Sauna for rheumatoid arthritis
Evidence review
Overview
Sauna use in rheumatoid arthritis has been studied only in small uncontrolled series. An infrared-sauna pilot reported statistically significant short-term reductions in pain and stiffness during sessions, with no rise in disease activity, but changes across a 4-week course did not reach significance. No randomized trial of whole-body sauna exists in RA, and a randomized trial of local dry heat (fluidotherapy) to the hands showed no benefit.
Key findings
- Infrared sauna, 8 sessions over 4 weeks (n=17 RA): pain and stiffness fell significantly during sessions (p<0.05); 4-week changes not statistically significant; no change in disease activity scores (Oosterveld 2009)
- Uncontrolled series of 196 RA patients with minimal or moderate activity: positive effect on pain and locomotor function reported at 80 +/- 5 C (176 F), 10-20% humidity; laboratory indices showed only insignificant transient shifts (Matveĭkov 1993)
- Null comparator: randomized trial of local dry heat (fluidotherapy) to the hands, n=93, no improvement in hand function or any clinical parameter vs exercise/joint protection alone (Erdinç Gündüz 2019)
- Survey of 59 pain-clinic patients with rheumatoid pain who use saunas: heat allodynia or hyperalgesia in 8% (Nurmikko 1992)
Every study we reviewed
2 mixed results · 1 found benefit · 1 found no effect
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 27 studies on rheumatoid arthritis, across all heat and cold therapies, including case reports and older work not graded here.
Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects.
Oosterveld FG et al. Clin Rheumatol. 2009. PubMed 18685882 · DOI · Free full text
- Who
- 17 patients with rheumatoid arthritis and 17 with ankylosing spondylitis (Netherlands)
- What
- Infrared sauna, series of 8 treatments over 4 weeks
- Protocol
- 2/wk · 4 wk
- Measured
- Pain, stiffness, fatigue, disease activity (DAS)
- Result
- RA subgroup (n=17): pain and stiffness decreased significantly during an IR session (p<0.05); improvements over the 4-week period were clinically relevant but not statistically significant; no relevant change in disease activity scores; no adverse effects
- Limitations
- Uncontrolled pilot; 17 RA patients; within-session effects only reached significance; abstract-level data
[An evaluation of the effect of the sauna on the clinical, laboratory and psychological indices in rheumatoid arthritis].
Matveĭkov GP et al. Ter Arkh. 1993. PubMed 8146771
- Who
- RA patients with minimal or moderate disease activity (Russia)
- What
- Sauna sessions under three temperature/humidity regimens
- Protocol
- 176 (+/- 9) °F
- Measured
- Locomotor function, psychoemotional status, pain, blood indices
- Result
- Authors report positive effect on locomotor system, psychoemotional status and pain; clinico-biochemical and immunological indices showed insignificant transient shifts (no numeric effect sizes in abstract)
- Limitations
- Uncontrolled; Russian-language; abstract gives no effect sizes or statistics
Is dry heat treatment (fluidotherapy) effective in improving hand function in patients with rheumatoid arthritis? A randomized controlled trial.
Erdinç Gündüz N et al. Clin Rehabil. 2019. PubMed 30450972 · DOI
- Who
- Adults with rheumatoid arthritis (Turkey)
- What
- Local dry heat (fluidotherapy) to the hands plus joint protection/exercise vs joint protection/exercise alone
- Protocol
- 3 wk
- Measured
- Health Assessment Questionnaire, Duruoz Hand Index; pain, stiffness, DAS28, grip
- Result
- No between-group differences at week 3; at week 12 Duruoz Hand Index was better in the control group (p=0.039); no positive effect on any clinical parameter
- Limitations
- Local heat to the hands, not whole-body sauna; included as an extrapolated null comparator
Effect of exposure to sauna heat on neuropathic and rheumatoid pain.
Nurmikko T et al. Pain. 1992. PubMed 1375727 · DOI
- Who
- Pain clinic patients who bathe in saunas: 61 peripheral neuropathic pain, 13 central pain, 59 rheumatoid pain (Finland)
- What
- Regular Finnish sauna bathing (self-reported experience) with quantitative sensory testing
- Measured
- Heat allodynia/hyperalgesia and pain response to sauna
- Result
- Heat allodynia or hyperalgesia was infrequent: 10% peripheral neuropathic, 15% central and 8% rheumatoid pain; 3 of 17 with post-injury nerve pain reported exacerbation; mechanical allodynia in 48-54% of neuropathic groups
- Limitations
- Self-report; no control group; does not measure therapeutic benefit
Protocols used in the studies
The only RA-specific sauna data used an infrared sauna for 8 sessions over 4 weeks (temperature not reported in the abstract) and a traditional dry sauna at about 176 F (80 C) with 10-20% humidity; session length and weekly frequency were not reported in the available abstracts.
What is still unknown
No randomized or sham-controlled sauna trial in RA; unknown whether symptom relief persists beyond sessions, the optimal dose, or any effect on inflammatory markers or joint damage.
Safety
Cautions for sauna in this condition
- No exacerbation of disease activity (DAS) was seen over a 4-week infrared-sauna course in RA (PMID 18685882).
- Heat-evoked pain was uncommon (8%) among rheumatoid pain patients who bathe in saunas (PMID 1375727).
- In Finnish clinical experience, rheumatic pain can worsen and joint mobility decrease on the day after a sauna, more often in women; the author attributes this to inadequate cooling (PMID 3265298).
- Studied patients had minimal to moderate disease activity (PMID 8146771); patients with highly active synovitis have not been studied.
- General contraindications include unstable angina, recent myocardial infarction and severe aortic stenosis; alcohol during sauna use increases risk of hypotension, arrhythmia and sudden death (PMID 11165553). RA carries elevated cardiovascular risk, so cardiac status should be reviewed.
For clinicians
Suggested rationale
Small uncontrolled studies suggest infrared sauna is tolerated in RA without increasing disease activity and gives short-term relief of pain and stiffness during sessions (Oosterveld 2009); it may be considered as an adjunct for symptom relief, not as disease-modifying therapy.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: M06.9, M05.79. Examples only; the clinician assigns the code.
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