RESEARCH - Response to application of ice may help differentiate between gouty arthritis and other inflammatory arthritides

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J Clin Rheumatol. 2006 Dec;12(6):275-6.

Response to application of ice may help differentiate between gouty

arthritis and other inflammatory arthritides.

Schlesinger N.

Clinical Rheumatology, Department of Medicine, UMDNJ- Wood

Medical School, New Brunswick, New Jersey 08903-0019, USA.

schlesna@...

AIM: The aim is to determine whether response to topical ice versus

heat differentiates between patients with gout versus other

arthritides. METHODS: The first 150 patients seen in our clinic with

joint pain from February 2004 onward were asked to fill out

questionnaires regarding their response to heat and ice. Patients who

responded that topical ice eased their pain and who did not have a

diagnosis of crystal-induced arthritis were asked to have a joint

aspiration if they had active synovitis on presentation to the clinic.

RESULTS: Of 150 completed questionnaires, 26 patients never tried heat

or cold as adjuvant treatment for their arthritis. The remaining 124

patients were divided into 6 groups: patients with crystal-proven gout

(n = 20), rheumatoid arthritis (RA; n = 32), osteoarthritis (OA; n =

32), other forms of inflammatory arthritis (n = 18), and soft tissue

conditions (n = 22). None of the patients with gout benefited from

topical heating of their affected joints and all preferred topical ice

(P < 0.001). Most patients with RA preferred heat (n = 24). Of 4

patients with RA who preferred topical ice, 3 had effusions and

arthrocentesis was performed. Intracellular monosodium urate (MSU)

crystals were seen in 2 and intracellular calcium pyrophosphate

dihydrate (CPPD) crystals were seen in one patient raising questions

about coexistence of 2 diseases or previous misdiagnoses. Most

patients with OA preferred heat (n = 28). A significantly higher

percentage of the patients with gouty arthritis found that topical ice

helped relieve their joint pain as compared with patients with RA (P =

8 x 10(-11)) and other inflammatory arthritides (P = 3 x 10(-8)).

DISCUSSION: Heat and cold are adjuvant treatments for arthritis. In

gouty arthritis, cold applications are a useful adjunct to treatment

and may help discriminate patients with gout from other forms of

inflammatory arthritis.

PMID: 17149056

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=ShowDetailView & TermToSear\

ch=17149056

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