Doctors and physical therapists often recommend hot and cold therapy to soothe the aching or stiff joints of?rheumatoid arthritis (RA)?and to increase mobility. Together, these methods to?temporarily relieve RA pain?are referred to as "thermotherapy."
While there is little evidence that thermotherapy is medically beneficial, a?review published in the Cochrane Database of Systematic Reviews?of hot and cold treatment for rheumatoid arthritis?concluded that superficial moist heat and cryotherapy (cold packs or baths) can be used as palliative, or supportive, therapy.
Still, hot and cold treatments won't?prevent rheumatoid arthritis?flares. “Using heat or cold can be helpful, relieving, and soothing. However, exercise, joint protection, and other forms of education, as well as protective splinting can be more beneficial,” says Lisa Maggiore, a registered and licensed occupational therapist at?Greenwich Hospital?in Connecticut. And, of course, making sure you are taking the most appropriate medication.
What thermotherapy can do is lessen the pain and inflammation, at least a bit.
As the?Arthritis Foundation notes: “Soaking in warm water?or applying a?heated?compress?is one of the oldest, cheapest, and safest?forms of?complementary?therapy.”
Hot Therapy for Rheumatoid Arthritis
For someone with an inflammatory disease like RA, applying heat may seem counterintuitive. But since heat works to reduce muscle tension and stimulate blood circulation, many patients find that applying something warm — even if it just means warming your clothes in the dryer before dressing, or lying with a heated blanket prior to getting up in the morning — simply feels good on the joints.
Heat can be effective because it helps to relax the muscles, the American College of Rheumatology notes.
According to the Arthritis Foundation, when you warm up a sore?joint, the heat enlarges your blood vessels, allowing more blood, oxygen, and nutrients to be?delivered to the tissues.
Although there aren’t recent studies for rheumatoid arthritis, researchers conducted a study on 35 people with chronic, nonspecific neck pain that was published in the International Journal of Environmental Research and Public Health in August 2020. They found that those receiving thermotherapy with a salt-pack for 30 minutes twice a day for five days (in addition to performing a neck stabilization exercise) improved stiffness more than the control group.
"Gentle heat in the morning can improve your range of motion," explains Katie Palmer, a physical therapist in Newtown, Pennsylvania. "It can relieve some of the joint pain and the stiffness and prepare your body for?exercise or to get up and get moving and out the door."
One version of hot therapy is the paraffin, or wax, bath, similar to what's used in nail salons to soften the skin and nails. "The paraffin is heated to a prescribed temperature and then you dip in your hands, wrists, and fingers, and it forms a coating," Palmer explains. "Then you wrap your paraffin-covered hands and wrists in a little towel, and it gives you a nice moist, deep heat that can help eliminate some of the pain and stiffness of RA."
Palmer recommends paraffin therapy for the hands when they're stiff, like first thing in the morning, but not when the joints are inflamed.
Another option: "Applying warm compresses (such as hot water bottles) works in a similar way to a paraffin bath," Palmer says.
In addition to putting heat on targeted areas, you can also warm up your whole body by taking a warm bath or shower or by swimming in a heated pool.
Because heat can promote inflammation, “[it] should be avoided during an active inflammatory phase when joint temperatures are elevated,” Maggiore says.
Cold Therapy for Rheumatoid Arthritis
If your joints are inflamed, it makes sense that something cold could ease the inflammation and thus the pain. The main benefits of cold therapy are reducing inflammation, swelling, and soreness, as well as temporarily relieving joint pain caused by an arthritis flare.
Cold therapy is best during an acute flare, Maggiore says. “Cold therapy is helpful as it can lower joint temperatures, reduce pain, and decrease inflammation,” she says.
Like heat therapy, cold therapy comes in several forms.
One simple method of cooling the joints is a cool-water soak in a tub. Just don't let the water get so cold that you become chilled.
Cold packs that you place directly on an aching joint include everything from common items — bags of frozen peas or gel packs found at the drugstore — to complete systems of coolers, cooling pads, and devices shaped to certain parts of the body, like the knees and back.
But if the cold doesn’t feel good or you can’t tolerate it, stop using it, Maggiore says.
Others who should avoid or limit cold therapy are people with Raynaud's syndrome, a condition in which small blood vessels in the fingers or toes constrict when exposed to cold. If you have this syndrome, you probably should not use cold therapy on the affected parts of your body.
Always consult your doctor or physical therapist before trying any hot or cold therapy for rheumatoid arthritis.
5 Tips for Using Heat Therapy for RA
- Use safe heat sources that don’t let the temperature get scalding, including hot towels, hot tubs, showers, or baths, hot water bottles, microwaveable hot pads, and electric heating pads.
- To prevent burns, do not use heat for excessive lengths of time (follow the manufacturer's guidelines).
- When using heating pads or?hot water bottles, place a towel or cloth on your skin first, to prevent direct contact with the heat source.
- Be careful to check your skin for redness often while applying heat, and remove the heat source if redness occurs.
- Follow the manufacturer's instructions when using a paraffin bath device.
5 Tips for Using Cold Therapy for RA
- Use a bag of frozen peas, wrap ice in a thin towel, or use commercially available cold gel packs for cold therapy.
- Avoid applying ice or cold packs directly to the skin — use a towel or cloth between the cold device and the skin.
- To avoid frostbite, do not apply cold for more than 15 minutes at a time.
- Allow your skin to return to normal temperature and color before using cold again.
- Don’t alternate hot and cold without a break. The Arthritis Foundation recommends waiting a couple of hours between sessions before switching to the other.
If you're using one of these hot or cold methods and it doesn't bring relief, or it seems to make the rheumatoid arthritis symptoms worse, talk to your doctor.