title: Response to application of ice may help differentiate between gouty arthritis and other inflammatory arthritides.
abstract: OBJECTIVE
  The aim is to determine whether response to topical ice versus heat differentiates between patients with gout versus other arthritides.
  
  
  METHODS
  The first 150 patients seen in our clinic with joint pain from February 2004 onward were asked to fill out questionnaires regarding their response to heat and ice. Patients who responded that topical ice eased their pain and who did not have a diagnosis of crystal-induced arthritis were asked to have a joint aspiration if they had active synovitis on presentation to the clinic.
  
  
  RESULTS
  Of 150 completed questionnaires, 26 patients never tried heat or cold as adjuvant treatment for their arthritis. The remaining 124 patients were divided into 6 groups: patients with crystal-proven gout (n = 20), rheumatoid arthritis (RA; n = 32), osteoarthritis (OA; n = 32), other forms of inflammatory arthritis (n = 18), and soft tissue conditions (n = 22). None of the patients with gout benefited from topical heating of their affected joints and all preferred topical ice (P < 0.001). Most patients with RA preferred heat (n = 24). Of 4 patients with RA who preferred topical ice, 3 had effusions and arthrocentesis was performed. Intracellular monosodium urate (MSU) crystals were seen in 2 and intracellular calcium pyrophosphate dihydrate (CPPD) crystals were seen in one patient raising questions about coexistence of 2 diseases or previous misdiagnoses. Most patients with OA preferred heat (n = 28). A significantly higher percentage of the patients with gouty arthritis found that topical ice helped relieve their joint pain as compared with patients with RA (P = 8 x 10(-11)) and other inflammatory arthritides (P = 3 x 10(-8)).
  
  
  CONCLUSIONS
  Heat and cold are adjuvant treatments for arthritis. In gouty arthritis, cold applications are a useful adjunct to treatment and may help discriminate patients with gout from other forms of inflammatory arthritis.
authors.affiliation: Clinical Rheumatology, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA. schlesna@umdnj.edu
authors.forename: Naomi
authors.initials: N
authors.lastname: Schlesinger
mesh_terms: D001168:Arthritis / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D006073:Gout / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007053:Ice; D007249:Inflammation / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D007053:Ice