Specialist rheumatological rehabilitation
The rehabilitation of rheumatic patients is also specific to the disease and its stage. Different rheumatic diseases have their own clinical picture and typical sites that they affect. A good diagnosis and, of course, a prognosis of the course of the disease are essential so that the rheumatologist and the physiatrist, through an integrated medical approach using all available treatments, can enable the patient to achieve a cure or remission – that is, good control of the disease without symptoms or signs, clinically, radiologically and in laboratory tests.
The special requirements of different inflammatory rheumatic diseases need to be considered very carefully, and the transitions between them are gradual. This should be understood as a recommendation, not as dogma. Rheumatoid arthritis – or rather the rehabilitation of a patient with arthritis – also includes non-pharmacological treatment: physiotherapy and occupational therapy, which complement medicines in the treatment of inflammatory rheumatic diseases, that is, of arthritis. Therapeutic exercise aims to improve range of motion, aerobic capacity and muscle strength. Choosing rehabilitation techniques requires the physiatrist and the rheumatologist to cooperate well and coordinate closely with the physiotherapist, occupational therapist and kinesiologist. The specific features and goals in different inflammatory rheumatic diseases are:
Rheumatoid arthritis – regular exercise improves functional level, endurance, muscle strength, activities of daily living and mobility. Isometric exercises are used while the inflammatory process is active. Patients with rheumatoid arthritis respond particularly well to isotonic exercises with few repetitions and a low level of resistance. Patients with rheumatoid arthritis are encouraged to alternate their exercise programme with periods of rest (short breaks) to conserve energy.
Spondylitis ankylosans / ankylosing spondylitis – the exercise programme includes spinal extension, that is, exercises for the spinal extensors, and exercises for the hip and shoulder extensors, focusing above all on range of motion and less on strength. Swimming is an excellent alternative to exercising in the gym.
Polymyositis / dermatomyositis – range-of-motion exercises should be done every day to prevent contractures. Strength exercises should be avoided in the acute (inflammatory) phase until the disease is under control.
Myopathy / glucocorticoid-induced myopathy – resistance exercises, as far as possible, can slow muscle atrophy but cannot prevent it. Systemic sclerosis – range-of-motion exercises to reduce contractures, possibly with orthoses. Therapeutic modalities such as warm baths and paraffin wraps increase joint mobility, reduce stiffness and improve skin manifestations.
Fibromyalgia – exercise, above all aerobic, together with strengthening exercises; increasing aerobic capacity reduces the symptoms of fibromyalgia.
Therapeutic modalities, acupuncture and psychotherapy are certainly welcome. Psychotherapy includes cognitive behavioural therapy and attention and concentration exercises, all as part of mental training. Complex regional pain syndrome / Sudeck's dystrophy / reflex sympathetic dystrophy – passive and active range-of-motion exercises must be part of every programme. The load on the affected region is increased gradually. Biofeedback, exercising in front of a mirror (mirror therapy) and motor imagery are useful in treating complex regional pain syndrome / Sudeck's dystrophy. Therapeutic modalities and exercise are needed to carry out desensitisation.
Contrast baths, TENS and massage are used as part of the desensitisation programme. Systemic lupus erythematosus – regular, planned exercise helps reduce fatigue and improves physical and mental health. The physiatrist and the rheumatologist will prescribe an exercise programme for you and decide what is best for you. Exercising without expert guidance and without supervision by a specialist doctor can harm you.
