Osteoarthritis, rheumatoid arthritis and arthritis: hot or cold?

Should you apply heat or cold to painful joints affected by osteoarthritis, arthritis or rheumatoid arthritis?

My perspective as a physiotherapist, based on studies on the subject!

Summary : in theory, it’s better to put cold on inflamed areas. But there’s no empirical evidence that hot is more effective or dangerous, so use whatever seems to give you the most relief!

Let’s take a closer look!

♻️ Last updated: October 2023.
👩‍⚖️ Declaration of financial interests: amazon affiliate links (this means that I can earn a small commission if you buy something via the links, at no extra cost to you). My complete declaration of financial interests is in the legal notice section. Written by Nelly Darbois, physiotherapist and scientific editor

Arthritis, osteoarthritis, rheumatoid arthritis: what’s the difference?

In this article, I talk about these 3 conditions because they are often confused. In fact, they are frequently associated: you can have osteoarthritis AND polyarthritis, and so on.

Arthritis is a generic term for joint inflammation.

So osteoarthritis and polyarthritis are forms of arthritis!

Osteoarthritis is the progressive degradation of the cartilage covering the bony ends of joints.

Sometimes this leads to pain, and sometimes… not!

Rheumatoid arthritis is rarer. It’s an autoimmune disease that targets the joints, causing chronic inflammation. It damages the joints.

Why is it often said that hot weather is bad for arthritis?

It’s often said that hot weather is bad for arthritis because arthritis causes inflammation in the joints, leading to heat, pain and swelling.

Applying heat can theoretically aggravate this inflammation, increasing pain.

What’s more, some arthritis sufferers are sensitive to heat, which can make symptoms more uncomfortable.

It’s all very theoretical… Because some people are better off in the heat!

That’s why research teams have been assessing whether heating up can worsen pain or joint condition. And that’s what I’m going to tell you now!

Can hot weather aggravate arthritis?

To answer this question, I went to the Google of medicine: Pubmed. It’s a search engine that lists all the studies published in the world on a given subject.

And I looked for studies that evaluated the effect of cold or heat on people who have at least one of these 3 conditions:

• arthritis
• osteoarthritis
• or rheumatoid arthritis.

You’ll find a list of these studies at the end of the article. Here, I’ll give you an easy-to-read summary!

Heat, cold and arthritis or osteoarthritis

Osteoarthritis is the most common form of arthritis. So it’s hard to separate studies of arthritis or osteoarthritis and polyarthritis, which is why I’m talking about these 2 conditions together.

The only recent summary of studies dates back to the 2000s (Cochrane, 2023), and concerns only a hundred or so people.

Here are his conclusions:

Ice massage, compared with doing nothing, had a statistically beneficial effect on knee mobility, function and strength.

Cold compresses reduced swelling.

Warm compresses had no beneficial effect on edema compared to placebo or cold application.

Ice compresses had no significant effect on pain compared with the control group in patients with osteoarthritis.

Cochrane, 2023

What does this mean?

• If you have swelling, cold can potentially reduce it.
• It’s not certain that cold will reduce your pain, but it may improve your knee’s mobility.
• Warmth in osteoarthritis can at best relieve pain, but is unlikely to reduce swelling or improve knee mobility.

In any case, you’re not taking a big risk by testing hot or cold on your joint pain in cases of osteoarthritis or arthritis!

There have been no reported side effects from the use of hot on the knee or other joints with osteoarthritis.

Heat, cold and rheumatoid arthritis

There are a few studies that specifically evaluate the effect of heat or cold on polyarthritis.

They’re also pretty old! They include around 300 people on whom the effect of heat or cold has been tested.

Here’s what the main study concludes (Cochrane 2022):

There was no significant effect of hot and cold compress applications, cryotherapy and faradic baths on objective measures of disease activity, including joint swelling, pain, medication use, range of motion, grip strength, hand function compared to a control group (no treatment) or active therapy.

There was no patient preference for any type of thermotherapy. No adverse effects of thermotherapy were reported.

Kerosene wax baths combined with exercise can be recommended for short-term beneficial effects on arthritic hands.

Cochrane 2022

What can we learn from it?

• It’s safe to put hot or cold on your joints when they’re sore from polyarthritis.
• What’s most likely to relieve hand pain in the short term (for the moment, or even a few hours or days): kerosene baths combined with exercise.

Neither cold nor heat can slow down the activity of polyarthritis, but some people can be relieved at least for the moment by one or the other.

How do I know what will work for me?

As you can see, it’s hard to say whether hot or cold will give you more relief.

In the case of athrosis, it’s more likely to be the cold.

I recommend that you spend a week regularly applying cold to your most painful joint, such as your knee. At least once a day for 20 minutes, if not more.

Every morning or evening, write down the intensity of your pain between 0 and 10 each day.

1 or 2 weeks later, you can test with heat, using the same procedure.

If you don’t see a significant difference between the 2, either give up on the idea of relief through thermotherapy, or stick with what’s easier for you to implement!

For polyarthritis, we don’t really know if cold relieves more. Do the same, but you can start with hot if it inspires you more!

What form of heat or cold should I use for arthritis?

There really is an almost infinite number of ways to apply cold or heat to the joints.

Here are the ones my patients use most often, because they’re the easiest to set up.

🧊 F or cold: buy cold compresses to put in the freezer OR a bag of small frozen weights from a pharmacy, supermarket or amazon. Then apply to the painful area, without direct contact with the skin (put a thin cloth between).

♨️ For heat: buy a heat pack from a chemist, supermarket or amazon. Some are reversible hot/cold (see amazon), and most can be heated in the microwave. Then apply to the painful area.

Here are a few other ways of doing this that aren’t as easy to set up, and aren’t necessarily more effective (but some people prefer them all the same):

• cryotherapy equipment for the whole body or only for certain parts of the body;
• heated massage cushions or seats (often available at Lidl);
• warming or cooling ointments or creams.

I hope this article on hot and cold for joint pain has been helpful!

Any comments or questions? See you in comments!