Cold therapy for psoriatic arthritis
Evidence review
Overview
No study of cold-water immersion in psoriatic arthritis was found. In a German randomized trial reported as a congress abstract, 36 inpatients received multimodal rheumatology therapy with or without six sessions of whole-body cryotherapy (WBC, cold air at -166 to -274 F for 1.5-3 minutes); pain fell more with WBC and stayed lower for up to 3 months, and DAS28, HAQ and skin scores improved after treatment. WBC is a different method from a home cold plunge, and these findings cannot be assumed to apply to water immersion.
Key findings
- No cold-water immersion study in psoriatic arthritis identified.
- WBC RCT (congress abstract), n=36: pain fell significantly vs control, lasting up to 3 months (p<0.003); DAS28 (p<0.001), HAQ (p<0.012) and PASI (p<0.001, cryotherapy group only) improved after therapy (Stock 2018).
- Analgesic or NSAID use fell in 73.33% of WBC-treated patients after therapy and 41.66% at 3 months (Stock 2018).
Every study we reviewed
1 found benefit
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 16 studies on inflammatory rheumatic disease (other), across all heat and cold therapies, including case reports and older work not graded here.
Effects of serial whole-body cryotherapy in psoriatic arthritis
Stock E et al. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2018. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Wirkeffekte serieller Ganzkörperkältetherapie (sGKKT) bei Psoriasis-Arthritis (PsA)
- Who
- Patients with psoriatic arthritis receiving multimodal inpatient rheumatology complex therapy (Germany)
- What
- WHOLE-BODY CRYOTHERAPY, 6 sessions in 16 days, 90 s rising to 180 s at -166 to -274 F (-110 to -170 C), added to multimodal rheumatology therapy (n=21) vs multimodal therapy alone (n=15)
- Protocol
- -166 to -274 °F · 1.5-3 min · 2-3/wk · 2.3
- Measured
- Pain (VAS, last 7 days), HAQ, FFbH, DAS28, PASI (cryotherapy group only), analgesic use, IL-1, IL-6, TNF-alpha; after 6 sessions and at 3 months
- Result
- Pain fell significantly vs control, lasting up to 3 months (p<0.003); directly after therapy PASI (p<0.001), DAS28 (p<0.001) and HAQ (p<0.012) improved; NSAID/analgesic use fell in 73.33% of the cryotherapy group after therapy and in 41.66% at 3 months; no cytokine correlate
- Limitations
- Congress abstract; unblinded; PASI measured only in the cryotherapy group; between-group effect sizes not given; German-language abstract (translated by us); WBC, not cold-water immersion
Protocols used in the studies
Whole-body cryotherapy chamber at -166 to -274 F (-110 to -170 C), 90 seconds rising to 180 seconds, 6 sessions over 16 days, added to multimodal inpatient rheumatology therapy. No cold-water immersion protocol has been tested.
What is still unknown
Whether cold-water immersion has any effect in psoriatic arthritis; full publication and independent replication of the WBC trial; durability beyond 3 months; effects on skin disease measured against a control group.
Safety
Cautions for cold therapy in this condition
- Secondary Raynaud's phenomenon is more common in rheumatic disease; cold triggers vasospastic attacks (Ramahi 2022, PMID 35699336). Screen before any cold exposure.
- Cold immersion acutely raises systolic blood pressure (Radtke 2016, PMID 26152773); psoriatic disease carries elevated cardiovascular risk.
- Adverse events were not reported in the congress abstract of the WBC trial (Stock 2018, DOI 10.1055/s-0038-1668291).
- Whole-body cryotherapy contraindications and adverse events (16 documented across case reports and RCTs) are specific to cold-air chambers and do not transfer directly to cold-water immersion (Legrand 2023, PMID 37770960). See general cold safety entry.
For clinicians
Suggested rationale
In a small randomized trial in psoriatic arthritis, whole-body cryotherapy added to inpatient rheumatology therapy reduced pain for up to 3 months and lowered disease activity (Stock 2018); this concerns a supervised cold-air chamber, reported only as a congress abstract, and does not establish benefit for cold-water immersion.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: L40.50, L40.59. Examples only; the clinician assigns the code.
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