Rehabilitation of patients with rheumatoid arthritis

Reumatoidni artritis (RA) je upalna reumatska bolest koja je najviše vidljiva na lokomotornom sustavu. Još uvijek se nije otkrio pravi uzrok bolesti. Reumatoidni artritis se manifestira kao kronična reumatska upala. Iako postoji nekoliko oblika artritisa najčešće se pojavljuje RA. Bolest varira od blagog oblika kada su zahvaćeni jedan ili dva zgloba pa do težeg oblika kada je zahvaćena većina ili pak svi zglobovi. Kroz povijest nema mnogo zapisa o bolesti te je stalni predmet istraživanja. Uočeno je da je bolest učestalija kod žena nego kod muškaraca. Od ove bolesti obolijeva oko 2% stanovništva te se javlja najčešće između 40. i 50. godine života. Započinje neupadljivim znakovima i teško ju je odmah prepoznati zbog virusne ili bakterijske infekcije ili ozljede koje su prethodile. Glavnina imunološke upale događa se u sinovijalnom tkivu. Klinički znakovi poput boli, zakočenosti i otekline zahvaćaju male zglobove šaka i stopala, a najčešće dovode do razaranja zglobova, hrskavice pa i susjedne kosti. U konačnici može doći do teške invalidnosti kao i sistemskog oštećenja ostalih dijelova tijela i organa. Postoji i ne mali broj slučajeva sa smrtnim ishodom. Klinička slika bolesti se može odvijati na zahvaćenim zglobovima ili pak na izvanzglobnoj zahvaćenosti. Za dijagnostiku RA se koriste kliničke pretrage, anamneza, rendgenske i laboratorijske pretrage. Rana dijagnoza postavljena na temelju kliničke slike, upalnih, seroloških i imunogenetskih parametara te radiološke procjene put je k uspješnom liječenju bolesnika. U cjelokupni proces važno je uključiti liječnika primarne zaštite, reumatologa, ortopeda, fizikalnu terapiju i okupacijsku terapiju. Uz ranu i pravilno postavljenu dijagnozu potrebno je primijeniti lijekove koji utječu na tijek bolesti. Kod bolesnika s RA potrebno je osigurati kombinaciju farmakološkog i nefarmakološkog liječenja te pojedinačna terapijska sredstva koja se mogu kombinirati. Lijekovi koji se koriste dijele se u tri skupine, nesteroidni antireumatici, glukokortikoidi i lijekovi koji mijenjaju tijek bolesti. Najčešća metoda liječenja koja spada u nefarmakološko liječenje je fizikalna terapija. U liječenju bolesnika s RA koriste se elektroterapija, magnetoterapija, krioterapija, parafinska terapija, terapija ultrazvukom, terapija udarnim valom, ultrasonoforeza, laser, hidroterapija, balneoterapija te kineziterapija. Pomagala u rehabilitaciji imaju bitnu ulogu jer smanjuju bolni podražaj i povećavaju sigurnost. Uz pomoć edukacije bolesnika moguće je ukloniti određene faktore rizika. Fizioterapeut ima bitnu ulogu u ostvarivanju ciljeva koji bi bolesniku omogućili napredak.Rheumatoid arthritis (RA) is a rheumatic inflammatory disease which is most visible on the locomotor system. The real cause of the disease has yet to be discovered. Rheumatoid arthritis is manifested as a chronic rheumatic inflammation. Even though there are several forms of arthritis, RA is the most common one. This disease variates from its mild form when there are only one or two joints affected to its more heavier form where most or maybe even all joints are affected. Throughout the history there are not that many documentations of it and it is a constant subject of research. However, it has been detected that the disease mostly affects women rather than men. Just about 2% of human population is infected by it and usually its people between forty and fifty years of age. It starts with unrecognisable signs and its hard to detect it right away because of other viruses, bacterial infections and injuries causing distress to the body. Most of the immune inflammation occurs in the synovial tissue. Clinical signs such as pain, stiffness and swelling alter smaller joints of fists and feet, and they usually lead to destruction of joints, cartilages and nearby bones. Ulitmately it can lead to disablement and systematic damage of organs and other body parts. There is even a small percentage of death caused by RA. The clinical picture of the disease can occur in the affected joints or even in extra-articular involvement. Clinical and laboratory tests, X-rays and amnesis are used for making a diagnosis of RA. Early diagnosis established on the basis of clinical picture, inflammatory, serological and immunogenetic parameters and radiological assessments are the way to a successful treatment of the patient. It is important to include a primary care physician, orthopedist, physical therapy and occupational therapy in the overall process. In patients, it is necessary to provide a combination of pharmacological and non-pharmacological treatment and individual therapeutic agents that can be combined. The drugs that are used are divided into three groups, non-steroidal, antirheumatic, glucocorticoid and drugs that change the course of the disease. The most commonly used method of treatment that belongs to non-pharmacological treatment is physical therapy. Electrotherapy, magnetotherapy, cryotherapy, paraffin therapy ultrasound therapy, shock wave therapy, ultrasonophoresis, laser, hydrotherapy, balneotherapy and kinesitherapy are used in the treatment of patients. Aids in rehabilitation play an important role because they reduce the painful stimulus and increase safety. With the help of patient education, it is possible to remove certain risk factors. The physiotherapist plays an important role in achieving goals that would allow the patient to progress