Cryotherapy decreases synovial Doppler activity and pain in knee arthritis: A randomized-controlled trial.
OBJECTIVE
To measure and compare the effects of 2 local cryotherapy techniques on synovial power Doppler activity (primary outcome) and pain in non-septic knee arthritis without any concurrent treatment.


METHODS
30 patients were randomized (ice: 30min, n=15 or cold CO2: 2min, n=15 both applied twice at 8h interval). Contralateral non-treated arthritic knees were used as paired controls (n=11 and n=10 respectively). The PDUS semi-quantitative score (0-3) and pain visual analogic scale were evaluated before/after each cold application, 2min, 2h, 24h after the first application. PDUS scores were checked in double-blind by 2 ultrasonographists.


RESULTS
The inter-class effect size of local cryotherapy on the power Doppler score remained significant the day after treatment in local cryotherapy-treated compared to contralateral non-treated knees (Global difference: -1 [95% confidence interval: -1.23; -0.77]; ice: -0.73 [-1.06; -0.4]; CO2: -0.7 [-1.18; -0.22]). Both techniques significantly and to the same extent reduced the power Doppler score and pain visual analogic scale at all evaluation times and globally throughout the 24 hour-study period. No dropout nor adverse event was reported. In multivariate analysis, the Power Doppler score decrease was associated with pain decrease, while pain decrease was associated with the female sex and ice technique.


CONCLUSIONS
Local ice and cold CO2applied twice equally reduced synovial Power Doppler activity and pain over 24h in knee arthritis. These effects remained significant the day after treatment. ClinicalTrials.gov identifier: NCT02573298.
Rheumatology Department, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France; FDE EA4267, FHU INCREASE, Bourgogne Franche-Comté University, 25000 Besançon, France. Electronic address: xguillot@chu-besancon.fr.
Xavier
X
Guillot
FDE EA4267, FHU INCREASE, Bourgogne Franche-Comté University, 25000 Besançon, France.
Nicolas
N
Tordi
Rheumatology Department, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France; FDE EA4267, FHU INCREASE, Bourgogne Franche-Comté University, 25000 Besançon, France.
Clément
C
Prati
Rheumatology Department, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France.
Frank
F
Verhoeven
CIC IT, INSERM Center CIT 808, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France.
Lionel
L
Pazart
Rheumatology Department, University Hospital of Besançon, Boulevard Fleming, 25030 Besançon Cedex, France; EA 4266, Bourgogne Franche-Comté University, 25000 Besançon, France.
Daniel
D
Wendling
D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D001168:Arthritis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D017679:Cryotherapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013583:Synovial Membrane / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler
Knee arthritis; Local cryotherapy; Pain; Power Doppler score