Lämpö- ja kylmähoidot nivelreumassa

Markku Hakala

Näytön aste: B

Lämpö- ja kylmähoidoilla ei ole osoitettua pidempikestoista tehoa oireisiin, toimintakykyyn eikä kipulääkityksen tarpeeseen nivelreumassa.

Cochrane review «Welch V, Brosseau L, Shea B ym. Thermotherapy for ...»1, «»1evaluated the effectiveness of different thermotherapy applications on objective and subjective measures of disease activity in patients with RA.

Search methods

Search methods assessed MEDLINE, EMBASE, Pedro, Current Contents, Sports Discus and CINAHL up to and including September 2001. The Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registers. Hand searching was conducted on all retrieved articles for additional articles.

Selection criteria

Comparative controlled studies, such as randomized controlled trials, controlled clinical trials, cohort studies or case/control studies, of thermotherapy compared to control or active interventions in patients with RA were eligible. No language restrictions were applied. Abstracts were accepted.

Data collection and analysis

Two independent reviewers identified potential articles from the literature search (VR, LB). These reviewers extracted data using pre-defined extraction forms. Consensus was reached on all data extraction. Quality was assessed by two reviewers using a 5 point scale that measured the quality of randomization, double-blinding and description of withdrawals.

Main results

Seven studies (n = 328 participants) met the inclusion criteria.

This review found that there were no significant effects for hot and ice packs applications and faradic baths on objective measures of disease activity including joint swelling, pain, medication intake, range of motion (ROM), grip strength, hand function or patient preference compared to control (no treatment) or active therapy.

There was one trial of paraffin wax alone or combined with exercise «Dellhag B, Wollersjö I, Bjelle A. Effect of active...»2 which did not report sufficient detail to analyze the results using review manager: standard deviation was not reported. However, this trial reported statistically significant results for some outcomes after four weeks of treatment: the wax + exercise group showed significantly greater improvement than the control group for flexion deficit (21% relative to control), pain on non-resisted motion (44% relative to control), grip function (8% relative to control) and pinch function (5% relative to control) of the hand (p<.05). There was no significant effect of wax+exercise on stiffness or grip strength. This trial found no significant improvement from baseline with paraffin wax only versus control for any outcomes (pinch and grip function, pain, stiffness and range of motion deficits).

In addition, one study «Rembe EC. Use of cryotherapy on the postsurgical r...»3 reported a tendency favouring cryotherapy versus no active treatment in the reduction of hand swelling after two days (-5.80 % from baseline, 95%CI: -11.78 to 0.18) and three days (-9.80 % from baseline, 95%CI: -19.91 to -0.31) post-surgery of the hand.

There is no significant difference between wax and therapeutic ultrasound or between wax and faradic bath combined with ultrasound for any of the outcomes measures. The reviewers concluded that thermotherapy can be used as a palliative therapy or as an adjunct therapy combined with exercises for RA patients. Wax baths appear especially helpful in the treatment of arthritic hands. These conclusions are limited by methodological considerations such as the poor quality of trials.


Superficial moist heat and cryotherapy can be used as palliative therapy. Paraffin wax baths combined with exercises can be recommended for beneficial short-term effects for arthritic hands. These conclusions are limited by methodological considerations such as the poor quality of trials.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentti: Tehtyyn arvioon lämpö- ja kylmähoitojen tehosta voi vaikuttaa tutkimusmetodologiset syyt, eritoten tutkimusten huono laatu. Käsiparafiinihoidosta on osoitettua tehoa ja sitä voidaan suositella yhdessä sorminivelharjoitteiden kanssa.

Sixty patients with active seropositive RA were recruited in a randomised controlled single-blinded study «Hirvonen HE, Mikkelsson MK, Kautiainen H ym. Effec...»4 to receive whole-body cryotherapy at -110 degrees C, whole-body cryotherapy at -60 degrees C, application of local cold air at -30 degrees C and the use of cold packs locally. In the final analysis, the last 2 groups were pooled. The patients had 2–3 cryotherapy sessions daily for one week plus conventional physiotherapy. Clinical and laboratory variables and patient's and physician's global assessments were used to assess the outcome. Disease activity was calculated by DAS.


Pain decreased in all treatment groups, most markedly in the whole-body cryotherapy (-110 degrees C) group. DAS decreased slightly with no statistically significant differences between the groups. No serious or permanent adverse effects were detected. Six of 40 patients (15 %) discontinued the whole-body cryotherapy.


Pain seemed to decrease more in patients in the whole-body cryotherapy at -110 degrees C than during other cryotherapies, but there were no significant differences in the disease activity between the groups. However, cryotherapy at -110 degrees C is expensive and available only in special centres and may have minor adverse effects. Based on the results, whole-body cryotherapy at -110 degrees C is not superior to local cryotherapy commonly used in RA patients for pain relief and as an adjunct to physiotherapy

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentti: Tämän tutkimustuloksen – eri kylmähoidot lievittävät kipua aktiivia nivelreumaa sairastavilla yhdistettynä fysioterapiaan - yleistettävyyttä heikentää puhtaan fysioterapiakontrolliryhmän puuttuminen.


  1. Welch V, Brosseau L, Shea B ym. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2001;4:CD002826 «PMID: 11406046»PubMed
  2. Dellhag B, Wollersjö I, Bjelle A. Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients. Arthritis Care Res 1992;5:87-92 «PMID: 1390969»PubMed
  3. Rembe EC. Use of cryotherapy on the postsurgical rheumatoid hand. Phys Ther 1970;50:19-23 «PMID: 5414653»PubMed
  4. Hirvonen HE, Mikkelsson MK, Kautiainen H ym. Effectiveness of different cryotherapies on pain and disease activity in active rheumatoid arthritis. A randomised single blinded controlled trial. Clin Exp Rheumatol 2006;24:295-301 «PMID: 16870097»PubMed