Thermotherapy is a commonly used modality in treating rheumatoid arthritis (RA). Thermotherapy modalities include superficial moist heat fomentations (hot packs) at different temperatures, cryotherapy (ice packs), paraffin wax baths and faradic baths. All studies included in this review (n=7) are randomized controlled trials (RCT).
This review found 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. However, there were positive results for paraffin wax baths alone for arthritic hands on objective measures of ROM, pinch function, grip strength, pain on non-resisted motion, stiffness compared to control (no treatment) after four consecutive weeks of treatment.
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.