Article

Cryotherapy decrease histamine levels in the blood of patients with rheumatoid arthritis

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Abstract

Conventional physiotherapy (electrotherapy, magnetic fields), kinesitherapy, and whole-body cryotherapy (plus kinesitherapy) are used to relieve pain and inflammation or to improve function in rheumatic diseases. The aim of this study was to investigate the effects of different physiotherapies and cryotherapy on biochemical blood parameters of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Twenty patients with RA and 17 patients with OA received whole-body cryotherapy at -140 to -160 degrees C for 2 to 3 min, once daily for 4 weeks. The second group of patients (24 with RA and 28 with OA) received conventional physiotherapy for 4 weeks. We measured the parameters of neutrophil activation (respiratory burst, calprotectin) and markers of cartilage metabolism [N-acetyl-beta-D-hexosaminidase (NAHase), ectonucleotide pyrophosphohydrolase (NTPPHase)] twice: before and 3 months after cryotherapy or physiotherapy. We showed, for the first time, that cryotherapy significantly reduced (P < 0.001) histamine levels in the blood of patients with RA. The effect was long-lasting (for at least 3 months). The levels of blood histamine in patients with OA were not changed significantly. Cryotherapy also downregulated the respiratory burst of PMNs and NAHase activity and upregulated calprotectin levels and the activity of NTPPHase. However, these changes were not statistically significant. In contrast, there were no significant changes in histamine levels or the other biochemical parameters measured in groups of patients treated only with physiotherapy and kinesitherapy. It may be concluded that the beneficial clinical effects of cryotherapy in RA patients are in part due to the action on the production, release, or degradation of histamine.

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... Although the advertised effects in healthy individuals for regenerative purposes might hold promise, the clinical evidence regarding real effects in RA patients is scarce. Thus far, WBC has been compared to different application forms of local cryotherapy (8,11), it has been evaluated at different freezing temperatures (8,11), and it has been compared to different physical therapy (PT) and rehabilitation programmes and modalities in RA patients (9,12,13). However, no randomised controlled trial to date has evaluated the effects of WBC compared with placebo or no treatment in RA patients. ...
... The results showing beneficial effects of WBC in this study are consistent with previous work (8,9,(11)(12)(13), albeit study design and hypothesis are not comparable. To the best of our knowledge, WBC was clinically evaluated in 5 studies thus far (8,9,(11)(12)(13). ...
... The results showing beneficial effects of WBC in this study are consistent with previous work (8,9,(11)(12)(13), albeit study design and hypothesis are not comparable. To the best of our knowledge, WBC was clinically evaluated in 5 studies thus far (8,9,(11)(12)(13). Hirvonen et al. compared WBC at -110°C to WBC at -60ºC and to application of local cold air at -30ºC in RA patients and found that the decrease in pain was Whole-body cryotheraphy in RA / P. Klemm et al. ...
Article
Objectives: To evaluate effects of whole-body cryotherapy (WBC) in rheumatoid arthritis (RA). Methods: Patients with active RA undergoing a 16-day multimodal rheumatologic complex treatment were randomly assigned to either WBC (6 applications in 14 days at -130°C for 3 min) or no treatment. The primary outcome was the difference between groups in pain on a numerical rating scale after intervention. Secondary outcomes assessed effects on i) disease activity, ii) functional capacity, iii) cytokine levels, and iv) use of analgesics. Results: A total of 56 RA patients completed the trial (intervention group [IG]: 31 patients, control group [CG]: 25 patients). The mean change (± standard error) in pain after intervention was -2 in the IG (95% confidence interval [CI] -2.75 to -1.31, p<0.001) and -0.88 (95% CI -1.43 to -0.33, p=0.003) in the CG, with a baseline-adjusted between-group difference of -1.31 ± 0.4 (95% CI -2.1 to -0.53; p=0.002). Pain at the 12-week follow-up visit remained significantly below baseline values in the IG. Disease activity and functional capacity showed statistically and clinically meaningful improvement after intervention but were not significant at the 12-week follow up. TNF and IL-6 levels changed significantly in the IG. Eighteen of 31 (58%) patients of the IG reduced or discontinued analgesics at the 12-week follow-up. No WBC-related side effects were reported. Conclusions: WBC in RA reduces pain and disease activity significantly and in a clinically meaningful manner, resulting in a reduction of analgesics. These effects are potentially based on a change in cytokine levels.
... » Postoperative cryotherapy using bagged ice, ice packs, or continuous cryotherapy devices reduced visual analog scale pain scores and analgesic consumption in approximately half of research studies in which these outcomes were compared with no cryotherapy (11 [44%] of 25 studies on pain and 11 [48%] of 23 studies on opioids). However, an effect was less frequently reported for increasing range of motion (3 [19%] of 16) or decreasing swelling (2 [22%] of 9). » Continuous cryotherapy devices demonstrated the best outcome in orthopaedic patients after knee arthroscopy procedures, compared with all other procedures and body locations, in terms of showing a significant reduction in pain, swelling, and analgesic consumption and increase in range of motion, compared with bagged ice or ice packs. ...
... Inflammatory markers are primarily secreted by macrophages, and studies have shown that cryotherapy also successfully reduces macrophage infiltration and activation 5,14 . Histamine, another key inflammatory mediator, was also decreased in patients with rheumatoid arthritis after the administration of wholebody cryotherapy 16 . Furthermore, a reduction in the concentration of the inflammatory mediator prostaglandin E 2 (PGE 2 ) was found in a rat tendon model and confirmed in a recent clinical study that evaluated patients after knee arthroscopy 17 . ...
... Also, if we can reduce postoperative stiffness and physical therapy visits after surgery with cryotherapy, then that could justify the cost as well. In this review of the literature, only 3 (19%) of 16 studies demonstrated improved range of motion after surgery with cryotherapy, whereas the majority of the studies (13 [81%] of 16) showed no difference. Considering the theoretical cost-effectiveness of cryotherapy protocols compared with other strategies, providers may have a valuebased incentive to utilize continuous cryotherapy more often for postoperative management, given the reduction in both pain scores (11 [44%] of the 25 studies reviewed) and pain medication consumption (11 [48%] of the 23 studies reviewed). ...
Article
»: Cold therapy, also known as cryotherapy, includes the use of bagged ice, ice packs, compressive cryotherapy devices, or whole-body cryotherapy chambers. Cryotherapy is commonly used in postoperative care for both arthroscopic and open orthopaedic procedures. »: Cryotherapy is associated with an analgesic effect caused by microvasculature alterations that decrease the production of inflammatory mediators, decrease local edema, disrupt the overall inflammatory response, and reduce nerve conduction velocity. »: Postoperative cryotherapy using bagged ice, ice packs, or continuous cryotherapy devices reduced visual analog scale pain scores and analgesic consumption in approximately half of research studies in which these outcomes were compared with no cryotherapy (11 [44%] of 25 studies on pain and 11 [48%] of 23 studies on opioids). However, an effect was less frequently reported for increasing range of motion (3 [19%] of 16) or decreasing swelling (2 [22%] of 9). »: Continuous cryotherapy devices demonstrated the best outcome in orthopaedic patients after knee arthroscopy procedures, compared with all other procedures and body locations, in terms of showing a significant reduction in pain, swelling, and analgesic consumption and increase in range of motion, compared with bagged ice or ice packs. »: There is no consensus as to whether the use of continuous cryotherapy devices leads to superior outcomes when compared with treatment with bagged ice or ice packs. However, complications from cryotherapy, including skin irritation, frostbite, perniosis, and peripheral nerve injuries, can be avoided through patient education and reducing the duration of application. »: Future Level-I or II studies are needed to compare both the clinical and cost benefits of continuous cryotherapy devices to bagged ice or ice pack treatment before continuous cryotherapy devices can be recommended as a standard of care in orthopaedic surgery following injury or surgery.
... Histamine, in turn, acts on nerve endings throughout a positive feedback to further induce the release of the neuropeptides. Hence, cold limits the painful sensation through this additional way [40]. ...
... In RA WBC at −110 °C had effects greater than WBC at −60 °C or local cold on the disease activity score (DAS), visual analogue scale (VAS) for pain [46] and swollen joint count, regardless of steroid treatment [28]. Although WBC was unable to elicit a measurable humoral response (e.g., inflammatory markers), but on histamine [40], it clearly improved several qualitative functional parameters more than the traditional physical therapies [22,52]. Similarly, based on our and other groups' studies, compared to analgesia/kinesiotherapy alone, the association with WBC had strong positive effects on pain, fatigue and indexes of physical and mental health (SF36) in a wide cohort of fibromyalgic patients [4] and on disease activity indexes, pain and spine mobility in ankylosing spondylitis patients [47]. ...
Chapter
Cold treatment is a popular therapy used by anyone in order to relieve or prevent pain and swelling after trauma, inflammatory conditions or any other condition from which pain originates. Nowadays, cold therapy treatments, referable as both whole-body and partial-body cryotherapy, are available and they are based on exposure to extremely cold air (either atmospheric air or liquid nitrogen vapours), with temperature ranging between −110 and −160 °C, in special chambers.
... La cryothérapie corps entier faisait également baisser les taux sériques d'IL-1β et de TNF-α chez 10 patients atteints de rhumatismes inflammatoires chroniques [43]. Dans une étude contrôlée, la cryothérapie corps entier (-140°C une fois par jour pendant 4 semaines) faisait significativement diminuer les taux sanguins d'histamine chez 20 patients PR [44]. La cryothérapie corps entier (-120°C appliquée 10 fois) faisait également diminuer le taux de CRP chez 13 patients PR dans une autre étude contrôlée [45]. ...
Thesis
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La cryothérapie est utilisée de manière large et empirique à visée adjuvante dans les rhumatismes inflammatoires, avec un niveau de preuve faible. Dans une revue systématique de la littérature, en poolant les données de 6 études non contrôlées, nous avons pu démontrer que la cryothérapie (locale ou corps entier) appliquée deux fois par jour pendant 7 à 15 jours réduisait significativement l'EVA douleur et le score d'activité DAS25 dans la polyarthrite rhumatoïde. La cryothérapie locale (glace ou gaz froide) montrait par ailleurs des effets taille intra-classes supérieurs à ceux obtenus en utilisant la cryothérapie corps entier. L'objectif de ce travail était de mesurer les effets de la cryothérapie locale sur al douleur, l'inflammation synoviale et systémique chez les patients arthritiques et dans le modèle murin d'arthrite à l'adjuvant. Dans les études randomisées CDRI et ALGGAR, nous avons évalué les effets de deux applications locales de froid (glace versus gaz froid) sur la douleur, l'activité Doppler et les taux protéiques de cytokines intra-articulaires controlatéraux non souffrant d'arthrites de genou non septiques. Les genoux arthritiques controlatéraux non traités étaient utilisés comme contrôles. Nous avons par ailleurs étudié in vitro les effets de l'hypothermie modérée (30°C pendant 2heures) sur l'expression protéique des cytokines dans un modèle de culture de rotules de rats arthritiques. Nous avons enfin étudié in vitro dans l'arthrite à l'adjuvant les effets de l'application sub-chronique de glace ou de gaz froid (2 fois par jour pendant 14 jours versus contrôles arthritiques non traités) sur le score d'arthrite, le diamètre de cheville, la transcription des gènes codant pour les cytokines pro-inflammatoires dans les pattes arrières (Q-RT-PCR) et l'expression protéique des cytokines dans le plasma (Multiplex et ELISA) après 14 jours de traitement. Dans l'étude CDRI, la cryothérapie locale (glace et gaz froid) réduisait significativement l'EVA douleur ainsi que le score Doppler dans les genoux traités, ces effets persistant le lendemain des deux applications. Dans une analyse intermédiaire des résultats de l'étude ALGGAR, en combinant les deux groupes de traitement (glace et gaz de froid), nous avons observé une baisse des taux d'IL-6, d'IL-1β et de VEGF dans le liquide articulaire arès deux applications. dans les cultures d'explants de rotules de rats arthritiques, l'hypothermie ponctuelle réduisait significativement les taux d'IL-6, IL-17A et IL-1β dans les pattes arrières après 14 jours de traitement. Les deux modalités réduisaient significativement les niveaux plasmatiques d'IL-17A et la glace réduisait en outre les taux d'IL-6 et de VEGF. Nous n'avons observé aucun effet de la cryothérapie locale sur le voie du TNF-α chez l'homme ni chez l'animal. Nos résultats démontrent pour la première fois un effet thérapeutique et anti-inflammatoire de la cryothérapie locale dans l'arthrite. Les effets biologiques était IL-6/IL-147 dépendants et TNF-α indépendants. Des études complémentaires permettront de mieux caractériser les mécanismes moléculaires sous-jacents et de déterminer su la cryothérapie locale pourrait être une alternative aux AINS et corticoïdes dans les rhumatismes inflammatoires.
... For example, whole blood levels of histamine and tryptase, both derived primarily from mast cell granules, are often used as markers of mast cell activity. (23)(24)(25)(26) Regardless of the context, mast cell degranulation occurs when the intracellular signaling initiated by an external stimulus induces an increase in cytosolic calcium, triggering fusion of preformed dense body granules with the cell membrane. Table 1 lists several of the immunoactive mediators released from mast cell granules via exocytosis. ...
Article
Sickle cell disease, caused by a mutation of hemoglobin, is characterized by a complex pathophysiology including an important inflammatory component. Mast cells are tissue-resident leukocytes known to influence a range of immune functions in a variety of different ways, largely through the secretion of biologically active mediators from preformed granules. However, it is not understood how mast cells influence the inflammatory environment in sickle cell disease. A notable consequence of sickle cell disease is severe pain. Therefore, morphine is often used to treat this disease. Because mast cells express opioid receptors, it is pertinent to understand how chronic morphine exposure influences mast cell function and inflammation in sickle cell disease. Herein, carbon-fiber microelectrode amperometry (CFMA) was used to monitor the secretion of immunoactive mediators from single mast cells. CFMA enabled the detection and quantification of discrete exocytotic events from single mast cells. Mast cells from two transgenic mouse models expressing human sickle hemoglobin (hBERK1 and BERK) and a control mouse expressing normal human hemoglobin (HbA-BERK) were monitored using CFMA to explore the impact of sickle-cell-induced inflammation and chronic morphine exposure on mast cell function. This work, utilizing the unique mechanistic perspective provided by CFMA, describes how mast cell function is significantly altered in hBERK1 and BERK mice, including decreased serotonin released compared to HbA-BERK controls. Furthermore, morphine was shown to significantly increase the serotonin released from HbA-BERK mast cells and demonstrated the capacity to reverse the observed sickle-cell-induced changes in mast cell function.
... Moreover, a growing body of literature [10,16] examined the use of cryotherapy to relieve rheumatic and inflammatory diseases such as rheumatoid arthritis. Cryotherapy has been used as a rehabilitation treatment in patients suffering from inflammatory arthritis due its analgesic effect [12,18] and its efficient effects in reducing inflammatory mediator's activity such as pro-inflammatory cytokines [6], histamine levels [35] and oxidative stress [2]. ...
Article
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Rehabilitation using cryotherapy has widely been used in inflammatory diseases to relieve pain and decrease the disease activity. The aim of this study was to explore the metabolite changes in inflammatory knee-joint synovial fluids following local cryotherapy treatment (ice or cold CO 2). We used proton nuclear magnetic resonance (1 H NMR) spectroscopy to assess the metabolite patterns in synovial fluid (SF) in patients with knee arthritis (n = 46) before (D0) and after (D1, 24 h later) two applications of local cryotherapy. Spectra from aqueous samples and organic extracts were obtained with an 11.75 Tesla spectrometer. The metabolite concentrations within the SF were compared between D1 and D0 using multiple comparisons with the application of a false discovery rate (FDR) adjusted at 10% for each metabolite. A total of 32 metabolites/chemical structures were identified including amino acids, organic acids, fatty acids or sugars. Pyruvate, alanine, citrate, threonine was significantly higher at D1 vs D0 (p < 0.05). Tyrosine concentration significantly decreases after cryotherapy application (p < 0.001). We did not observe any effect of gender and cooling technique on metabolite concentrations between D0 and D1 (p > 0.05). The present study provides new insight into a short-term effect of cold stimulus in synovial fluid from patients with knee arthritis. Our observations suggest that the increased level of metabolites involved in energy metabolism may explain the underlying molecular pathways that mediate the antioxidant and anti-inflammatory capacities of cryotherapy.
... Despite the fact that WBCT has become an accepted physiotherapy method, it remains unclear how the extremely low temperatures work, what is the optimal number of sessions and how long the positive therapeutic effects for the cutaneous microcirculation last. In healthy individuals the analgesic and relaxing effects persist for several months after a series of cryotherapy sessions (Zagrobelny and Zimmer, 1999; Wojtecka-Lukasik et al., 2010). In this study 10 cryogenic sessions were applied during 10 consecutive days as this is the most frequently applied procedure, recommended by the producers of cryogenic chambers, which does not mean it is optimal. ...
Article
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The aim of the present study was to evaluate the basic and evoked blood flow in the skin microcirculation of the hand, one day and ten days after a series of 10 whole body cryostimulation sessions, in healthy individuals. The study group included 32 volunteers – 16 women and 16 men. The volunteers underwent 10 sessions of cryotherapy in a cryogenic chamber. The variables were recorded before the series of 10 whole body cryostimulation sessions (first measurement), one day after the last session (second measurement) and ten days later (third measurement). Rest flow, post-occlusive hyperaemic reaction, reaction to temperature and arterio–venous reflex index were evaluated by laser Doppler flowmetry. The values recorded for rest flow, a post-occlusive hyperaemic reaction, a reaction to temperature and arterio – venous reflex index were significantly higher both in the second and third measurement compared to the initial one. Differences were recorded both in men and women. The values of frequency in the range of 0,01 Hz to 2 Hz (heart frequency dependent) were significantly lower after whole-body cryostimulation in both men and women. In the range of myogenic frequency significantly higher values were recorded in the second and third measurement compared to the first one. Recorded data suggest improved response of the cutaneous microcirculation to applied stimuli in both women and men. Positive effects of cryostimulation persist in the tested group for 10 consecutive days.
... It has also been proven that cryostimulation is a safe method that does not have a negative impact on peripheral vessels and heart function (it does not cause adverse changes in the electrocardiogram). The analgesic effect of cryotherapy in RA patients is, inter alia, associated with the destimulating effect on pain receptors and the regulation of the production, release and degradation of histamine [27]. ...
Article
Full-text available
Reumatoidalne zapalenie stawów (RZS) jest jedną z najczęstszych chorób autoimmunologicznych tkanki łącznej. Pierwsze objawy choroby pojawiają się zwykle między 30 a 50 rokiem życia i obejmują przewlekły proces zapalny, który powoduje postępujące niszczenie układu kostno-stawowego i zmiany narządowe. Etiologia RZS nie jest dotychczas dostatecznie poznana, a zarówno czynniki genetyczne, jak i środowiskowe odgrywają rolę w patogenezie RZS. Rozpoznanie opiera się na kryteriach American Collegium of Reumathology (ACR) oraz European League Against Rheumatism (EULAR) z 2010 roku. Wśród metod fizykoterapii stosowanych w leczeniu RZS szczególną rolę odgrywa krioterapia (kriostymulacja). Zgodnie z wytycznymi Panelu Ottawa kinezyterapia czynnościowa powinna odgrywać szczególną rolę u chorych na RZS, który ma na celu przywrócenie wzorców ruchowych najbardziej zbliżonych do fizjologii. Stosując kinezyterapię u chorych na RZS, należy monitorować przebieg procesów kompensacyjnych. Brak nadzoru lekarza i fizjoterapeuty nad powyższym procesem prowadzi do przeciążenia, a następnie deformacji układu mięśniowo-szkieletowego.
... Wojtecka-Lukasik et al. confirm that the beneficial clinical effects of whole-body cryotherapy in patients with rheumatoid arthritis are in part due to the action on the processes of production, release, and the degradation of histamine [47]. ...
Article
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Whole-body cryotherapy (WBC) has been frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA). The aim of this study was to compare the effect of WBC and traditional rehabilitation (TR) on clinical parameters and systemic levels of IL-6, TNF- α in patients with RA. The study group comprised 25 patients who were subjected to WBC (−110°C) and 19 patients who underwent a traditional rehabilitation program. Some clinical variables and levels of interleukin-6 (IL-6) and tumor necrosis factor- α (TNF- α ) were used to assess the outcomes. After therapy both groups exhibited similar improvement in pain, disease activity, fatigue, time of walking, and the number of steps over a distance of 50 m. Only significantly better results were observed in HAQ in TR group ( p < 0.05). However, similar significant reduction in IL-6 and TNF- α level was observed. The results showed positive effects of a 2-week rehabilitation program for patients with RA regardless of the kind of the applied physical procedure.
... C-reactive protein), mukoproteidów, fibrynogenu oraz s-ICAM, immunoglobulin IgG i IgA, interleukin prozapalnych (IL-2 i IL-8) [1,3,26,43,54]. Z kolei inny mechanizm działania przeciwzapalnego temperatur kriogenicznych stosowanych ogólnoustrojowo może być związany z ich wpływem na stabilizację błon lizosomalnych i następowego zahamowania uwalniania enzymów z lizosomów [68,69]. ...
Article
Adjuvant drug-free therapies like occupational therapy and physiotherapy are despite of improved medication essential in the treatment of patients with rheumatic diseases. In terms of content both do differ significantly. Occupational therapy and physiotherapy are thereby used in a preventive, therapeutic or rehabilitative manner. In postoperative care they are still highly important. Resident physicians are often confronted by patients demanding an intensive long-term physio-therapy and occupational therapy and by surgeons not clearly formulated requests for post-operative care. This article shell give an overview of the existing therapy forms with reference to indications and levels of evidenz. Reviews published over the years showed little or inconsistent therapeutic effects of well established approaches. Nevertheless international clinical practice guidelines recommend occupational therapy and physiotherapy explicitly.
Article
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Background Cryotherapy is used empirically as a symptomatic treatment in rheumatology, with well-known analgesic, vasoconstrictive, anti-inflammatory properties. It can be applied locally or to the whole body. This widespread use contrasts with a lack of standardization in techniques and a poor level of evidence. Objectives The aim of this work is to quantify cryotherapy’s therapeutic effects in rheumatologic inflammatory diseases using available evidence. Methods We performed a systematic review (pubmed, LILACS, Cochrane library). Keywords “cryotherapy”,“cold”,“inflammation”,“arthritis” were used alone and in combination. We also considered abstracts from rheumatology congresses (ACR, EULAR) and unpublished data. Selection criteria were inflammatory rheumatologic disease patients treated with local or whole-body cryotherapy, with endpoints evaluating pain, activity and inflammation parameters. Articles about post-operative joint cryotherapy and infectious diseases were excluded. Results were expressed as means +/- SD (continuous variables). A fixed effect model was used. Paired or unpaired t-tests (α=5%) were used to compare pooled means +/- SD (before/after cryotherapy and versus control when possible). Results We identified 116 potentially relevant abstracts and excluded 96 articles (postoperative, non-inflammatory diseases, inadequate endpoints or outcomes, lack of accuracy (technique, results), duplicates). Among the 20 potentially appropriate articles for meta-analysis, 14 more were excluded (inappropriate design or data presentation, study populations). We finally selected 6 articles for quantitative analysis. There was no significant heterogeneity. We could only perform quantitative analysis for 2 endpoints (pain VAS and DAS28) in RA patients after chronic application (7 to 15 days). -Local cryotherapy (cold packs, cold air, liquid nitrogen for 3 to 30 min (ice) – 10 to 20 applications on 1-5 joints) significantly decreased pain VAS (mm) in 68 RA patients (56,57 +/- 27,44 versus 32,5 +/- 19,99 mm ; p<10exp(-6)). However, there was no significant difference with 17 RA patients treated with “drug therapy”. -Local cryotherapy also significantly decreased DAS28 in the same patients (5,47+/-1,53 versus 4,56 +/- 1,19 ; p<5X10exp(-5)) ; no usable control group. -Whole-body cryotherapy (-110 or -160°C for 2 to 5 min ; 8 to 30 sessions) significantly decreased pain VAS in 124 RA patients (53,15+/-20,46 versus 35,64 +/- 26,69 mm ; p<10exp(-6)). There was again no statistical difference with 17 RA patients treated with low frequency magnetic field. -Whole-body cryotherapy (-110°C for 2 to 3 min ; 8 to 20 sessions) decreased DAS28 significantly in 83 RA patients (4,86 +/- 0,83 versus 4,74 +/- 0,81 ; p<10exp(-3). There was no statistical difference with the same control group. Physical therapy was associated to cryotherapy in 5/6 studies and drug therapy intake (NSAIDs, corticosteroids, DMARDs, biologics) was not assessed in 5/6 studies. Conclusions Local and whole-body cryotherapy significantly decrease pain VAS and DAS28 in RA patients. Further RCTs with adequate control groups and methodology are required to calculate effect size properly. Disclosure of Interest None Declared
Article
In patients suffering from rheumatoid diseases, the complex rehabilitation is one of themost importantmethods to restore themovement system functionality and to recover. Combining kinesiotherapy, especially an individual one, with various physiotherapymethods (e.g. ultrasounds, cryotherapy, laser radiation, electrotherapy) enables to gain positive treatment results. A patient suffering fromrheumatoid arthritis (RA) and ankylosing spondylitis (AS) is offered an individual therapeutic programwith respect to themiscellaneous disease progress and its activity as well as environmental and social factors. In the article the current rehabilitation guidelines, applied in RA and AS patients' treatment are presented.
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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.
Article
Aim: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. Materials and methods: Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. Results: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. Conclusions: Complex rehabilitation in RA has a positive effect on patients' clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect. Implications for Rehabilitation Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation. Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation. Complex rehabilitation, particularly treatment using cryotherapy, improves patients' subjective assessment of their overall well-being and perception of their disease. Complex rehabilitation in rheumatoid arthritis has a positive effect on patients' clinical condition.
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In this review only some of the physical therapeutic options for treating chronic inflammatory diseases are discussed. These include a wide variety of procedures and should not exclusively be assessed using the criteria of evidence-based medicine because in most studies there was no blinding or for ethical reasons no placebo group was included. Nevertheless, these treatment options are quite essential as part of a multimodal treatment concept for patients with inflammatory joint diseases. The increasing interest in adjuvant therapeutic options emphasizes the need for further well designed studies concerning the effectiveness of physical therapy. Dynamic exercise is closely integrated into the treatment strategy for rheumatoid arthritis. In addition to a conditioning stimulus to joints and cartilage it is known that physical therapy is useful in preventing mechanisms of disease chronification. Locally applied and whole body cryotherapy leads to muscular relaxation resulting in a more effective treatment intensity of subsequent exercise. With extracorporeal shockwave therapy (ESWT) a new promising therapeutic approach is available. However, the evidence level is still weak when used for patients with rheumatoid arthritis. Locally applied steroid injections still have a significant value when treating inflammatory synovial conditions.
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This is the protocol for a review and there is no abstract. The objectives are as follows: The purpose of this review is to determine whether adjunctive therapy when used in addition to exercise therapy is beneficial for people with hip or knee osteoarthritis, compared with exercise only or exercise delivered in conjunction with a placebo adjunctive therapy.
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