Effects of Whole-Body Cryotherapy vs. Far-Infrared vs. Passive Modalities on Recovery from Exercise-Induced Muscle Damage in Highly-Trained Runners Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi Exposures following Severe Exercise Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder. Effect of intensive lipid-lowering therapy on cardiovascular outcome in patients with and those without inflammatory joint disease. Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass. Temperature changes in rheumatoid hand treated with nitrogen vapors and cold air Immune changes in humans during cold exposure: effects of prior heating and exercise. Mild hypothermia alone or in combination with anesthetic post-conditioning reduces expression of inflammatory cytokines in the cerebral cortex of pigs after cardiopulmonary resuscitation Whole-Body Cryostimulation Limits Overreaching in Elite Synchronized Swimmers. Local ice therapy during bouts of acute gouty arthritis. Effects of local heat and cold treatment on surface and articular temperature of arthritic knees. Hyperbaric gaseous cryotherapy: effects on skin temperature and systemic vasoconstriction. Pain in the elderly: Prospective study of hyperbaric CO2 cryotherapy (neurocryostimulation). Influence of selective brain cooling on the expression of ICAM-1 mRNA and infiltration of PMNLs and monocytes/macrophages in rats suffering from global brain ischemia/reperfusion injury. Cryotherapy for postoperative pain relief following knee arthroplasty. The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty.
Enhanced recovery following physical activity and exercise-induced muscle damage ( EIMD ) has become a priority for athletes . Consequently , a number of post-exercise recovery strategies are used , often without scientific evidence of their benefits . Within this framework , the purpose of this study was to test the efficacy of whole body cryotherapy ( WBC ) , far infrared ( FIR ) or passive ( PAS ) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race . In 3 non-adjoining weeks , 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill  , design ed to induce muscle damage . Immediately ( post ) , post 24 h , and post 48 h after exercise , all participants tested three different recovery modalities ( WBC , FIR , PAS ) in a r and om order over the three separate weeks . Markers of muscle damage ( maximal isometric muscle strength , plasma creatine kinase [ CK ] activity and perceived sensations [ i.e. pain , tiredness , well-being ] ) were recorded before , immediately after ( post ) , post 1 h , post 24 h , and post 48 h after exercise . In all testing sessions , the simulated 48 min trail run induced a similar , significant amount of muscle damage . Maximal muscle strength and perceived sensations were recovered after the first WBC session ( post 1 h ) , while recovery took 24 h with FIR , and was not attained through the PAS recovery modality . No differences in plasma CK activity were recorded between conditions . Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage ( EIMD ) and inflammation obtained after a simulated trail running race . Endurance trained males ( n = 11 ) completed two experimental trials separated by 1 month in a r and omized crossover design ; one trial involved passive recovery ( PAS ) , the other a specific whole body cryotherapy ( WBC ) for 96 h post-exercise ( repeated each day ) . For each trial , subjects performed a 48 min running treadmill exercise followed by PAS or WBC .  The Interleukin ( IL ) -1 ( IL-1 ) , IL-6 , IL-10 , tumor necrosis factor alpha ( TNF-α ) , protein C-reactive ( CRP ) and white blood cells count were measured at rest , immediately post-exercise , and at 24 , 48 , 72 , 96 h in post-exercise recovery . A significant time effect was observed to characterize an inflammatory state ( Pre vs. Post ) following the exercise bout in all conditions ( p<0.05 ) . Indeed , IL-1β ( Post 1 h ) and CRP ( Post 24 h ) levels decreased and IL-1ra ( Post 1 h ) increased  following WBC when compared to PAS .  In WBC condition ( p<0.05 ) , TNF-α , IL-10 and IL-6 remain unchanged compared to PAS condition . Overall , the results indicated that the WBC  was effective in reducing the inflammatory process . These results may be explained by vasoconstriction at muscular level , and both the decrease in cytokines activity pro-inflammatory , and increase in cytokines anti-inflammatory Fibromyalgia is a chronic widespread pain disorder in which , the neurogenic origin of the pain , featured by allodynia and hyperalgesia , results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators . Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases , through the regulation of the cytokine expression . The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients . A total of 100 fibromyalgic patients ( age range 17–70 years ) were observed ; 50 subjects were addressed to cryotherapy , while the second group ( n = 50 ) did not underwent to the cryotherapic treatment .  All subjects kept the prescribed pharmacological therapy during the study ( analgesic and antioxidants ) . The referred health status pre- and post-observation was evaluated with the following scales : Visual Analogue Scale , Short Form-36 , Global Health Status and Fatigue Severity Scale . Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life , in comparison with the non-cryo treated fibromyalgic subjects , as indicated by the scores of the qualitative indexes and sub-indexes , that are widely recognized tools to assess the overall health status and the effect of the treatments . We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain OBJECTIVE To compare 2 different treatment approaches , physical therapy modalities , and joint mobilization versus whole-body cryotherapy ( WBC ) combined with physical therapy modalities and joint mobilization , for symptoms of adhesive capsulitis ( AC ) of the shoulder . DESIGN A r and omized trial . SETTING Hospital . PARTICIPANTS Patients with AC of the shoulder ( N=30 ) . INTERVENTION Patients were r and omly assigned to 2 groups . The WBC group received physical therapy modalities , passive joint mobilization of the shoulder , and WBC , whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder . MAIN OUTCOME MEASURES Visual analog scale ( VAS ) , active range of motion ( ROM ) of flexion , abduction , internal and external rotation of the shoulder , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) were measured before and after the intervention . RESULTS A statistically significant difference between groups was found for the VAS , active ROM of flexion , abduction , internal rotation , and external rotation , and the ASES with greater improvements in the WBC group ( Ps<.01 ) . Overall , both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01 . CONCLUSIONS There is significant improvement with the addition of WBC to treatment interventions in this sample of patients OBJECTIVE To examine the effect of intensive lipid-lowering therapy on a composite cardiovascular outcome ( cardiovascular disease [ CVD ] ) , consisting of mortality and morbidity end points , in patients with inflammatory joint disease ( rheumatoid arthritis [ RA ] , ankylosing spondylitis [ AS ] , or psoriatic arthritis [ PsA ] ) by post hoc analysis of 2 prospect i ve trials of statins with a secondary end point of CVD outcome ( the Treating to New Targets [ TNT ] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [ IDEAL ] studies ) . METHODS Of the 18,889 patients participating in the 2 trials , 199 had RA , 46 had AS , and 35 had PsA.  Lipid-lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low-dose regimen of atorvastatin 10 mg or simvastatin 20 - 40 mg . The median duration of followup was nearly 5 years . Changes in lipid levels were examined by analyses of covariance . The effect on CVD was examined by Cox regression analyses , and heterogeneity tests were performed . RESULTS Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease ( least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl , respectively , versus 185.6 ± 0.2 mg/dl ; P = 0.03 and P = 0.05 , respectively ) . Statin treatment led to a comparable decrease in lipid levels and a 20 % reduction in overall risk of CVD in both patients with and those without inflammatory joint disease . CONCLUSION Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid-lowering effects and CVD risk reduction after intensive treatment with statins PURPOSE To investigate the effects of different conditions used during  cardiopulmonary bypass ( CPB ) surgery  on accompanying production of cytokine and nitric oxide ( NO ) . METHODS Patients undergoing CPB for the first time were prospect ively enrolled and divided into two groups according to CPB parameters performed : i )  normothermia ( 36.5 - 37 degrees C ) with blood cardioplegia ( NB group , n=10 ) and ii ) hypothermia ( 29 - 31 degrees C ) with crystalloid cardioplegia ( HC group , n=10 ) . Plasma sample s obtained following intubation ( baseline ) , during ( 5 and 30 min ) and after ( 4 and 24 h ) CPB were assayed for cytokines ( ELISA ) and NO metabolites ( Griess reaction ) . RESULTS Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups , but in the HC group those levels increased earlier and persisted for longer ( 24 h ) compared to baseline ( P < 0.05 ) . IL-10 levels also increased at 4 h compared to baseline , but only significantly so in the HC group . NO metabolites were reduced in HC group at all time points compared to baseline ( P < 0.05 ) , while no significant differences were detected in the NB group . CONCLUSION The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and /or perfusion temperature used during CPB may contribute to the extent of inflammatory response The aim of the study was the thermovisual comparison of mean temperature of h and surface changes after local cryotherapy with vapors of nitrogen ( −160 ° C ) and cold air ( −30 ° C ) . Forty-seven patients with rheumatoid arthritis ( 39 women and 8 men ; average age 56.2 ± 10.5 years ) were included in the study . They had the application of topic cryotherapy using nitrogen vapors or cold air on one h and . Main outcome measure was surface temperature of dorsal sides of the cooled and contralateral h and s. Thermal images of both h and s were taken before and up to 3 h after the treatment . One minute after application , nitrogen vapors induced decrease in surface skin temperature of the cooled h and from 28.9 ± 1.8 ° C to 17.9 ± 2.2 ° C , P < 0.05 , whereas cold air from 29.4 ± 2.4 ° C to 23.1 ± 2.2 ° C , P < 0.05 . However , significantly lower temperature was obtained with vapors of nitrogen ( P < 0.05 ) . Just after the treatment , a rapid rewarming occurred and h and s reached baseline temperature in 15 min in both applications and they did not differ till the end of the procedure . Both nitrogen vapors and cold air induce similar temperature changes in h and s with the exclusion of temperature obtained 1 min after the treatment . Changes in non-cooled h and s indicate contralateral reaction This study examined the immunological responses to cold exposure together with the effects of pretreatment with either passive heating or exercise ( with and without a thermal clamp ) . On four separate occasions , seven healthy men [ mean age 24.0 + /- 1.9 ( SE ) yr , peak oxygen consumption = 45.7 + /- 2.0 ml . kg(-1 ) . min(-1 ) ] sat for 2 h in a climatic chamber maintained at 5 degrees C. Before exposure , subjects participated in one of four pretreatment conditions . For the thermoneutral control condition , subjects remained seated for 1 h in a water bath at 35 degrees C. In another pretreatment , subjects were passively heated in a warm ( 38 degrees C ) water bath for 1 h. In two other pretreatments , subjects exercised for 1 h at 55 % peak oxygen consumption ( once immersed in 18 degrees C water and once in 35 degrees C water ) . Core temperature rose by 1 degrees C during passive heating and during exercise in 35 degrees C water and remained stable during exercise in 18 degrees C water ( thermal clamping ) . Subsequent cold exposure induced a leukocytosis and granulocytosis , an increase in natural killer cell count and activity , and a rise in circulating levels of interleukin-6 . Pretreatment with exercise in 18 degrees C water augmented the leukocyte , granulocyte , and monocyte response . These results indicate that acute cold exposure has immunostimulating effects and that , with thermal clamping , pretreatment with physical exercise can enhance this response . Increases in levels of circulating norepinephrine may account for the changes observed during cold exposure and their modification by changes in initial status Introduction  Hypothermia  improves survival and neurological recovery  after cardiac arrest . Pro-inflammatory cytokines have been implicated in focal cerebral ischemia/reperfusion injury . It is unknown whether cardiac arrest also triggers the release of cerebral inflammatory molecules , and whether therapeutic hypothermia alters this inflammatory response . This study sought to examine whether hypothermia or the combination of hypothermia with anesthetic post-conditioning with sevoflurane affect cerebral inflammatory response after cardiopulmonary resuscitation . Methods Thirty pigs ( 28 to 34 kg ) were subjected to cardiac arrest following temporary coronary artery occlusion . After seven minutes of ventricular fibrillation and two minutes of basic life support , advanced cardiac life support was started according to the current American Heart Association guidelines . Return of spontaneous circulation was achieved in 21 animals who were r and omized to either normothermia at 38 ° C , hypothermia at 33 ° C or hypothermia at 33 ° C combined with sevoflurane ( each group : n = 7 ) for 24 hours . The effects of hypothermia and the combination of hypothermia with sevoflurane on cerebral inflammatory response after cardiopulmonary resuscitation were studied using tissue sample s from the cerebral cortex of pigs euthanized after 24 hours and employing quantitative RT-PCR and ELISA techniques . Results Global cerebral ischemia following resuscitation result ed in significant upregulation of cerebral tissue inflammatory cytokine mRNA expression ( mean ± SD ; interleukin (IL)-1β 8.7 ± 4.0 , IL-6 4.3 ± 2.6 , IL-10 2.5 ± 1.6 , tumor necrosis factor (TNF)α 2.8 ± 1.8 , intercellular adhesion molecule-1 ( ICAM-1 ) 4.0 ± 1.9-fold compared with sham control ) and IL-1β protein concentration ( 1.9 ± 0.6-fold compared with sham control ) . Hypothermia was associated with a significant ( P < 0.05 versus normothermia ) reduction in cerebral inflammatory cytokine mRNA expression ( IL-1β 1.7 ± 1.0 , IL-6 2.2 ± 1.1 , IL-10 0.8 ± 0.4 , TNFα 1.1 ± 0.6 , ICAM-1 1.9 ± 0.7-fold compared with sham control ) . These results were also confirmed for IL-1β on protein level . Experimental setting s employing hypothermia in combination with sevoflurane showed that the volatile anesthetic did not confer additional anti-inflammatory effects compared with hypothermia alone . Conclusions Mild therapeutic hypothermia result ed in decreased expression of typical cerebral inflammatory mediators after cardiopulmonary resuscitation . This may confer , at least in part , neuroprotection following global cerebral ischemia and resuscitation INTRODUCTION Elite athletes frequently undergo periods of intensified training ( IT ) within their normal training program . These periods can lead athletes into functional overreaching , characterized by high perceived fatigue , impaired sleep , and performance . Because whole-body cryostimulation ( WBC ) has been proven to be an effective recovery method in the short term ( < 76 h ) , we investigated whether daily WBC sessions during IT could prevent exercise and sleep-related signs of overreaching . METHODS After a normal training week ( BASE ) , 10 elite synchronized swimmers performed two 2-wk IT periods in a r and omized crossover fashion using WBC daily ( ITWBC ) or not ( ITCON ) , separated by 9 d of light training . Swim time trials ( 400 m ) were performed at BASE and after each IT to quantify blood lactate ( [La]B ) , HR ( HR400 ) , salivary alpha amylase ( [α-amylase]s400 ) , and cortisol ( [cortisol]s400 ) responses . Swimmers wore a wrist actigraph nightly to monitor sleep patterns . RESULTS Swim speed ( 400 m ) , [La]B400 , and [α-amylase]s400 decreased from BASE to ITCON , although no significant changes were found after ITWBC . Decreased swim speed was correlated to decreased HR400 and [cortisol]s400 . During ITCON , significant decreases in actual sleep duration ( -21 ± 7 min ) and sleep efficiency ( -1.9 % ± 0.8 % ) were observed , with increased sleep latency ( + 11 ± 5 min ) and fatigue compared with BASE , although these variables did not change during ITWBC . Using a qualitative statistical analysis , we observed that daily WBC use result ed in a 98 % , 59 % , 66 % , and 78 % chance of preserving these respective variables compared with ITCON . CONCLUSION WBC use during IT helped mitigate the signs of functional overreaching observed during ITCON , such as reduced sleep quantity , increased fatigue , and impaired exercise capacity . These results support the daily use of WBC by athletes seeking to avoid functional overreaching during key periods of competition preparation OBJECTIVE To evaluate the effect of local application of ice on duration and severity of  acute gouty arthritis . METHODS Nineteen patients with acute gout were enrolled and r and omized into 2 groups . Group A ( n = 10 ) received topical ice therapy , oral prednisone 30 mg PO tapered to 0 over 6 days and colchicine 0.6 mg/day . Group B was the control group ( n = 9 ) , given the same regimen but without the ice therapy . The patients were followed for one week . RESULTS The mean reduction in pain for those patients treated with ice therapy was 7.75 cm ( on 10 cm visual analog scale ) with st and ard deviation + /- 2.58 compared with 4.42 cm ( + /- SD 2.96 ) for the control group . Using a Wilcoxon rank-sum test there was a significant difference ( p = 0.021 ) in pain reduction between the ice therapy and control groups . Joint circumference and synovial fluid volume also tended to be more effectively reduced after one week of therapy in the ice group compared with controls , but these did not achieve statistical significance . CONCLUSION The group treated with ice had a significantly greater reduction in pain compared with the control group . Although the clinical improvement was impressive , due to the small sample size we could not show statistically significant improvement in all the variables that tended to suggest that effect was more than simply analgesic . Cold applications may be a useful adjunct to treatment of acute gouty arthritis OBJECTIVE To evaluate and compare the effects of locally applied heat and cold treatments on skin and intraarticular temperature in patients with arthritis . METHODS Thirty-nine patients with arthritis of the knee were divided at r and om into 4 treatment groups ( ice chips , nitrogen cold air , ligno-paraffin , and placebo short wave ) . A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin , and changes in temperature over 3 hours were recorded for each treatment group . RESULTS The mean temperature of the surface of the skin dropped from 32.2 degrees C to 16.0 degrees C after application of ice chips and from 32.6 degrees C to 9.8 degrees C after application of nitrogen cold air ; the mean intraarticular temperature decreased from 35.5 degrees C to 29.1 degrees C and from 35.8 degrees C to 32.5 degrees C , respectively , after these treatments . Treatment with ligno-paraffin increased the surface temperature by 7.5 degrees C and the temperature in the joint cavity by 1.7 degrees C. No significant changes were observed with placebo short wave diathermy . CONCLUSION The traditional model , that intraarticular temperature is decreased by superficial heat and increased by superficial cold , must be discarded . In arthritis patients , intraarticular temperature is increased by superficial heat and decreased by superficial cold . This has clear consequences for treatment policy OBJECTIVE To compare skin-surface cooling caused by the application of an ice bag ( 15min ) and the projection of carbon dioxide microcristals ( 2min ) under high pressure ( 75 bar ) and low temperature ( -78 degrees C ) , a modality called hyperbaric gaseous cryotherapy . DESIGN R and omized controlled trial with repeated measure . SETTING Laboratory experiment . PARTICIPANTS Twelve healthy male subjects ( mean + /- st and ard deviation , 22.9+/-1.8y ) . INTERVENTIONS Ice bag and hyperbaric gaseous cryotherapy were r and omly applied on the skin of the nondominant h and . MAIN OUTCOME MEASURE Skin temperature of the cooled ( dorsal and palmar sides ) and contralateral ( dorsal side ) h and s were continuously measured with thermistor surface-contact probes before , during , and after ( 30min ) cooling . RESULTS Hyperbaric gaseous cryotherapy projection induced a large decrease ( P<.05 ) of the dorsal skin temperature of the cooled h and ( from 32.5 degrees + /-0.5 degrees C to 7.3 degrees + /-0.8 degrees C ) and a significant decrease of the skin temperature of the palmar side and of the contralateral h and . The skin temperature of the dorsal side of the cooled h and was decreased with an ice bag ( from 32.5 degrees + /-0.6 degrees C to 13.9 degrees + /-0.7 degrees C , P<.05 ) . However , the lowest temperature was significantly higher than during hyperbaric gaseous cryotherapy , and no significant changes in the other skin temperatures were observed . Rewarming was equal after the 2 modalities , highlighting a more rapid increase of the skin temperature after hyperbaric gaseous cryotherapy . CONCLUSIONS Hyperbaric gaseous cryotherapy projection decreased the skin temperature of the cooled and contralateral h and , suggesting a systemic skin vasoconstriction response . On the other h and , the vascular responses triggered by ice pack cooling appeared limited and localized to the cooled area OBJECTIVE To evaluate the analgesic effects of hyperbaric CO(2 ) cryotherapy in elderly in patients . METHODS An open-label prospect i ve study was conducted in two geriatrics departments in patients with a broad range of pain characteristics . Each patient underwent a physical evaluation followed by hyperbaric CO(2 ) cryotherapy sessions , whose spacing and number were at the discretion of the physiotherapist . Patients completed a 100-mm visual analog scale for pain severity before and after the sessions . RESULTS We included 51 patients , who were treated between May 2 and June 30 , 2005 . Mean age was 83.7years , and the female-to-male ratio was 4/1 . The patients had acute or chronic pain whose origin was usually musculoskeletal ( 80.3 % ) or neurological ( 18.6 % ) .  Pain scores decreased significantly after four sessions , from 52 mm to 13 mm ( P<0.001 ) in patients with acute pain and from 45 mm to 13 mm ( P<0.001 ) in those with chronic pain . CONCLUSION Hyperbaric CO(2 ) cryotherapy is an innovative tool that should be incorporated within the non-pharmacological armamentarium for achieving pain relief in older patients This study sought to evaluate the effects of selective brain cooling on the expression of intercellular adhesion molecule-1 ( ICAM-1 ) mRNA and infiltration of polymorphonuclear leukocytes ( PMNLs ) and monocytes/macrophages ( MPhi ) during global cerebral ischemia/ reperfusion ( I/R ) . Global ischemia of the brain was produced by four-vessel occlusion for 30 min followed by reperfusion for 240 min . Thirty-five SD rats were r and omly divided into five groups : group I had no ischemia and reperfusion ; groups II , III , IV , and V were subjected to ischemia for 30 min at 37 degrees C and reperfusion for 240 min at 37 , 35 , 32 , and 28 degrees C , respectively . Cerebral tissue sample s were taken for pathological examination of the infiltration of PMNLs and MPhi and to detect ICAM-1 mRNA expression by reverse transcription-polymerase chain reaction ( RT-PCR ) . The expression of ICAM-1 mRNA and infiltration of PMNLs and MPhi increased more markedly in group II than in group I ( p < 0.01 ) , suggesting that hypothermia evidently inhibited ICAM-1 mRNA expression and PMNL and MPhi infiltration in the damaged cerebral tissue . In addition , significant differences were also found between group III and group II ( p < 0.05 ) and among groups IV , V , and II ( p < 0.01 ) . These results suggest that I/R injury induces ICAM-1 mRNA expression and PMNL and MPhi infiltration in SD rats and that selective brain cooling , and especially moderate hypothermia ( 28 - 32 degrees C ) , may provide better cerebral protection by markedly inhibiting the expression of ICAM-1 mRNA while decreasing the infiltration of PMNLs and MPhi in the brain Ninety consecutive patients undergoing primary knee arthroplasty received local cryotherapy 72 hours after surgery for pain relief . Thermal-pad circulating temperatures were r and omly assigned to 50 degrees , 60 degrees , or 70 degrees F ( room temperature ) . Pain relief was monitored using patient-controlled analgesia machines . The amount of morphine received and number of attempts per hour were statistically analyzed with relation to temperature group , age , sex , weight , side , and diagnosis . The amount of morphine injected was positively correlated to the number of attempts per hour and moderately correlated to body weight . There was no correlation between thermal-pad temperature or any other parameter and the amount of morphine injected after surgery The higher mortality rate among rheumatoid arthritis ( RA ) patients in comparison with the general population is largely attributable to cardiovascular ( CV ) disease , particularly coronary atherosclerosis , but also non-fatal myocardial infa rct ion and heart failure . It may be due to RA-specific risk factors such as hyperhomocysteinemia , disease-related dyslipidemia or vascular inflammation , or morbidity related to high levels of cytokines such as tumour necrosis factor ( TNF ) and RA medications . Non-steroidal anti-inflammatory drugs ( NSAIDs ) are among the most important in rheumatology , but many are associated with CV disease . A number of r and omised control trials have shown that , although exposure to low doses of corticosteroids for 1 - 3years does not significantly increase CV risk , longer exposure can increase CV events . The use of disease-modifying antirheumatic drugs ( DMARDs ) , particularly methotrexate , increases homocysteinemia , reduces inflammation and improves lipid profiles , thus reducing the development of atherosclerosis and clinical ly overt CVD . Although contraindicated in RA patients with severe heart failure , biological agents such as anti-TNF agents delay and even reverse the progression of endothelial dysfunction and atherosclerosis .  Tocilizumab leads to changes in lipid profiles without increasing adverse vascular events . The effects on the CV system depend on the drug itself , the dose and the period of exposure , and so CV risk should be evaluated before starting treatment with any drug OBJECTIVE The aim of this study was to assess the efficacy of gaseous cryotherapy  following total knee arthroplasty ( TKA ) and to compare it to routinely used strategies for applying cold therapy . PATIENTS AND METHODS Sixty-six patients undergoing primary unilateral TKA were r and omized into three groups and received " gaseous cryotherapy ( GC ) " , " cold pack " and " cryocuff " applications , respectively throughout the hospital stay . Primary outcomes ( knee pain intensity , mobility and girth measurements ) were recorded on preoperative day 1 as well as on postoperative day ( POD ) 7 . Cutaneous temperature of the knee sides were also measured on POD7 just before and immediately after cold application . RESULTS Although skin temperature dropped to 14 ° C following GC versus 22 to 24 ° C for the other two applications ( P<0,05 ) , the three groups did not differ at POD7 regarding the three primary outcomes . No adverse effects were observed with any of the ways of application . CONCLUSIONS Gaseous cryotherapy was not more beneficial than routinely used strategies for applying cold therapy . Further studies with larger sample size and with a more frequent and closer gaseous cryotherapy applications are needed to confirm our results
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases ( therapeutic and biological effects ) .