a larger study population are necessary.
Because this was the first study of IR sauna, we had no
idea about the mean group effect in RA or AS patients.
Comparing the changes on prim ary outcome var iables
during treatment with those during the previous nontreat-
ment perio d, we found an improvement of approximately
10% to 15%. So, from power calculations with 80% power
and α of 0.05 for following controlled clinical studies, at
least 25 patients per group are required. Furthermore, it is
recommended to conduct comparable studies in patients
with other types of musculoskeletal disorders such as
osteoarthritis, osteoporosis, and fibromyalgia.
The results of this study show that the use of IR sauna as
treatment is feasible and well tolerated in patients with
inflammatory arthritis.
We would recommend that patients should first experi-
ence a couple of trial sessions to see whether they achieve
any clinical benefit prior to commencing a course of IR.
Based on that experience, continuation of treatment and the
appropriate dose and application can be discussed with the
physician or physiotherapist. Despite the evidence from this
Table 6 Well-being during and after IR sauna
After 15 min After 30 min 30 min after treatment
Percentage Number
Percentage Number
RA patients
1 0 0 2 11.8 0 0
2 2 11.8 2 11.8 0 0
3 3 17.6 2 11.8 2 11.8
4 10 58.8 9 52.9 10 58.8
5 2 11.8 2 11.8 5 29.4
AS patients
1 0 0 3 17.6 0 0
2 4 23.5 3 17.6 1 5.9
3 2 11.8 3 17.6 1 5.9
4 9 52.9 2 11.8 9 52.9
5 2 11.8 6 35.3 6 35.3
IR Infrared, RA rheumatoid arthritis, AS ankylosing spondylitis
Number of patients; 1 = very uncomfortable, 2 = uncomfortable, 3 = neutral, 4 = comfortable, 5 = very comfortable
Clin Rheumatol (2009) 28:2934 33
study for positive short-term results and a trend towards
beneficial clinica l l ong- ter m effects, fur ther controlle d
clinical studies are warranted.
Disclosure The study was supported by a non-restricted grant from
the Health Company, Alphen aan de Rijn, The Netherlands, and the
measuring equipment was kindly provided by the Department of
Physiotherapy of Hospital Medisch Spectrum Twente.
Conflict of interest statement None.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
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... depression, cardiovascular disease, viral reactivation syndromes involving HIV and herpes viral infections, rheumatoid arthritis, and prolonged wound healing, etc.). [50][51][52] Of these disease states, only cardiovascular disease 11,16 and, to a much lesser extent, depression 44 and rheumatoid arthritis 53 have been the focus of sauna interventional studies. As a result, the clinical prescribing of sauna use for stress reduction may present as a fruitful area for future research. ...
... These include: 'improved circulation' interpreted as improvement in cardiovascular status 11,16 as previously discussed, and 'relieve aches and pains' which has been demonstrated in some sauna interventional studies involving populations with chronic pain states. 17,42,53 While some motivations such as 'enjoyment/invigoration', 'social -to meet and talk with friends' and 'routine bathing regime' do not necessarily require medical validation, they could benefit from further social-scientific verification and exploration. Other identified motivations including 'detoxification' 43,54,55 and 'cleanse skin/enhance beauty' require further controlled sauna studies and currently lack acceptable physiological models to support the use of sauna as a therapeutic intervention. ...
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Advances in Integrative Medicine Volume 6, Supplement 1, May 2019, Page S135 Abstract for Poster Presentation at the 14th International Congress on Complementary Medicine Research in Brisbane, Australia – “Heating Up for Health -Exploring the Results of a Global Sauna Survey” Background Many people worldwide sauna-bathe regularly. This study reports findings from the first ever online global sauna survey polling men and women on their demographics, motivations and health-related experiences. Methods A 71-item purposed questionnaire was designed and posted on a dedicated website. A link to the e-survey was then distributed via sauna-related social media from October 2016 to October 2017. Results There were 482 valid responses with 78.4% (378 of 482) fully completing the questionnaire. Participants sauna-bathed an average of 8 – 9 times per month. Almost a third of respondents had medical conditions. The top reasons motivating participants to sauna-bathe were rest and relaxation, pain relief and socializing. Sleep benefits after sauna use were indicated by 83.5% (353 of 423) of respondents. After stratifying sauna bather’s frequency into three groups and using the validated ‘SF-12 quality of life scoring tool’, those who reported sauna-bathing 5 -15 times per month had summated mental health well-being scores that were significantly higher (Chi square 6.603 > ꭔ2 of 5.991, p = 0.0368, df = 2) compared to the other two groups who sauna-bathed either more or less frequently. The most commonly reported adverse reactions to sauna bathing were mild symptoms of dizziness, dehydration and headache. Conclusion Sauna-bathing is used by populations worldwide as a lifestyle tool for rest and relaxation. The results of this cross-sectional study suggest frequent sauna-bathing has expanded health benefits that deserve further consideration from health practitioners and researchers as a complementary therapy, especially for mental wellness.
... The concept of stimuli-responsive carriers could be especially beneficial either when the target tissue has pathological trigger to release drug locally in the disease environment (e.g. the acidic environment of cancer tissue or bacterial infections) or when an external trigger can be applied to enhance the efficacy of the drug treatment (e.g. the use of hyperthermia for treatment of arthritis to increase the blood supply and relieving the pain) [107]. ...
Solid lipid nanoparticles (SLNs) have greatly been engaged in the research field, owing to their advantages over other nanocarriers including the ease of large‐scale production, biocompatibility, biodegradability, low toxicity, possibility of controlled and modified drug release, enhancement of drug solubility, and ability to encapsulate both hydrophilic and hydrophobic moieties. This chapter reviews the art of SLNs' production including various components comprising it and the methods of preparation. In addition, different aspects of SLNs' characterization are discussed. The potential of surface modification of SLNs using different polymers and surfactants that have been adapted to selectively carry the cargo to its targeted site, to improve drug efficacy, and to reduce its side effects is also covered. The various approaches and benefits of formulating stimuli‐sensitive SLNs are highlighted. Finally, a special attention is paid to utilizing chemoinformatics tools in modeling drugs–SLNs interactions.
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Orthotopic allograft transplantation (OAT) is a major strategy for solid heart and kidney failure. However, the recipient’s immunity-induced chronic rejection induces OAT vasculopathy that results in donor organ failure. With the exception of immunosuppressive agents, there are currently no specific means to inhibit the occurrence of OAT vasculopathy. On the other hand, far-infrared (FIR) therapy uses low-power electromagnetic waves given by FIR, with a wavelength of 3–25 μm, to improve human physiological functions. Previous studies have shown that FIR therapy can effectively inhibit inflammation. It has also been widely used in adjuvant therapy for various clinical diseases, especially cardiovascular diseases, in recent years. Thus, we used this study to explore the feasibility of FIR in preventing OAT vasculopathy. In this study, the model of transplantation of an aorta graft from PVG/Seac rat to ACI/NKyo rat, and in vitro model of human endothelial progenitor cells (EPCs) was used. In this report, we presented that FIR therapy decreased the serious of vasculopathy in OAT-recipient ACI/NKyo rats via inhibiting proliferation of smooth muscle cells, accumulation of collagen, and infiltration of fibroblast in the vessel wall; humoral and cell-mediated immune responses were decreased in the spleen. The production of inflammatory proteins/cytokines also decreased in the plasma. Additionally, FIR therapy presented higher mobilization and circulating EPC levels associated with vessel repair in OAT-recipient ACI/NKyo rats. In vitro studies demonstrated that the underlying mechanisms of FIR therapy inhibiting OAT vasculopathy may be associated with the inhibition of the Smad2-Slug axis endothelial mesenchymal transition (EndoMT). Thus, FIR therapy may be the strategy to prevent chronic rejection-induced vasculopathy.
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The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.
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The aim of the study was to investigate the effect of a Finnish sauna on the immune status markers. Healthy males (20–25 years old) were divided into gropes: the trained (T; n = 10), and the untrained group (N; n = 10). All participants were subjected to 10 baths (3X15-minute with cooled down for 2 minutes). Blood was collected before the 1st and 10th sauna bath, and 10 minutes after their completion. The levels of: cortisol, Il-6, HSP70, IgA, IgG, IgM and blood cells (WBC), leukocyte populations counts: neutrophils, lymphocytes, eosinophils, monocytes, and basophils were determined. No differences were found in the increase in rectal temperature, cortisol and Ig between groups. In response to the 1st sauna bath, a greater increase in HR was observed in the U group. After the last one, the HR value was lower in the T group. The impact on WBC, CD56+, CD3+, CD8+, IgA, IgG and IgM shows a differences in trained and untrained body responses. It seems that in trained people, the non-specific immune response increases, while in untrained, the specific one. Series of sauna baths can be a way of acclimation to high ambient temperatures for athletes and a solution to improve immune response.
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During a long shutdown of the motors, the insulation quality of the windings of asynchronous motors deteriorates due to moisture. This requires additional costs for drying the insulation of electrical machines. The signs and possible causes of malfunctions of electrical machines, as well as methods of drying insulation, are studied: Drying by external heating, Drying by heating from an external source, Convective drying, Drying by induction loss, drying using light emitters. Drying using infrared radiation is the mildest method and helps to maintain the quality of the insulation. The movement of moisture in the layers of insulating windings occurs according to the laws of heat-mass exchange, that is, heat and moisture are simultaneously transferred. In this case, heat is transferred from more heated layers to less heated layers and at the same time promotes moisture transfer. A physical and electronic model was developed to study the effect of infrared radiation on the drying process of insulation of electrical machines. The main factors influencing the process under consideration are the power of the radiation sources and the supply voltage, that is, the temperature changes in the layers of the insulated windings were studied depending on the change in the power of the emitters and the supply voltage. The created model was investigated according to the main features corresponding to the real process (even the geometrical dimensions coincide). An indispensable condition for physical modeling is the strict geometric similarity of the model and nature, as well as the equality of the corresponding similarity criteria in them.
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Proper and regular sweating plays a significant thermoregulatory role. It is a common perception that, sweating has other important homeostatic functions such as clearance of excessive micronutrients, waste products of metabolic processes, and toxins from the body, which helps to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment strategy as well. In this study, we aim to explain the beneficial effects of sweating in human health and its role in the management of various diseases, as well as introducing the therapeutic applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi, Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic. The results of this study revealed that PM scientists believed proper sweating removes waste products and maintains the body's health, thus, any disturbances in the excretion of these waste products can cause diseases. They recommended the induction of sweating through hot and dry baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various diseases. Therefore, further researches are recommended to evaluate the effectiveness of these diaphoretic plants. [GMJ.2020;9:e2003]
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Background: Far-infrared irradiation (FIR) is used in the medical field to improve wound healing, hemodialysis with peripheral artery occlusive disease, and osteoarthritis but seldom used in ameliorating poor lower extremity circulation. The purpose of this study was to evaluate the effect of FIR on changes in foot skin surface temperature (FSST) and autonomic nerve system (ANS) activity to evaluate its effectiveness in improving lower limb circulation. Methods: A randomized controlled study was conducted. Subjects (n = 44), all over the age of 50 years and satisfying the inclusion criteria, were randomly allocated into 2 groups. The intervention group received FIR on a lower limb for 40 minutes and the control group received no intervention. Left big toe (LBT), right big toe (RBT), left foot dorsal (LFD), right foot dorsal (RFD) surface skin temperature, autonomic nervous activity, and blood pressure were assessed. Results: The main results were skin surface temperature at the LBT increased from 30.8 ± 0.4°C to 34.8 ± 0.4°C, at RBT increased from 29.6 ± 0.4°C to 35.3 ± 0.4°C and LFD increased from 31.9 ± 0.3°C to 36.4 ± 0.4°C, RFD increased from 30.7 ± 0.3°C to 37.7 ± 0.2°C. FIR caused a significant increase of the FSST ranging in a 4°C to 7°C increase after 40 minutes irradiation (P < .001). The ANS low-frequency (LF) and high-frequency (HF) activity showed a statistically significant increase in the FIR group (P < .05) but not the LF/HF ratio. Conclusion: FIR significantly increased the FSST from between 4°C and 7°C after 40 minutes irradiation, which might improve lower extremity circulation and regulation of ANS activity.
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Background: Dry sauna has been very popular as an alternative therapy for promoting health among people who want to improve their health condition without relying on pharmaceuticals. The aim of this study was to investigate whether dry sauna therapy improved quality of life and reduced pain in participants with low back pain. Methods: Study participants comprised a total of 37 consecutive patients who were over 20 years of age with low back pain. Dry sauna therapy was performed twice per day for 5 consecutive days over the course of 1 week, thus comprising a total of 10 sessions each of 15 min of exposure to a 90°C dry sauna. Results: The verbal numerical rating scale (VNRS) and Oswestry disability index (ODI) scores were significantly reduced after dry sauna therapy (P < 0.001 for both). VNRS pain scores had a median (range) of 5 (2-8) before dry sauna therapy and 3 (0-8) after dry sauna therapy. ODI scores had a median (range) of 12 (2-24) before dry sauna therapy and 8 (1-17) after dry sauna therapy. The proportion of participants who reported successful treatment (excellent + good) was 70%. No adverse effects were observed related to dry sauna therapy. Conclusions: Our results suggest that dry sauna therapy may be useful to improve quality of life and reduce pain in patients with low back pain. Therefore, pain physicians can recommend dry sauna therapy as an alternative and complimentary therapy for patients with low back pain.
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Objective: To investigate the physiological effects of infrared sauna total-body heat treatment in healthy young subjects. Methods: Fifteen healthy subjects were exposed to total-body heat treatment in an infrared cabin at three different intensities (for the saunas output gauge). Three different temperatures were chosen: 40°C (condition A), 55°C (condition B) and 70°C (condition C) respectively. Before, during and after treatment the cabin temperature and subject's skin surface, core temperatures, blood pressure and heart rate were recorded. Additionally the subject's well being and loss of bodyweight were measured. Results: Mean skin surface temperature and core temperature increased significantly in conditions A, B and C during treatment with 2.6°C (p≤0,001), 6.8°C (p≤0,001) and 9.1°C (p≤0,001) and with 0.4°C (p≤0,01), 0.5°C (p≤0,001) and 0.6°C (p≤0,001) respectively. Significant loss of bodyweight after treatment was also found in all conditions (-0.1 kg (p≤0,001), -0.3 kg (p≤0,001) and -0.4 kg (p≤0,001)). In general a small decrease of systolic and diastolic blood pressure was shown, significant at 40°C and 55°C. The heart rate increased significantly (+14 (p≤0,001), +37 (p≤0,001) and +58 (p≤0,001) beats per minute respectively in condition A, B and C) with significant differences between conditions. The well being in condition A and B remained stable at "comfortable". In condition C (temp 70°C) a statistically significant decrease in well being was found towards the end of the session, to uncomfortable. Conclusion: Significant physiological effects of total-body infrared treatment were found in healthy subjects, indicating the potency of this treatment to influence the human physical condition. Whether these physiological changes will also provide beneficial effects in patients with rheumatic disorders will need further research.
The reproducibility of pain measurements recorded on visual analogue scales (VAS) by 30 patients with rheumatoid arthritis has been assessed. Patients were presented with two VAS, one vertical and one horizontal, on four occasions over two consecutive days with a 1 h interval between assessments on each day. There was good within-patient agreement between results obtained with vertical and horizontal scales applied at the same time (P < 0.001), but there was a tendency for higher results using vertical scales. There were statistically significant differences between pain assessments made an hour apart. The greatest variation in results was seen near the midpoint of the scale and the least variation near the ends of the scale.
The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
Exposure to sauna heat during sauna bathing raises the skin temperature of the bather near the hot pain perception threshold and enhances sympathetic activity. Self-reports provided by regular bathers of changes in intensity of their ongoing pain might, therefore, add novel information on the effect of intense heat on various pain conditions. We interviewed consecutive patients attending our pain clinic over a period of 1 year about their pain-related responses to sauna bathing and controlled the results by quantitated somatosensory tests. There were 61 patients with chronic neuropathic pain of peripheral origin, 13 patients with central pain and 59 patients with rheumatoid pain. Allodynia and hyperalgesia to heat were relatively infrequent in all groups (10%, 15% and 8%, respectively), Three out of 17 patients with postinjury nerve pain reported similar exacerbation. By contrast, mechanical allodynia was present in 48% of patients with peripheral neuropathic pain and in 54% of patients with central pain. The results speak against an important role for C-afferent or sympathetic postganglionic fibres in most subclasses of neuropathic pain. Animal models of neuropathic pain should be critically viewed against this finding.
This summary of a Cochrane review presents what we know from research about the effect of Balneotherapy for Rheumatoid Arthritis (RA). The review shows that in people with RA: - Radon-carbon dioxin baths compared with carbon dioxin baths may not lead to any difference in pain on the short-term, only possibly at 6 months. - Tap water baths compared to land exercises or relaxation may not lead to any difference in pain. - Mineral baths compared with taking the drug Cyclosporine A may lead to a significant difference in pain at 8 weeks, but may also lead to some side effects . - Sulfur baths or Dead Sea baths compared to no treatment may not lead to any difference in the way people feel overall. Swollen or tender joints, inflammation (acute phase reactants), the doctor's assessment of overall well-being, x-rays of joints and other laboratory tests were not measured in these studies. Not enough data was provide to tell whether mineral baths would improve how people feel overall compared with taking the drug Cyclosporine A. Not enough data was provided to tell whether physical disability would improve with various forms of balneotherapy. What is RA and what is Balneotherapy? In rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for RA at present, so the treatments aim to relieve pain and stiffness and improve your ability to move. Balneotherapy (also called mineral baths or spa-therapy) is an ancient and popular therapy. It involves spending time in an indoor pool filled with mineral water at temperature of between 31 to 36 degrees Celsius (88 to 97 degrees Farenheit). Different types of mineral water can be used in this therapy, for example, radon or carbon dioxin.
The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.
Objective. The development and validation of Modified Disease Activity Scores (DAS) that include different 28-joint counts. Methods. These scores were developed by canonical discriminant analyses and validated for criterion, correlational, and construct validity. The influence of disease duration on the composition of the DAS was also investigated. Results. No influence of disease duration was found. The Modified DAS that included 28-joint counts were able to discriminate between high and low disease activity (as indicated by clinical decisions of rheumatologists). Conclusion. The Modified DAS are as valid as disease activity scores that include more comprehensive joint counts.