relative contraindications to treating with heat in rheumatoid arthritis
Tissue pain and damage commence with tissue temperatures of 113°F (45°C). Increased collagenolysis has been found to occur with increased intraarticular temperatures. While there are potentially adverse implications for using heat in inflammatory conditions, such as RA, investigators have not found increased joint destruction when heat is used. Because pain is a warning sign of tissue injury, sensory deficits or a reduction in mental status are contraindications to the use of heat. Other common contraindications include bleeding disorders, acute hemorrhage or trauma, atrophic or scarred skin, and local malignancy. Also, heat applications to the gonads or to a gravid uterus should be avoided. Deep heat should not be used if metal is in the area being treated. Areas with inadequate vascular supply should not be heated because of their inability to dissipate heat appropriately or to meet the increased metabolic demands caused by increased temperature.