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IRD IA – Reduce pain

Evidence summary (Updated 2022)

In Rheumatoid arthritis, a meta-analysis has demonstrated that aerobic training produced a significant reduction in pain scores (using the visual analogue scale) (1). A separate meta-analysis examining resistance exercise also showed a trend towards positive effect on pain but this was not significant (2). 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 (3 ).

Quality of evidence:
Grade B – Moderate quality evidence in rheumatoid arthritis

Strength of recommendation
Grade 2 – Weak Recommendation for rheumatoid arthritis given only a small benefit found in the most recent meta-analysis.

There is a moderate quality evidence base that physical activity and exercise interventions can have a small improvement on pain scores in patients with inflammatory rheumatic diseases. Recommending that patients start gradually with paced activity is a helpful way for them begin to regain control and help address these symptoms.


  1. Baillet A, Zeboulon N, Gossec L, et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-1. analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 2010;62(7):984-992.
  2. Baillet A, Vaillant M, Guinot M, Juvin R, Gaudin P. Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials. Rheumatology (Oxford). 2012;51(3):519-527.
  3. 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.