Sauna for psoriatic arthritis
Evidence review
Overview
In a German randomized trial of 35 inpatients with psoriatic arthritis, adding six sessions of water-filtered infrared-A whole-body hyperthermia (a clinic radiant-heat device) to standardized physical therapy gave greater pain relief and less analgesic use than physical therapy alone, and DAS28 fell only in the hyperthermia group, with effects reported up to 6 months. Skin involvement (PASI) and ESR/CRP did not change in either group. The trial was small and unblinded, and no study has tested a conventional or infrared sauna in psoriatic arthritis.
Key findings
- RCT, n=35 inpatients: 6 sessions of water-filtered infrared-A whole-body hyperthermia added to physical therapy gave significantly greater pain relief than physical therapy alone, with reduced NSAID/analgesic use (Lange 2014)
- DAS28 fell significantly only in the hyperthermia group, lasting up to 6 months; HAQ improved in both groups (Lange 2014)
- PASI, ESR and CRP did not change in either group; TNF-alpha, IL-1beta and IL-6 stayed stable with hyperthermia (Lange 2014)
- No trial of conventional or infrared sauna in psoriatic arthritis identified
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.
Effect of iterative whole-body hyperthermia with water-filtered infrared-A radiation in psoriatic arthritis: a controlled, randomized, prospective study
Lange U et al. Aktuelle Rheumatologie. 2014. Not in PubMed: source · DOIGerman publication; title and summary translated by SaunaLMN. Original title: Wirkung iterativer Ganzkörperhyperthermie mit wassergefilterter Infrarot-A-Strahlung bei Arthritis psoriatica – eine kontrollierte, randomisierte, prospektive Studie
- Who
- Hospital inpatients with psoriatic arthritis (Germany); medication comparable between groups
- What
- Whole-body hyperthermia with water-filtered infrared-A radiation (clinic radiant-heat device, not a sauna), 6 sessions, added to standardized physical therapy (n=20) vs standardized physical therapy alone (n=15)
- Measured
- Pain (VAS), DAS28, HAQ, FFbH, PASI, ESR, CRP, TNF-alpha, IL-6, IL-1beta; follow-up to 3 months (6 months in the hyperthermia group)
- Result
- Pain relief significantly greater with hyperthermia than control over follow-up, with reduced NSAID/analgesic use; DAS28 fell significantly only in the hyperthermia group (lasting up to 6 months); FFbH improved (only a trend at 3 months); HAQ improved significantly in both groups; PASI, ESR and CRP unchanged in both groups; cytokines stable with hyperthermia, while TNF-alpha and IL-1beta rose at 3 months in controls. No effect sizes in the abstract
- Limitations
- Small (n=35), unblinded, no sham; German-language abstract (translated by us); between-group effect sizes not reported; 6-month data in the hyperthermia group only; clinic hyperthermia device rather than a sauna; a 2010 prospective report of 20 hyperthermia-treated patients from the same group (DOI 10.1055/s-0030-1265661) probably describes the same cohort and is not counted separately
Protocols used in the studies
Six sessions of water-filtered infrared-A whole-body hyperthermia during an inpatient stay, added to standardized physical therapy; session length and target temperature were not given in the trial abstract (a 2010 report from the same group describes at least 6 sessions in 6-8 days with a rectal target of 101.3 F, 38.5 C). No sauna protocol has been tested.
What is still unknown
No second or sham-controlled trial; whether conventional or infrared sauna reproduces the clinic hyperthermia results; dose, durability and effects on skin disease, enthesitis and dactylitis are unknown.
Safety
Cautions for sauna in this condition
- In the randomized trial, no disease exacerbation was described: pro-inflammatory cytokines stayed stable with hyperthermia, analgesic use fell and the authors describe the treatment as well tolerated; adverse events were not itemized in the abstract (Lange 2014, DOI 10.1055/s-0034-1383589).
- Psoriatic plaques sweat less than normal skin (PMID 6643057), which may reduce local heat loss; extensive plaque psoriasis or erythroderma warrants caution with heat exposure.
- Next-day worsening of rheumatic pain after sauna is described and attributed to inadequate cooling (PMID 3265298).
- General contraindications include unstable angina, recent myocardial infarction and severe aortic stenosis; avoid alcohol during sauna use (PMID 11165553). Psoriatic disease carries elevated cardiovascular risk, so cardiac status should be reviewed.
For clinicians
Suggested rationale
In a randomized trial in psoriatic arthritis, adding six sessions of water-filtered infrared whole-body hyperthermia to physical therapy gave greater pain relief, less analgesic use and a fall in DAS28 compared with physical therapy alone (Lange 2014); sauna-type heat may be considered as an adjunct for pain, recognizing that this single small trial used a clinic hyperthermia device and had no effect on skin disease.
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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