New evidence supports the use of local cryotherapy in rheumatoid arthritis.
New evidence supports the use of local cryotherapy in rheumatoid arthritis relief.
What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic, erosive inflammatory auto-immune disease in which synovial inflammation causes pain, joint destruction and degradation, and can severely limit locomotion. Rheumatoid arthritis (RA) is, according to National Rheumatoid Arthritis Society, thought to affect 1% of the UK population, or approximately 400,000 individuals. Although there is currently no cure for the autoimmune disease, most patients can expect to lead an active life. Current treatments, for the most part, can get the disease under control, moderate and slow the progress of degenerative and irreversible aggravation to the joints.
What are the symptoms?
- Joint pain and swelling/inflammation
- Stiffness
- Aneamia: RA is an inflammatory disease which affects the whole body. It can cause tiredness and fatigue.
- Weakness: Painful, stiff joints often end up not getting as much use, which can cause the muscles to gradually weaken.
- Flu-like symptoms
- Rheumatoid nodules
The costs of long-term anti-inflammatory drugs and corticosteroid use
Despite highly efficient targeted biological treatments, many arthritic patients still need adjunct anti-inflammatory drugs such as corticosteroids or NSAIDS, known to be iatrogenic and to increase morbidity and mortality. In fact, a 2005 study published by the American Gastroenterolgoical Association (AGA) points to the fact that chronic users of NSAIDS have an increased risk of bleeding and visible damage to their small intestine, including increased risk of ulcer disease. NSAIDS can cause ulcers by compromising the protective barriers of the stomach, interfering with the stomach’s ability to protect itself from gastric acids. Over time, and with the long-term use of NSAIDS, the risk for an ulcerative sore in the mucosal lining increases.
Using adjunct therapy with a better safety profile, for instance local cryotherapy, might lead to drug-dose sparing effects and reduced NSAID and/or opioid consumption for long-term, chronic users.
What is the evidence for local cryotherapy as an adjuvant treatment?
1) In 2014, French researchers pooled 6 studies including 257 rheumatoid arthritis patients, showing a significant decrease in pain visual analogic scale, and 28-joint disease activity score after chronic cryotherapy. Their follow up research has sought to explain the molecular pathways which might explain why and how local cryotherapy downregulates mediators involved in joint inflammation and destruction.
2) A more recent 2017 study by the same group of researchers evaluates intra-joint synovial inflammation by using power-Doppler ultrasonographic scores (PDUS) which have been shown to correlate well with disease activity, intra-joint inflammation as well as radiographic destructions. The result of the study showed that local cryotherapy applied twice in a day, reduced PDUS scores without any concurrent treatment as well as pain visual analogic scales. Interestingly, the anti-inflammatory effects remained statistically significant the day after treatment.
3) These researchers also published work revealing novel insights into the molecular pathways on local and systemic inflammation in arthritis in a murine model. The researchers investigated the effects of local cryotherapy on cultured rats. The findings of the study were that 1) treatment with local cryotherapy is efficient for reducing arthritis activity in rats 2) the beneficial effects are in part explained by the anti-inflammatory effects associated with the down-regulating of joint and systemic IL-6/IL-17 cytokine pathways. This study was recently confirmed by another study in human patients, whereby local cryotherapy applied twice during one day showed anti-inflammatory effects by reducing synovial IL-6, IL-1β and VEGF levels in arthritic knees.
The Takeaway
Local cryotherapy is an effective and relatively cheap modality for Rheumatoid arthritis patients to implement and experiment with. Pressurice™ provides the added benefit of compression to magnify the length, depth and magnitude of intra-articular cooling and has been used by thousands of patients with both rheumatoid arthritis and osteoarthritis. It’s ease-of-use makes it popular with patients, as well as its multi-body part use and its cost effectiveness.
References:
Graham, David Y., et al. “Visible Small-Intestinal Mucosal Injury in Chronic NSAID Users.” Clinical Gastroenterology and Hepatology, vol. 3, no. 1, 2005, pp. 55–59., doi:10.1016/s1542-3565(04)00603-2.
Guillot X, Martin H, Seguin-Py S, Maguin- Gate ́ K, Moretto J, Totoson P, et al. (2017) Local cryotherapy improves adjuvant-induced arthritis through down-regulation of IL-6 / IL-17 pathway but independently of TNFα. PLoS ONE 12(7): e0178668. https://doi.org/10.1371/journal. pone.0178668
Guillot X, Tordi N, Laheurte C, et al, SAT0626 Local Cryotherapy (Pulsed CO2 or Ice) Decreases Il-6, IL-1β and VEGF Synovial Levels in Knee Arthritis Annals of the Rheumatic Diseases 2016;75:896.
Guillot X, Tordi N, Prati C, Verhoeven F, Pazart L, Wendling D. Cryotherapy decreases synovial Dopp- ler activity and pain in knee arthritis: A randomized-controlled trial. Jt Bone Spine Rev Rhum. 2016; https://doi.org/10.1016/j.jbspin.2016.09.004
Guillot X, Tordi N, Laheurte C, Pazart L, Prati C, Saas P, et al. [SAT0626] Local cryotherapy (pulsed CO2 or ice) decreases IL-6, IL-1β and VEGF synovial levels in knee arthritis. Ann Rheum Dis. 2016; 75: Suppl2: 896. https://doi.org/10.1136/annrheumdis-2016-eular.1699