It almost sounds too good to be true. Specialized spas are touting whole-body cryotherapy (WBC) as a way of reducing rheumatoid arthritis (RA) symptoms of inflammation, swelling, and pain.

On its surface, it sounds logical. After all, cold therapy, typically in the form of ice packs, is often recommended to bring relief to achy joints.

But cryotherapy isn’t just cold. It is way below freezing. The temperature where water freezes is 32 degrees Fahrenheit (0 degrees Celsius). Whole-body cryotherapy temporarily exposes skin to temperatures as low as minus 200 degrees Fahrenheit.

Little Evidence Supports Whole-Body Cryotherapy

Although athletes and celebrities have touted whole-body cryotherapy as helping their health and feelings of well-being, there's little documentation of extreme cold having tangible effects, or whether there are side effects from use of this treatment long-term.

Many spas tout the ability of cryotherapy to help muscles recover from injury or overuse. But as scientists at Lenox Hill Hospital in New York City noted in a review published in August 2021 in the European Journal of Applied Physiology, “Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking.”

One study that looked at the effect of cryotherapy on people with rheumatoid arthritis didn’t find it beneficial. Sixty people were randomized either to WBC at minus 166 degrees F, or minus 66 degrees, or cryotherapy in just one localized area. Each treatment was given three times a day for a week, with rheumatologists subsequently measuring antioxidant capacity in the blood. Those having the coldest treatment did receive a short-term boost in this capacity, but none of the other groups did, and the effects didn’t last the week. “The cold treatments did not cause a significant oxidative stress or adaptation during one week, the study authors conclude in the September 2017 issue of Rheumatology International.

More positive results were found in a small Polish study for another inflammatory autoimmune condition, ankylosing spondylitis (AS), published in October 2018 in Oxidative Medicine and Cellular Longevity. Here too, just over 60 people were randomized to the two WBC temperature treatments, and there was also a control group receiving no cryotherapy treatment. After eight days of the intervention, those in the group experiencing the coldest cryotherapy reported a subjective decrease in disease activity at rates statistically higher than the others.

The FDA Hasn’t Given Its Approval

The last time the U.S. Food and Drug Administration (FDA) weighed in on cryotherapy was in 2016 when the agency issued a statement that although some spas suggest they have gotten the agency’s nod, “In fact, not a single WBC device has been cleared or approved by the agency in support of these claims.”

The statement quoted an FDA official on the lack of strong science: “Given a growing interest from consumers in whole body cryotherapy, the FDA has informally reviewed the medical literature available on this subject. … We found very little evidence about its safety or effectiveness in treating the conditions for which it is being promoted.”

When asked what happens physiologically — to your heart, blood pressure, and other bodily functions — when exposed to such extreme cold, an FDA scientific reviewer responded, “We simply don’t know.”

Cryotherapy Treatment Takes Place in a Small Tank

In a cryotherapy spa, you wear minimal clothes and are exposed to the cold by standing solo in a tank that covers everything but your head. Or, in some places, you enter a specialized room with several other people. A substance such as liquid nitrogen is pumped in, but since it turns to gas when it is frozen, you don’t actually feel it.

What you do feel, according to people who have tried it, is a sensation of a blast of cold air, then the chattering of your teeth as if you were outside on a frigid day, to several seconds more when your body starts to feel like an icicle.

There’s Probably Little to No Downside — Except That WBC Treatment Is Not Cheap

Daniel Muller, MD, a rheumatologist at UCHealth in Fort Collins, Colorado, and a coauthor of the book Integrative Rheumatology, says it’s unlikely that severe negative effects would result in people with RA from the few minutes of exposure.

For most people, he says, the biggest risk is likely to your wallet, since most cryotherapy treatment centers recommend you go several times a week for an extended period of time, and the payments will add up fast.

People with severe Raynaud's syndrome, a comorbid condition to rheumatoid arthritis, in which small blood vessels in the fingers or toes constrict when exposed to cold, should probably stay away, Dr. Muller advises.

If You Want to Try Cryotherapy, Look for a Reputable Place

If you do decide to try it, look for a cryotherapy spa with a lot of positive reviews on ratings sites. You might also ask about the medical training of the owner of the spa. Because no credentialing is currently required, owners can range from someone with a formal medical degree (the ideal) to someone with absolutely no medical knowledge.

There are dangers to going to a place that doesn’t take safety seriously. In 2015, a young woman who worked at a cryotherapy spa in Las Vegas died after going into the whole-body cryotherapy chamber after-hours. She suffocated, although exactly how that happened is a mystery, since she was alone. The state of Nevada promptly shut down that spa.

Whole-Body Cryotherapy Risks and Potential Problems

In its statement the FDA cites potential hazards from the treatment, including:

Frostbite
Burns
Eye injury
Oxygen deficiency
Asphyxiation

Talk to Your Doctor Before Trying Cryotherapy

It’s always a good idea to discuss therapies like WBC with your doctor before you try it. And as with all complementary approaches, it should never be done in place of treatment options with established records of safety and effectiveness.

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