title: Cryotherapy in inflammatory rheumatic diseases: a systematic review.
abstract: 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 For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy.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.
authors.affiliation: Department of Rheumatology, University Hospital of Besançon, boulevard Fleming, 25030 Besançon Cedex, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Guillot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Tordi
authors.forename: Laurent
authors.initials: L
authors.lastname: Mourot
authors.forename: Céline
authors.initials: C
authors.lastname: Demougeot
authors.forename: Benoît
authors.initials: B
authors.lastname: Dugué
authors.forename: Clément
authors.initials: C
authors.lastname: Prati
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000529:Complementary Therapies; D017679:Cryotherapy / Q000379:methods* / Q000639:trends; D019317:Evidence-Based Medicine; D006801:Humans; D007249:Inflammation / Q000628:therapy*; D018836:Inflammation Mediators / Q000378:metabolism; D007596:Joints / Q000187:drug effects / Q000276:immunology* / Q000528:radiation effects; D012216:Rheumatic Diseases / Q000628:therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators