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IRD AS – Reduces pain

Evidence summary (Added 2022)

Sveaas et al., in their meta-analysis of a broader group of patients with inflammatory rheumatic disease found twelve RCTs provided data on pain (7 of those trials where included patients with rheumatoid arthritis and one with axial spondyloarthropathy ). The results showed moderate quality evidence for a small beneficial effect of exercises (1).
There are numerous systematic reviews that support a variety of physical activity interventions for the management of pain in AxSpA. Liang et al (2) looked at the effects of any form of water therapy (mainly involving hydrotherapy and balneotherapy) and found significant in pain scores across 8 studies included in their systematic review. This was further supported by a robust systematic review by Regnaux et al (3) published in 2019 that showed found moderate‐quality evidence showing a reduction of pain with exercise (MD ‐0.5, 95% CI ‐0.9 to ‐0.1; 2 studies, 911 participants; absolute reduction 5%, 95% CI 9% to 1%). Further, Hu et al (4) published in 2020 with a few more studies suggesting a significant improvement in pain scores when studying a range of physical activities including both home-based and supervised exercise programmes.

Quality of evidence:
Grade A – Good quality evidence in axial spondyloarthritis , shown in multiple systematic reviews showing significant improvement in pain scores.

Strength of recommendation
Grade 1 – Strong Recommendation axial spondyloarthritis from multiple systematic reviews

There is a good quality evidence that physical activity and exercise interventions can have improve pain scores in patients with axial spondyloarthritis.


  1. Sveaas SH, Smedslund G, Hagen KB, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. Br J Sports Med. 2017;51(14):1065-1072.
  2. Zejun Liang, Chenying Fu, Qing Zhang, Feng Xiong, Lihong Peng, Li Chen, Chengqi He & Quan Wei (2021) Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis, Disability and Rehabilitation, 43:7, 895-902, DOI: 10.1080/09638288.2019.1645218
  3. Regnaux JP, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, Lefevre-Colau MM. Exercise programmes for ankylosing spondylitis. Cochrane Database Syst Rev. 2019 Oct 2;10(10):CD011321. doi: 10.1002/14651858.CD011321.pub2. Epub ahead of print. PMID: 31578051; PMCID: PMC6774752.
  4. Hu X, Chen J, Tang W, Chen W, Sang Y, Jia L (2020) Effects of exercise programmes on pain, disease activity and function in ankylosing spondylitis: A meta‐analysis of randomized controlled trials. Eur J Clin Invest.