Hot and cold treatments won't prevent rheumatoid arthritis flares, but they can lessen the pain and inflammation.

Doctors and physical therapists often recommend hot and cold therapy to soothe the aching or stiff joints of rheumatoid arthritis and temporarily relieve pain and increase mobility. Together these methods are referred to as "thermotherapy."

While there is little evidence that thermotherapy is medically beneficial, a 2001 review by the Cochrane Collaborative of hot and cold treatment research for rheumatoid arthritis concluded that superficial moist heat and cryotherapy (cold packs or baths) can be used as palliative therapy. Paraffin wax baths combined with exercises can also provide beneficial short-term effects for arthritic hands.

Hot and cold treatments won't prevent rheumatoid arthritis flares, but they can lessen the pain and inflammation. To lessen the chance of a flare, some doctors recommend warming the joints before exercising and using cold on them afterward.

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.

"Gentle heat in the morning can improve your range of motion," explains Ann Ahlman, a physical therapist and editor of Today in PT magazine. "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," Ahlman 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 with RA."

Ahlman recommends paraffin therapy for the hands when they're stiff, like first thing in the morning, but not when the joints are inflamed. "When the joints are acutely inflamed, when things are a little bit out of control, it's more useful to use a cool temperature to decrease the inflammation and the swelling," she says.

Katie Palmer, DPT, a doctor of physical therapy in Newtown, Pa. offers up a possible alternative. "Applying warm compresses works in a similar way to a paraffin bath," she says. "Research has shown warm compresses provide pain relief for patients with RA and help to increase hand and finger range of motion when combined with exercises. It also helps to decrease overall stiffness.”

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.

Like heat therapy, cold therapy comes in several forms. Cold packs that you place directly on an aching joint include everything from the minimalist — 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, including the knees and back.

Another 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. And there are widely available over-the-counter cold sprays and ointments, such as Bio Freeze or CryoDerm, that relieve inflammation by numbing the nerves.

One word of caution about cold therapy: If you have Raynaud's syndrome, a condition in which small blood vessels in the fingers or toes constrict when exposed to cold, you probably should not use cold therapy on the affected part of your body. Of course, you should always consult your doctor or physical therapist before trying heat or cold therapy for rheumatoid arthritis.

Follow these guidelines for safely using hot and cold therapy for rheumatoid arthritis:

Tips on Using Heat Therapy for RA

• Use safe heat sources, 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 manufacturers' guidelines).
• When using heating pads or hot water bottles, place a towel or cloth between the heating pad or hot water bottle and your skin.
• Be careful to check your skin for redness often while applying heat and remove the heat source if redness occurs.
• Follow all manufacturers' instructions when using a paraffin bath device.

Tips on 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.

If you're using one of these hot or cold methods and it doesn't bring relief, or it seems to make your rheumatoid arthritis symptoms worse, talk to your doctor.