RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS (RA)

is a chronic inflammatory autoimmune disorder where the body attacks its own connective tissue. The primary focus is the joints, with inflammation of the synovial membranes that line the joints, and eventually also the destruction of cartilage and bone. It is commonly systemic and can also affect other organs in the body including skin, eyes, blood vessels and the lungs.

There is currently no known cure and the goal of treatment is to decrease disease intensity and delay progression. Drug management relies on anti-inflammatory and immune-blocking mechanisms. New therapies focus on blocking TNF-α, and although they are effective in delaying disease progression, localized and systemic adjunctive therapies remain important modalities in the management of rheumatoid arthritis. in

Role of Cryotherapy in RA

Cryotherapy, both localized and whole body, has been used in the management of the disease since it was first described in Japan in 1978. It is a highly beneficial adjuvant therapy, with studies showing multiple benefits, not least of which is an improved ability to do physiotherapy, significantly improving the outcome of a course of treatment.

Summary of benefits of Whole Body Cryotherapy in RA

  • Improvements in well-being
  • Decreased swelling and oedema
  • Decreased use of NSAIDS in up to 40% of patients
  • Relief of symptoms
  • Reduction in pain and restriction of movement
  • Improved ability to do physiotherapy directly following a treatment
  • Reduced disease activity
  • Decreased inflammatory markers: Decreased pro-inflammatory cytokines TNF-α and interleukin IL-1
  • Improvements can still be seen three to six months following a course of treatments

Benefits of localised cryotherapy in RA

  • Decreased ESR
  • Decreased histamine levels
  • Decreased scores on the Disease Activity Score (DAS28)
  • Reduced joint edema and swelling
  • Improved handgrip strength measured via sphygmomanometer
  • Improved muscle strength measured via EMG
  • Improved joint mobility: increased range of motion and reduced stiffness
  • Decreased morning stiffness
  • Reduced pain (measured using visual analog scales) lasting up to two months
  • Decreased pain during examinations

Suggested treatment protocols in RA

Protocols generally suggest WBCT treatments up to three times a day for 2- 3 weeks during phases of increased disease activity, with ongoing assessment of the efficacy of the treatment. Studies have shown relief of symptoms, reduction in pain and restriction of movement, reduced disease activity and decrease in inflammatory markers after 10 to 15 sessions, even with high inflammatory disease activity. Longer term benefits are seen after longer courses of treatment (20 to 30 sessions).

  • Localised cryotherapy protocols show maximum benefit when done twice a day for at least 10 days.