Thermotherapy for treating rheumatoid arthritis

Abstract

Thermotherapy is often used as adjunct in the treatment of rheumatoid arthritis (RA) by rehabilitation specialists. To evaluate the effectiveness of different thermotherapy applications on objective and subjective measures of disease activity in patients with RA. We searched 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. 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. 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. Seven studies (n=328 participants) met the inclusion criteria. The results of this systematic review of thermotherapy for RA found that there was no significant effect of hot and ice packs applications (Ivey 1994), cryotherapy (Rembe 1970) and faradic baths (Hawkes 1986) on objective measures of disease activity including joint swelling, pain, medication intake, range of motion (ROM), grip strength, hand function compared to a control (no treatment) or active therapy. There is no significant difference between wax and therapeutic ultrasound as well as between wax and faradic bath combined to ultrasound for all the outcomes measured after one, two or three week(s) of treatment (Hawkes 1986). There was no difference in patient preference for all types of thermotherapy. No harmful effects of thermotherapy were reported. 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. 熱療用於治療類風濕性關節炎 熱療常被復健專業人員用於治療類風濕性關節炎的輔助療法 評估不同熱療用於治療類風濕性關節炎之主觀與客觀疾病活性指標效果。 我們搜尋包括MEDLINE, EMBASE, Pedro, Current Contents, Sports Discus and CINAH，連絡Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group，同時搜尋所選文章之參考文獻 (直到2001年9月)。 所有比較不同熱療與其他治療類風濕性關節炎之隨機對照試驗研究、對照試驗研究、世代研究或病例對照研究。沒有語言限制。可接受摘要。 兩位作者獨立由文獻中確認可能的文章(VR, LB)。回顧者使用未定義的摘錄來提取資訊。所有資訊提取後達成共識。兩位回顧者並以5點計分法評估摘錄資料有關隨機、雙盲、及描述退出研究的品質。 7篇臨床隨機對照試驗(328位患者)符合納入標準。熱敷及冷敷包(Ivey 1994)及冷凍療法 (Rembe 1970)及感應電浴 (Hawkes 1986) 在客觀疾病活性指標包括關節腫脹、疼痛、藥物使用、關節活動度、握力及功能，在熱療與安慰劑或其他治療並無顯著差異。蠟療與超音波以及蠟療與感應電浴結合超音波在1到3週皆無顯著差異(Hawkes 1986)。病患並無特殊熱療形式的喜好。這些熱療亦無副作用被報告。 表面溼熱及冷療法可當輔助治療，石蠟浸泡結合運動對手部關節炎有短期好處。因研究試驗品質低，限制本結論可用性。 本摘要由林口長庚醫院余光輝翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 熱療在治療類風濕關節炎(RA)是一種常用的方式。熱療方式包括在不同溫度下表面的濕熱(熱敷)，冷凍(冰包)，石蠟浴和感應電浴。所有的研究納入本review(7例)都是隨機對照試驗(RCT)。這次review發現，相較對照組(無處理)或積極治療，熱敷,冰包和感應電浴在客觀的疾病活動分析，包括關節腫脹，疼痛，藥物攝入量，運動範圍(ROM)，握力，手的功能或病人偏好上沒有顯著影響。不過，相較於控制組(不治療)，在連續 4個星期的石蠟浴單獨治療於關節炎的雙手, 在客觀分析ROM，捏功能，握力，對非抵抗性運動的疼痛度，僵硬等，有積極的結果。蠟療與超音波以及蠟療與感應電浴結合超音波則無顯著差異。該評論者認為，在類風濕關節炎(RA)，熱療可作為一種姑息性治療或與運動並用作為輔助治療。蠟浴治療關節炎的雙手顯得尤為有用的。但因研究試驗品質低，限制本結論可用性。