For the past few years, a lot of people has been aware of what is Rheumatoid Arthritis and there has been a confusion among the people.

Whether to ice it up or to heat it up. My physician said to ice it but that physician said heat it up.

So who is right, who is wrong, and who should I listen to? Well before we start lets go back to the basic.

What is Rheumatoid Arthritis (RA)?

According to Malaysia Health Technology Assessment Section (MaHTS) (2019), RA is a chronic progressive autoimmune disease which causes inflammation of the joints.

It is an uncontrolled proliferation of synovial tissue. It is unpredictable with insidious onset and with variable courses, unlike osteoarthritis which is usually caused by ‘wear and tear’.

The etiology is still unknown. So if you ask Dr. Google or a Doctor, well it is a wild goose chase for now. You can blame the environment (eg. Infection), your genes, your hormones and your lifestyle (smoking). Because these are the ones that said, it will double the risk of developing RA.

Is RA common?

Yes it is.

No need to be afraid as you are not alone. According to The Malaysian National Inflammatory Arthritis Registry (NIAR) (2019), it shows that nearly 50% of cases are diagnosed a year after the onset of symptoms.

What does it mean? Yes it means that you are lucky, because you are reading this right now. I’m just joking. It says that although people are started to aware of it right now but there is still a large of number of people who doesn’t actually know what is it and how does it affects you and even how bad it is.

According to the preliminary report from (April 2009-August 2010) from (NIAR), out of 1000 people, 87.4% are female, 89.8% were from the lower socio-economic group and 50.4% are Malay. Alright, alright im not going to beat around the bush.

Hot or Cold?

The topic of the day, I will say both.
However there are terms and conditions. You heard me right, it depends on the conditions. Example when your knee is hot and warm (flares) do you put Hot modalities on it again? Yes of course you might feel much more mobile after putting Hot modalities on it, but you will feel much more pain.

Why? Because RA flare up brings inflammation and makes your joint swollen. Instead of restricting the blood flow that we want at this phase you are increasing the blood flow. Frankly speaking you are making it more painful and making yourself even more depress. “So when do I put hot modalities? “.

Research says that you can put hot modalities when the flares are not there. Put ice when it’s an acute inflammation says Teresa (2018); Ice packs are especially good for joint pain caused by arthritis flare, (Nayana Ambarderker, MD, 2022); Use cold therapy during flare-ups to reduce inflammation and swelling (Beth Sissons, 2022)


Will let me put it in this way. I prepare my son a lunch box so that he can have something to eat during recess and there is soup in it. He loves to drink my soup very much but we can’t afford a thermal flask. So I put it into a container.

Yes it’s a hot soup as I just finish cooking it. Now here’s the catch, he is going to hold the container with his bare hands. So it’s definitely going to be uncomfortable if its hot. But it taste bad if the soup is cold. So what will you do?

(A) Cool it down first, when he is at school, he can heat it up again during recess or,

(B) Pass him the container without cooling it down (a hot container) and you heat it up all the way with all means, until recess.

What say you? (A) or (B)?

Something more even simple. Do you put hot when you are having a fever?
Think about it.

Alternating Heat and Cold

People may choose to alternate between heat or cold therapy throughout the day. Repetitive use of heat and cold therapy is safe to do as long as individuals are careful about their methods (Beth Sissons, 2022).


Beth Sissons (2022) When to use heat or ice for arthritis. Retrieved from https://www.medicalnewstoday.com/articles/heat-or-ice-for-arthritis

Dr Azmillah Rosman, Dr Hasselynn Hussein, Dr Gun Suk Chyn, Dr Lau Ing Soo, Dr Mollyza Mohd. Zain, Dr Habiba @ Habibah Mohd Yusoof Dr Asmahan Mohamed Ismail, Dr Liza Mohd.Isa, Dr Nor Shuhaila Shahril, Dr Ramani Arumugam, Dr Ong Yew Chong (2010). Premilary Report. Retrieved from https://www.crc.gov.my/wp-content/uploads/documents/report/NIAR_Report.pdf

Jasvinder Singh, MD, MPH (2021) Using Heat and Cold to Treat a Rheumatoid Arthritis Flare-Up. Retrieved from https://www.arthritis-health.com/blog/using-heat-and-cold-treat-rheumatoid-arthritis-flare

Lina Serhala May N.Lwina Christopher Holroyd b Christopher J.Edwards (2020) Rheumatoid arthritis in the elderly: Characteristics and treatment considerations. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1568997220300835?via%3Dihub

Malaysia Health Technology Assessment Section (MaHTAS) Medical Development Division, Ministry of Health Malaysia Level 4, Block E1, Precinct 1 Federal Government Administrative Centre 62590 Putrajaya, Malaysia. (2019) MANAGEMENT OF RHEUMATOID ARTHRITIS.Retried from https://www.moh.gov.my/moh/resources/Penerbitan/CPG/2)_CPG_Management_of_Rheumatoid_Arthritis.pdf

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