Two- and three-dimensional Doppler sonographic evaluation of the effect of local cryotherapy on synovial perfusion in wrist arthritis

Extract

Sir, Physical treatment including local cold and heat application has been used since antiquity in patients with arthritis. Both methods are known to relieve pain and improve disability in different stages of various rheumatic diseases. An analgesic effect can be readily accomplished after 3 min of local cryotherapy by destimulating pain receptors, which are located in the subcutis. Antiphlogistic effects are obtained after cold application for 20 min and longer by vasoconstriction, by inhibiting the cellular metabolism in the inflammatory cells and by repressing the release of lysosomal enzymes [1, 2]. Whereas the effects of local cold treatment inside the cutis and subcutis have been investigated extensively, not much is known about the influence of cryotherapy inside the affected and inflamed joints themselves. In a study by Oosterveld and Rasker [3] in which a temperature probe was positioned inside the knee joint cavity of patients with rheumatoid arthritis (RA), a decrease in temperature not only in the skin and superficial tissues but also inside the joint cavity could be verified.