Advertisement

Rheumatology International

, Volume 33, Issue 8, pp 2053–2060 | Cite as

Effects of different local cryotherapies on systemic levels of TNF-α, IL-6, and clinical parameters in active rheumatoid arthritis

  • Robert Jastrząbek
  • Anna Straburzyńska-LupaEmail author
  • Radosław Rutkowski
  • Wojciech Romanowski
Original Article

Abstract

Cryotherapies are frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA) owing to their analgesic and anti-inflammatory effects. Forty patients with active RA were recruited and received 10 days of comprehensive therapy with different local cryotherapies. None of the respondents were subjected to biological treatment. They were divided into two groups according to the therapy received: nitrogen vapour at −160 °C (group I) or cold airflow at −30 °C (group II). Levels of tumour necrosis factor α (TNF-α), interleukin 6 (IL-6), disease activity score (DAS28), and functional variables were used to assess the outcomes. After the therapy, both groups exhibited similar improvements. Significant reduction in TNF-α level (nitrogen: p < 0.01; cold air: p < 0.05) and no change in IL-6 were observed. DAS28, the clinical severity of pain, duration of morning stiffness, degree of self-reported fatigue, and health assessment questionnaire (HAQ) scores improved significantly. In addition, the active range of knee extension, time, and the number of steps in the 50-m walk test also clearly got better in both groups. The 10-day comprehensive therapies including different local cryotherapies for the patients with RA cause significant decrease in TNF-α systemic levels, meaningly improve DAS28, HAQ scores, and some functional parameters, but do not change IL-6 levels. However, there were no differences in the effectiveness of either cryotherapy.

Keywords

Rheumatoid arthritis Cryotherapy Tumour necrosis factor Interleukin-6 Physical function Pain 

Notes

Conflict of interest

All authors state no conflicts of interest.

References

  1. 1.
    Scott DL, Wolfe F, Huizinga TWJ (2010) Rheumatoid arthritis. Lancet 376:1094–1108PubMedCrossRefGoogle Scholar
  2. 2.
    Pollard L, Choy EH, Scott DL (2005) The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol 23(Suppl 39):S43–S52PubMedGoogle Scholar
  3. 3.
    Robinson V, Brosseau L, Casimiro L et al (2002) Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2:CD002826PubMedGoogle Scholar
  4. 4.
    Vliet Vlieland TPM, Pattison D (2009) Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 23:103–116PubMedCrossRefGoogle Scholar
  5. 5.
    Demoulin C, Vanderthommen M (2012) Cryotherapy in rheumatic diseases. Joint Bone Spine 79:117–118PubMedCrossRefGoogle Scholar
  6. 6.
    Hayes KW (1993) Heat and cold in the management of rheumatoid arthritis. Arthritis Care Res 6:156–166PubMedCrossRefGoogle Scholar
  7. 7.
    Hirvonen HE, Mikkelsson MK, Kautiainen H et al (2006) Effectiveness of different cryotherapies on pain and disease activity in active rheumatoid arthritis. A randomized single blinded controlled trial. Clin Exp Rheumatol 24:295–301PubMedGoogle Scholar
  8. 8.
    Oosterveld FG, Rasker JJ (1994) Treating arthritis with locally applied or cold. Semin Arthritis Rheum 24:82–90PubMedCrossRefGoogle Scholar
  9. 9.
    Kröling P, Mühlbauer M (1992) Einfluss von Eisbeutel, Kaltluft und N2-Kaltgas auf die gelenknahe elektrische Schmerzschwelle. Phys Rehab Kur Med 2:1–6CrossRefGoogle Scholar
  10. 10.
    Korman P, Straburzyńska-Lupa A, Romanowski W et al (2011) Temperature changes in rheumatoid hand treated with nitrogen vapors and cold air. Rheumatol Int. doi: 10.1007/s00296-011-2078-5 PubMedGoogle Scholar
  11. 11.
    Fricke R, Richter C, Fricke B, Frye K, Moheb A (1998) Cytokine reduction and immunomodulation without stress provoking by whole body cryotherapy at −110°C in rheumatoid arthritis and ankylosing spondylitis. Reumatologia 38:191Google Scholar
  12. 12.
    Straub RH, Pongratz G, Hirvonen H, Pohjolainen T, Mikkelsson M, leirisalo-Repo M (2009) Acute cold stress in rheumatoid arthritis inadequately activates stress response and induces an increase of interleukin 6. Ann Rheum Dis 68:522–578CrossRefGoogle Scholar
  13. 13.
    Lange U, Uhlemann Ch, Müller-ladner U (2008) Serielle Ganzkörperkältetherapie im criostream bei entzündlich-rheumatischen Erkrankungen. Med Klin 103(6):383–388CrossRefGoogle Scholar
  14. 14.
    Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  15. 15.
    Prevoo ML, van’t Hof MA, Kuper HH et al (1995) Modified disease activity scores that include twenty-eight-joint counts. Arthritis Rheum 38:44–48PubMedCrossRefGoogle Scholar
  16. 16.
    Bruce B, Fries JF (2005) The health assessment questionnaire (HAQ). Clin Exp Rheumatol 23(Suppl 39):S14–S18PubMedGoogle Scholar
  17. 17.
    Lea RD, Gerhard JJ (1995) Range of motion measurements. J Bone Joint Surg Am 77:784–798PubMedGoogle Scholar
  18. 18.
    Fransen M, Crosbie J, Edmonds J (2003) Isometric muscle force measurement for clinicians treating patients with osteoarthritis of the knee. Arthritis Rheum 49:29–35PubMedCrossRefGoogle Scholar
  19. 19.
    Edgren CS, Radwin RG, Irwin CB (2004) Grip force vectors for varying handle diameters and hand sizes. Hum Factors 46:244–251PubMedCrossRefGoogle Scholar
  20. 20.
    Marino F, Sockler JM, Fry JM (1998) Thermoregulatory, metabolic and sympathoadrenal responses to repeated brief exposure to cold. Scand J Clin Lab Invest 58:537–545PubMedCrossRefGoogle Scholar
  21. 21.
    Rhind SG, Castellani JW, Brenner IKM, Shepard RJ et al (2001) Intracellular monocyte and serum cytokine expression is modulated by exhausting exercise and cold exposure. Am J Physiol Regul Integr Comp Physiol 291:R66–R75Google Scholar
  22. 22.
    Pool AJ, Axford JS (2001) The effects of exercise on the hormonal and immune systems in rheumatoid arthritis. Rheumatology 40:610–614PubMedCrossRefGoogle Scholar
  23. 23.
    Sobieska M, Stratz T, Samborski W, Hrycaj P, Mennet P, Müller W (1993) Interleukin-6 (IL-6) after whole body cryotherapy and local hot mud pack treatment. Eur J Phys Med Rehabil Vol 3(5):205Google Scholar
  24. 24.
    Dugué B, Leppänen E (2000) Adaptation related to cytokines in man: effects of regular swimming in ice-cold water. Clin Physiol 20(2):114–121PubMedCrossRefGoogle Scholar
  25. 25.
    Janský L, Pospísilová D, Honzová S, Ulicný B, Srámek P, Zeman V, Kamínková J (1996) Immune system of cold-exposed and cold-adapted humans. Eur J Appl Physiol Occup Physiol 72(5–6):445–450PubMedCrossRefGoogle Scholar
  26. 26.
    Nadler SF, Weingand K, Kruse RJ (2004) The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician 7:395–399PubMedGoogle Scholar
  27. 27.
    Metzger D, Zwingmann C, Protz W et al (2000) Whole body cryotherapy in rehabilitation of patients with rheumatoid diseases—pilot study. Rehabilitation 39:93–100PubMedCrossRefGoogle Scholar
  28. 28.
    Neuberger BG, Press AN, Lindsley HB et al (1997) Effects of exercise on fatigue, aerobic fitness, and disease activity measures in person with rheumatoid arthritis. Res Nurs Health 20:195–204PubMedCrossRefGoogle Scholar
  29. 29.
    Minnock P, FitzGerald O, Bresnihan B (2003) Women with established rheumatoid arthritis perceive pain as the predominant impairment of health status. Rheumatology 42:995–1000PubMedCrossRefGoogle Scholar
  30. 30.
    Wolfe F, Hawley DJ, Cathey MA (1991) Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis. J Rheumatol 18:1290–1297PubMedGoogle Scholar
  31. 31.
    Ward M, Leigh P (1993) The relative importance of pain and functional disability to patients with rheumatoid arthritis. J Rheumatol 20:1494–1499PubMedGoogle Scholar
  32. 32.
    Sokka T, Kankainen A, Hannonen P (2000) Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 43:386–389PubMedCrossRefGoogle Scholar
  33. 33.
    Welsing PM, van Gestel AM, Swinkels HL et al (2001) The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum 44:2009–2017PubMedCrossRefGoogle Scholar
  34. 34.
    Lemmey AB, Marcora SM, Chester K et al (2009) Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 61:1726–1734PubMedCrossRefGoogle Scholar
  35. 35.
    Brorsson S, Hilliges M, Sollerman C et al (2009) A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis. J Rehabil Med 41:338–342PubMedCrossRefGoogle Scholar
  36. 36.
    Westerlund T, Oksa J, Smolander J et al (2009) Neuromuscular adaptation after repeated exposure to whole-body cryotherapy (−110°C). J Therm Biol 34:226–231CrossRefGoogle Scholar
  37. 37.
    Matschke V, Thom JM, Lemmey AB et al (2012) Adverse changes in tendon–muscle physiology and physical function caused by an isolated acute rheumatoid knee effusion: a case study. Arthrit Care Res 64:117–121CrossRefGoogle Scholar
  38. 38.
    Ferrucci L, Guralnik JM, Buchner D et al (1997) Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the women’s health and aging study. J Gerontol A Biol Sci Med Sci 52:M275–M285PubMedCrossRefGoogle Scholar
  39. 39.
    Häkkinen A, Kautiainen H, Hannonen P et al (2006) Muscle strength, pain, and disease activity explain individual subdimensions of the health assessment questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis 65:30–34PubMedCrossRefGoogle Scholar
  40. 40.
    McKenna F, Wright V (1985) Pain and rheumatoid arthritis. Ann Rheum Dis 44:805–806PubMedCrossRefGoogle Scholar
  41. 41.
    Wessel J (2004) The effectiveness of hand exercises for persons with rheumatoid arthritis: a systemic review. J Hand Ther 17:174–180PubMedCrossRefGoogle Scholar
  42. 42.
    Van Den Ende CHM, Vliet Vlieland TPM, Munneke M et al (1998) Dynamic exercise therapy in rheumatoid arthritis: a systemic review. Br J Rheumatol 37:677–687PubMedCrossRefGoogle Scholar
  43. 43.
    Bodur H, Yιlmaz Ö, Keskin D (2006) Hand disability and related variables in patients with rheumatoid arthritis. Rheumatol Int 26:541–544PubMedCrossRefGoogle Scholar
  44. 44.
    Ekdal C, Eberhardt K, Andersson SI et al (1988) Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol 17:263–271CrossRefGoogle Scholar
  45. 45.
    Eberhardt K, Sandqvist G, Geborek P (2008) Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol 37:109–112PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Robert Jastrząbek
    • 1
  • Anna Straburzyńska-Lupa
    • 1
    • 2
    Email author
  • Radosław Rutkowski
    • 1
  • Wojciech Romanowski
    • 2
  1. 1.Department of PhysiotherapyUniversity School of Physical EducationPoznańPoland
  2. 2.Rheumatological Centre in ŚremŚremPoland

Personalised recommendations