INTRODUCTION: Aim of this randomized controlled trial was to evaluate the effects of serial locally applied water-filtered infrared A radiation (sl-wIRAR) in patients with axial spondyloarthritis (axSpA). METHODS: axSpA patients with active disease undergoing a 7-day multimodal rheumatologic complex treatment under non-steroidal anti-inflammatory drug (NSAID) therapy were eligible. Patients were randomly assigned in a 1:1 ratio. The intervention group (IG) received additional sl-wIRAR treatment of the back (2 treatments for 30 min per day for 6 days) to assess whether locally applied hyperthermia can (i) reduce pain levels, (ii) reduce disease activity and improve functionality and (iii) whether an effect on tumor necrosis factor alpha (TNFalpha) levels is detectable. Additionally, it was examined whether a reduction in NSAID therapy could be achieved after trial completion. RESULTS: 71 patients completed the trial (IG: 36 patients, control group (CG) 35 patients). sl-wIRAR led to a significant pain reduction measured by a numeric rating scale (p < 0.0005) and in comparison, to the CG (p = 0.006). sl-wIRAR treatment resulted in a significant reduction in the Bath Anyklosing Spondylitis Disease Activity Index (BASDAI) (p = 0.004) and Bath Ankylosing Spondylitis Functional Index (p = 0.004) with no significant difference to the CG. TNF-alpha levels were significantly decreased (p = 0.001) only in the IG with a significant difference to the CG (p = 0.01). 26 (76%) of patients in the IC reduced their NSAID therapy after trial completion. CONCLUSION: sl-wIRAR treatment in axSpA leads to a rapid reduction in pain allowing NSAID dosage reduction. A reason for these desirable effects could be a change in TNFalpha levels.

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